NEH: Patient Health Through Narrative Medicine
In 2000, a grant from the National Endowment for the Humanities gathered a group of clinicians and scholars at VP&S to establish a collaborative learning seminar. The group explored and began to articulate the consequences of bringing literary and creative practices into the realm of health care. The discipline of Narrative Medicine emerged, and in honor of the NEH’s 50th anniversary in 2015, this grant was named one of the top 50 out of 63,000-lifetime grants they have awarded.
Patient Health through Narrative Medicine
NIH K07 Academic/Teacher Award Grant
Rita Charon and the Division of Narrative Medicine were awarded a NIH K07 Academic/Teacher Award grant to gather medical school teachers at VP&S. The Foundations of Clinical Medicine ("FCM") course was established, now a mandatory course for all preclinical medical students at VP&S. With the K07 grant, Rita introduced the group to the principles and practice of Narrative Medicine. The group began to discover the centrality of Narrative Medicine to medical training–and began to incorporate Narrative Medicine into the FCM curriculum. VP&S preclinical students are placed into a small group and meet weekly with their teacher, where they engage in narrative medicine work. Once a semester, students write a Signature Reflection, which is stored in the student’s portfolio and available as a point of reference when the students begin to apply to residency programs.
Josiah Macy Jr. Foundation Interprofessional Education Grant
Simultaneously, the Division of Narrative Medicine pioneered interprofessional healthcare team-based learning with the help of a grant from the Josiah Macy Jr. Foundation. Originally termed the Macy Group, following the end of the grant they renamed themselves Columbia Commons for Interprofessional Education ("IPE"): Collaboration Across Professions. Twice a month, key leaders from the School of Nursing, Public Health, Physical Therapy, Occupational Therapy, Nutrition, Medicine, Dentistry and Pastoral Care gather to discuss, design, and execute interprofessional learning activities for students. The Commons serves as a breeding ground for interdisciplinary research, and multiple projects among students and faculty have emerged as a result of this group. Unique to VP&S, the Commons distinguishes itself from other interprofessional initiatives by using narrative methods of inquiry as its foundation. Each Spring semester, the Commons offers an interdisciplinary seminar to all CUIMC students for credit.
Over the course of this project, Columbia diverged from the mainstream national currents in IPE. Through our involvement with IPEC and the National Center for Interprofessional Practice and Education at the University of Minnesota, we are well aware of the skills-based approaches often adopted elsewhere. Through a ten-year collaboration with colleague schools in a broad NIH-funded grant program in enhancing social science and behavioral science curricula in medical schools, we have worked closely with an IPE sub-group of health professionals from Oregon Health Sciences University, University of California at San Diego, UCLA, Indiana University, University of Texas at San Antonio, and Brown University. Some of the programs at other institutions in the U.S. emphasize joint learning of concrete interprofessional skills: learning each profession’s specific role in clinical situations, training for courtesy toward members of other professions, and check-listing approved behaviors in clinical simulations.
In contrast, the emerging philosophy and approach to IPE at VP&S is focused less on specific tasks completed by each role, and more on shared values and ways to work together to produce better health care for the patient. Our narrative approach results in individual-to-individual contact within the context of health care teams. We don’t gather to discuss operating room checklists or who does what at the cardiac arrest code. Instead, whether with faculty groups or student groups, we invite participants to grapple with fundamental issues of the human condition. Each of our courses and seminars devotes some time to intensive close reading and creative writing, in addition to more conventional seminar discussions. Through rigorous and guided examination of cultural works—literary texts, visual images, or performing arts—groups of participants confront powerful carriers of meaning. This is not as obscure as it sounds: together, a group will read a poem or a paragraph from a great novel or watch a clip of a movie or look slowly at a painting. Then, they talk about it, about what it says or shows; they learn how diverse are their individual perspectives on the work. They are invited to write—spontaneously, in just a few minutes—about their thoughts released by the work. When they read aloud or talk about what they’ve written, they achieve privileged views of their own and one another’s subjectivity. Within a half-hour, they’ve enjoyed intimate contact with their own and their colleagues’ deep ways of knowing of the world.
Due to the high demand for seats in the narrative medicine-based Columbia Commons seminar, the Division of Narrative Medicine offers school-specific electives in Medicine, Nutrition, Dentistry, Physical Therapy, and Occupational Therapy. Narrative Medicine work is integrated into mandatory coursework for medical and physical therapy students.
Clinician-focused Narrative Medicine Groups
Aligning with our mission to revolutionize healthcare teams through the use of narrative medicine, we offer Narrative Medicine Rounds to a variety of groups affiliated with CUIMC. We host rounds with social workers, Emergency Department staff, and Obstetrics-Gynecology hospital staff. We have been holding rounds with family medicine residents at the Allen Pavillon for more than 15 years. We also host social work oncology writing groups with patients.
Lang Youth Medical Program at NewYork-Presbyterian Hospital
We connect with future medical scholars in The Lang Youth Medical Program. Beginning in seventh grade, a group of students from Manhattan is selected to participate in this six-year science enrichment and internship program offered through Columbia University Irving Medical Center and NewYork-Presbyterian Hospital. Each spring, the Division of Narrative Medicine hosts a six-week Narrative Medicine workshop series. This workshop series introduces students to the framework of Narrative Medicine, while also allowing them to experience its practice first hand.
Reading Group: Literature at Work
For more than a decade, we have hosted an interdisciplinary reading group, Literature at Work, open to all CUIMC/NYP employees and staff.