Post-Graduate Fellowship in Narrative Medicine
The Program in Narrative Medicine is pleased to invite proposals for the 2020–2021 Narrative Medicine Fellowship, open to graduates of the Columbia University Master of Science in Narrative Medicine who are interested in promoting narrative understanding in patient care, professional education and curriculum development or in forging new pathways in research important to the growth of the field of narrative medicine. This year’s Fellowships will be awarded to work that uses narrative medicine to combat racism and advance anti-racism, as at least one facet of the project.
- To advance narrative medicine as a tool for anti-racism
- To contribute to the development of narrative medicine graduates as leaders, teachers, and scholars and to create a strong corps of alums with ongoing collaboration with the Division of Narrative Medicine and Columbia University
Consideration will be based on strength of the proposal, its intended outcomes and promise, and whether the applicant has received a fellowship in the past. Group applications of eligible Narrative Medicine M.S. grads are also welcome; if awarded, each member of the group will receive a Fellowship with individual financial support. Fellows will be supported within a range of $500–$4,000, and will be assigned a project mentor. All Fellows will be required to submit a mid-year written report, due on February 1, 2021, and a final written report and/or presentation, due by August 31, 2021. In addition, all Fellows must present their work at a Narrative Medicine gathering such as Volvox.
Alumni interested in applying should submit the following by July 31, 2020:
- Title page with project title, name and contact information of graduate or graduates
- Statement of purpose
- Specific aims, including the ways in which the proposed project advances narrative medicine as a tool for anti-racism
- Description of the project including
- Previous related work including a literature review (if applicable)
- Association with an organization or institution (if applicable)
- Site supervisor (if applicable)
- Collaborators (if applicable)
- Budget (For group applications, please specify proposed budget for each individual)
- Anticipated impact, including (but not limited to) products such as published article, outcome analysis, presentations, curricular development, etc.
Enajite Igho, Guneet Kaur, Zahra Khan, and Oluwatomisin Sontan
The Life Jacket, zine
We are four graduates of the Narrative Medicine master’s program and writers/co-editors of a collective zine called The Life Jacket. The Life Jacket centers liberation, justice, and antiracist women of color feminism, and symbolizes the way in which community-centered care functions as a lifeline, refuge, and sanctuary in struggles for social justice. As we move through a world of oppressive systems shaped by racism, heteropatriarchal sexism, xenophobia, capitalism, and ableism, we claim the emancipatory potential of zine-making as a framework for our radical, intersectional critiques. We would like to engage in a multidimensional project of reflexive writing and workshopping that applies narrative medicine in a creative context grounded in discussions around racial identity and solidarity. We see narrative medicine as a tool for witnessing and interpreting the phenomenological experiences of those who reside at the margins of society, for facilitating dialogue in community, and, when paired with zines, a radical, intersubjective method of knowledgemaking.
Creating an Embodied Anti-Racist Medical Culture: Narrative Medicine Informed Constructive White Conversations
Narrative Medicine Informed Constructive White Conversations is an anti-racism pilot program combining Narrative Medicine methodology and Constructive White Conversations (CWC) methodology. It is designed for voluntary participation by residents and fellows of Columbia University Irving Medical Center Rehabilitation and Regenerative Medicine Department (Rehab Medicine) who identify as white. The hybrid will be composed of two parts: a virtual workshop series and a qualitative research initiative.
Ramon Martinez Vale
Surveying race and racism in Puerto Rican medical education: a mixed-method approach
This study aims to elucidate whether Puerto Rican medical students and physicians perceive anti-black racism to exist; whether they have experienced it personally, or observed racist behaviors and practices. Considering the racial and ethnic discrimination events that permeate healthcare and medical education in the continental US, it pays special attention to those doctors who consider themselves to be black, or any of the categories used in Puerto Rico to describe being Afro-Caribbean. It also explores the way race is conceptualized among medical students, being attentive to the way they identify themselves. Overall, as a project that stems from the field of Narrative Medicine, our goal is to gather the untold stories and experiences about race and racism that seep medical education and healthcare. Due to the lack of research in this area, this study, in itself, is a tool for anti-racism.
Narrative medicine sessions among Columbia internal medicine residents to address individual and structural racism in healthcare
The goal of this project is to use narrative medicine sessions with internal medicine residents as a means to address racism in healthcare in a broad sense. Key topics would include being a healthcare professional who experiences discrimination from patients, seeing a healthcare worker exhibit discriminatory behavior toward a patient or co-worker, and firsthand observations and reflections on healthcare disparities as evident at institutional and structural levels.
Sarah Holdren and Yoshiko Iwai
Narrative Medicine at UNC School of Medicine: A New Approach for Anti-Racism in Medical Education
This project, entitled “Narrative Medicine at UNC School of Medicine: A New Approach for Anti-Racism in Medical Education,” aims to advance narrative medicine (NM) endeavors at the University of North Carolina School of Medicine by initiating NM workshops on anti-racism for medical students and conducting a mixed methods study on workshop efficacy. We seek to evaluate the use of NM workshops as a pedagogical tool for teaching anti-racism, with the deeper goals of promoting self-reflection, collaboration, affiliation, and engagement with critical issues that have risen out of COVID-19, the epidemic of police brutality, and subsequent protests against state violence.
Phantom Physician and Illness Interrupted: On Narrative Ethics and Ghost Surgeries
I will apply a narrative ethics approach in order to analyze the under-recognized practice of ghost surgery. This project will not only examine medical harm and physician accountability through a narratological perspective, but also allow for a deeper understanding of their impact on patients’ health, wellbeing, and stories. These objectives will be achieved through independent scholarly research and literature review, as well as guidance from the interdisciplinary working group provided through the Fellowship.
Narrative Medicine in Research
I have a rare opportunity to research a myriad of narrative medicine curriculum and interventions with a unique population of students: underrepresented minorities in a highly competitive seven-year BS/MD program that are trained to address social determinants of health. This fellowship would empower me to robustly advocate for increased, sustained institutional investment in the curriculum and programming I have developed at CSOM. Additionally, it would benefit the new wave of young future MDs who are training with me in the skills of Narrative Medicine who have begun to conduct qualitative and quantitative research of our programming with my limited ability to guide in conjunction with a few colleagues who specialize in other forms of social research.
Advancing Culture of NM at Baylor College of Medicine: A Faculty Facilitator Training Program and Medical Student Curriculum
This project will advance narrative medicine initiatives at Baylor College of Medicine (BCM) by inaugurating a Narrative Medicine Faculty Facilitator Training Program in November 2019 and a narrative medicine curriculum for medical students, to be implemented in January 2020. Faculty trained in the training program will serve as facilitators in the medical student curriculum, which will be comprised of a narrative medicine (NM) workshop series as part of the students’ core clinical clerkships in their second, third, or fourth year. By training this inaugural faculty cohort and implementing a workshop curriculum that will be undertaken by all medical students as part of their core clerkships, we hope to build a strong foundation for a sustainable program in–and culture of–narrative medicine in medical training and practice at BCM.
Narrative Medicine and Incarceration
I see the promise of narrative medicine to dismantle and disrupt the very systems and institutions that have continued to oppress and marginalize individuals and communities in the context of mass incarceration. While I would bring tangible experience in community health to this project, I would also bring immense passion and the willingness to learn and challenge others and myself. While I began this program with the hopes that it would afford me the opportunity to discover the power of narratives in clinical practice, research, and education as a means to promote quality, patient-centric health care; narrative medicine has also reinvigorated my passion for social justice in new ways. Although I have always seen the endless possibilities for discovery, challenge, and innovation that narrative medicine has to offer, I know that the knowledge and tools I have acquired require me to make a real difference in the world. I aspire to be someone who will have an active role in shaping the landscape of social reform in the United States. The prison system is just one of the first places I would like to start.
Natalia Romano Spica
Stroke Narratives and ICU Support Tools
This fellowship will explore and amplify the narrative of patients who have experienced a stroke, of their loved ones who often find themselves as improvised caregivers, and of the clinicians who take care of both. It also intends to leverage the lessons from each of their narratives to develop resources and materials addressing the needs of these groups of individuals. I will apply Narrative Medicine and Qualitative Research tools to design a project that will collect stroke narratives from patients, caregivers, and clinicians through a combination of semi-structured interviews as well as through the implementation of a new tool in the ICU: that of “ICU diaries,” available to patients, visitors, and clinicians for chronicle of hospital courses and lived experiences. This gathering and analysis of narratives will allow me to develop and tailor informational pamphlets, “poetry carts,” and detailed Narrative Medicine workshop guides to offer in the setting of the ICU, as well as of the post-ICU follow-up and rehabilitation setting. It will also allow me to guide the creation of “care packages” for families visiting the ICU alongside an advocacy organization I have established and developed a relationship with, the Bee Foundation.
We: The S.N.A.C.C. Sessions
Art is research; a way of investigating our experiences and producing results that are observable. The purpose of this project is to create a collective voice from individual contributions of faculty, staff, and student artwork from the CUNY School of Medicine. These creative contributions emerged from narrative medicine sessions called SNACC (Seeking Narrative Affirmations and Connecting Cohorts) sessions. This collective voice will allow for insight surrounding themes of community, interior landscapes, and professional and personal development at The CUNY School of Medicine. Furthermore, it will serve as an investigation as to what works and what does not in regards to SNACC sessions that have been held at the school. The means to this collective voice will be through a video collage/documentary that will both serve as process and product.
Surveying interest for the creation of a Narrative Medicine International network
Networks are often designed as organizational advocates to advance, as well as protect and preserve, treatment, or treatment standards. The creation of an international Narrative Medicine network could be used to provide leadership, awareness, and advancement for the field. It could further establish ways to connect and centralize communities of NM professionals, and foster interdisciplinary collaboration, programming, education, and research. The network may provide for an international registry for NM practitioners and program graduates. An NM network would further serve as a marketing device to increase awareness and understanding of the field and hopeful integration of NM methods into more medical and health care practitioner education programs, as well as health care wellness program offerings. The network may provide awareness and international support for the promotion of increased NM professional interaction, cooperation and advocacy, and towards further deployment of NM therapies and methods around the world.
Mapping the Paramedical Surround: Distributed Narrative Competence in Medicine and Family Systems
I will study the collective impacts of the physician's, caregiver's, and medical staff's experience of a patient's illness. During the year, I intend to elaborate on Danielle Spencer and Stephanie Yuan's method of the "360 degree Clinical Portrait" by collecting one set of oral histories for what I am calling the paramedical surround. I will interview the family members and caregivers of a patient in addition to documenting the narratives of the specialists, primary care physicians, receptionists, and medical staff that the clinical portrait already encompasses. By expanding the narrative circumference of the clinical portrait to include the nested structure of care in a family system, I hope to document the often hidden narrative affinities and divergences, along with the competing beliefs and commitments that comprise caring for a patient.
Voices of Vaccine-Hesitancy in a Waldorf School Community
In this project, I will employ Oral History principles as the main methodology of collection, coding, and analysis of the narratives. I will create as space for an empathic listening and learning between narrator (vaccine hesitant parents in a Waldorf School Community) and interviewer, so that interviewees can openly share their beliefs and concerns regarding vaccination. I will then analyze the meanings in those narratives to have a deeper understanding of vaccine-hesitancy phenomenon.
Elective Course for Medical and Non-Medical students at Julius-Maximilians-Universität Würzburg, Germany
My goal is to teach a group of ten medical and non-medical students the basic principles of Narrative Medicine to show them how an analysis of narratives not only applies to their professional work, but also to themselves. Through prompts, close-reading and discussions, I want the participants to learn to slow down and reflect on different topics in order to explore new perspectives for themselves. Hosting these workshops will provide an opportunity to explore different opinions without the traditional evaluations of right and wrong that is embedded in the medical school curriculum. In order to observe the impact of this course on the students, I plan on handing out feedback evaluations at the beginning, middle, and end of this course. I want to find out how this class will affect the students in their professional and daily life and how it can be improved in the future. At the end, my goal is to write and publish a paper about how effective implementing a Narrative Medicine course in Germany can be for both medical and non-medical students involved in the experience.
NATIVES: VR limited series about rescue workers and refugees in the central Mediterranean
I am currently in development stages on a VR limited series about rescue workers and refugees in the central Mediterranean. It’s title is Natives. I have already established several consulting, creative, and equity partnerships, and the next step is to take research trips to the locations in which the series takes place. The migration crisis in Europe attracts me both practically and symbolically: practically because it is vast, speciﬁc, real, and to a certain extent exotic; symbolically because of its haunting resonance with my own identity, and for its strange symmetry with America’s current political realities regarding migration and immigration. I aim for Natives to be part of that groundswell, while also venturing into the unexplored subjects of medicine, illness narratives, and care.
John Carlo Pasco
Boston University School of Medicine Narrative Medicine Elective
The purpose of this request is to seek funding for a 10-session narrative medicine workshop for first and second-year medical students at Boston University School of Medicine (BUSM). Building from the work and experiences from Fall 2017, the Fall 2018 Narrative Medicine Workshop at BUSM will be composed of 10 two-hour sessions over the course of 10 weeks. The first hour of a session will focus on topics at the intersection between medicine and literature (e.g., embodiment, inter-subjectivity, observation). In particular, we will perform a close reading of texts written by authors who identify as members of marginalized communities. The second hour will be devoted to a peer workshop of one or two students’ own works. Students will be asked to give feedback on each other’s work during this time each week. At the end of the semester, each student will submit a final draft incorporating their peers’ comments.
Pooja Mehandra Varmen and Sussabah Boyed
Murmurs in Medicine: a zine by and for underrepresented voices
We are two young women of color pursuing careers as physicians and about to begin our formal clinical training. We are proposing a project that would call for stories and artwork from people who are underrepresented and historically marginalized in medicine (especially women of color, nonbinary people, and queer people) from any stage of their medical careers to be collected in a self-published anthology in the style of a zine. An important motivation for this project stems from our belief that finding and expressing joy in medical training and practice is radical, is political, is necessary. We hope that the moments and lives represented in this zine will encourage a diverse array of medical students, residents and attending physicians to nurture seeds of joy, art, justice, and community throughout their time in the medical field.
Charles Ethan Paccione
Narrative Medicine Workshop for Chronic Widespread Pain
Chronic widespread pain (CWP) is considered one of the most common and costly health conditions today. Current forms of CWP treatment; opioids, psychosocial therapy such as cognitive behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR) have left patients and caregivers seeking new and innovative forms of treatment to more effectively and safely address expressions of pain. The values upon which narrative medicine sessions are based (i.e. listening, reflecting, understanding, and communicating) can provide both clinicians and patients with promising avenues for creating a deeper and healthier outlook upon chronic pain treatment and expression. Every patient suffering from CWP can have their own experience of trauma, loss, hardship, and physical and emotional injury–a unique illness narrative. This would be the first investigation of its kind to explore the effectiveness and service of Narrative Medicine when applied to patients suffering from CWP.
Weight Stigma Reduction among Medical Students through Narrative Medicine
This qualitative study uses narrative medicine workshops for medical students to reduce anti-fat bias and increase empathy for the experiences of patients deemed “fat” by current medical standards. The objectives of this study are two-fold. First, to investigate the use of narrative medicine as a stigma reduction initiative in medical education. Secondly, to assess the effectiveness of this initiative to reduce fat stigma in particular. The outcome would entail implementation of a modified narrative medicine workshop format to account for the corporeal, phenomenological barriers that accompany stigma. Workshops will involve pairing medical students with people who have experienced weight-based discrimination in a clinical encounter, as well as dyadic workshopping of a long-term writing project inspired by Narrative Medicine faculty Sayantani DasGupta and Nellie Hermann.
Recording Patient Stories in Clinical Encounter PhotoVoice Training
PhotoVoice (PV) is a method of participatory research and story-taking that brings the subject into an intimate visual space of their narrative. Participants are taught basic photography skills, encouraged to integrate photo capture in their daily lives, and then asked to share stories surrounding images during a facilitated discussion. PhotoVoice could be an excellent way to test the boundaries of Narrative Medicine. Pairing PhotoVoice with Narrative Medicine will allow students and alumni of the program to create an archive of patient and illness stories. The depth of listening changes when new media is introduced, and visual media excites and energizes other forms of understanding and empathy. Sara’s vision is to utilize training in PhotoVoice to then create a Narrative Medicine based curriculum using this distinct and innovative tool.
A proposal to introduce Narrative Medicine to Istanbul Faculty of Medicine
Figen, a Turkish scholar discovered Narrative Medicine through the amazing TED talk of Dr. Rita Charon entitled Honoring the Stories of Illness. Meeting with Dr. Charon in Greenwich Village and learning more about Narrative Medicine was the first step of her journey, and changed her story going forward. The main objective of her fellowship is to introduce Narrative Medicine as a new field to The Istanbul Faulty of Medicine (IFM). First, by teaching Narrative Medicine to scholars in IFM, and then to create a Narrative Medicine based curriculum that would educate their scholars. Figen believes that altering educational approaches first in Turkish communities is promising as there is a growing interest in the field of Medical Humanities.
Alexander R. Lichtenberg
This Land is a proposed oral history project based on Alexander’s ongoing ancestral and embodied research. The foundation of his work rests on artists and social justice pioneers like James Baldwin and Maya Angelou, among many others. He also draws inspiration from his own ancestors, German Jews who were traders, bankers, communists, painters, writers, feminists, and survivors, and English, Irish Catholics who fled the potato famine, and other Germans who settled on Native American land in the Midwest. This Land consists of three main components, namely conducting oral histories, facilitating a series of free/donation-based workshops using the main principles of Narrative Medicine (embodiment, storytelling, close reading, and listening) and lastly, developing new performance work in the spring of 2018 that draws from this research. The workshops in dance and storytelling are meant to engage with personal and family histories as a way of sharing, expanding insight, and creating possibilities of collaboration and interrelationship. Alexander models this work on Narrative Medicine’s Self & Other course, which he has been able to further develop in his own practices through various teaching and choreographic roles.
Narrative Medicine as a Wisdom Practice
Wisdom and narrative practices have fascinated Annie for over 15 years within and outside of academia. The hallmarks of Narrative Medicine—close reading, reflective writing, and collective sharing— seamlessly correspond with and encourage the defining features of wisdom as suggested by theorist and researcher Monika Ardelt. With the support of a Narrative Medicine fellowship, Annie will be able to explore the potential for Narrative Medicine to be taught as a Wisdom Practice with the explicit intention to use the methods to inculcate wisdom. The project will be composed of three parts: to study wisdom spanning philosophy, the creative arts, Eastern and Western spiritual traditions, and contemporary neuroscience, to formulate two curricula, and to culminate in an article entitled “Narrative Medicine as a Wisdom Practice” that will be submitted for publication. Presenting Narrative Medicine as a Wisdom Practice will deepen its application in health care and medical education by connecting it with larger wisdom traditions. It will reinforce its application in other settings, and further extend Narrative Medicine’s use for lay populations and spiritual and contemplative communities.
Faiz Jiwani and Jenna Reece
Envisioning Narrative Competence in Medical Education: A Qualitative Study of Narrative Medicine Alumni in Medical School
We are medical students who completed the Master of Science in Narrative Medicine program between our third and fourth year of training during the 2015-2016 academic year. As the Narrative Medicine Master’s Program enters its seventh year, the first alumni classes to complete medical school are now entering residency training programs. This is an opportune moment to examine the impact of the Master’s Program on the medical education experiences of alumni and, through their work, on their peers and faculty. We propose to interview Narrative Medicine alumni who are currently in or have recently completed their medical education to learn how they have used their narrative medicine training in their medical schools. Forty-seven alumni of the Master’s program were either medical students when they enrolled in the MS or applied to medical school upon completion of the degree. We plan to invite these alumni to be interviewed by one of us about their experiences in medical school.
Evaluating Narrative Medicine Practicums: CUIMC Lang Youth Program
I propose to evaluate Narrative Medicine workshops at Columbia University Irving Medical Center’s (CUIMC) Lang Youth Program in order to explore the impact of narrative methods training for teens/youth, who are in a competitive and specialized pre-health professional track, in developing empathy, self-reflection/awareness, skills of close reading, and attentive listening. An outcome of this project would be to 1) develop Narrative Medicine curriculum for youth and 2) demonstrate the importance and benefit of integrating narrative training with medical education for future health care providers.
Ssanyu Birigwa and Apurva Khedagi
Exploring the Implementation of Narrative Medicine Workshops among Brooklyn Hospital Pediatric Residents
In this qualitative research methods project, we will explore the application of Narrative Medicine as a tool toward wellness, emotional wellbeing, and selfcare. We will be facilitating Narrative Medicine workshops at The Brooklyn Hospital with pediatric residents. Through close reading of various forms of literature, art, and concepts of spirituality, we hope to empower pediatric residents by making selfcare and mindfulness practices accessible. We strive to share innovative methods of selfcare in graduate medical education through the practice of Narrative Medicine, a fluid, diverse, and potentially powerful medium of personal reflection and coping. We hope to illuminate how art and literature can bring about a different, expansive way of thinking that allows one to listen to one’s own mind and to others.
Applied Phenomenology: An Investigation of the Use and Practice of Theatre/Performance to Develop a Pedagogy and Syllabus for Teaching Core Efficiencies in Narrative Medicine
The aim of this Fellowship is to research, curate, and construct a comprehensive pedagogy and companion 12-week syllabus for the purpose of instructing students in the graduate program in Narrative Medicine at the School of Professional Studies, Columbia University. The primary intention is to facilitate for students a “lived experience” of the philosophically-based Narrative Medicine principles of Self and Other. A second but equally vital intention is to generate an embodied understanding of Listening as a core efficiency in the practice of Narrative Medicine.
On Conversational Narratives and Accounts
This research project aims to write a publishable paper on conversational narratives, that is, narratives seen as co-constructed or as interactional achievements (see, e.g., Mishler, 1986; Riessman, 1991 and 2002), and accounts, that is, forms of elicited narratives (see De Fina, 2009). The project proposes that these narrative forms are relevant genres of study that require the attention of Narrative Medicine as an emerging discipline. In this manner, this project intends to advance an initiative in the new field of Narrative Medicine.
Talk about it: Using Narrative and Graphic Medicine to Encourage End of Life Conversations
The purpose of this project is to research and develop a story bank from which a pilot group of four graphic/comic narratives that will get people talking about their values and wishes at the end of life will be created and tested. I will serve as researcher and reviewer of personal end-of-life stories and as coordinator of the work of the graphic artists and the pilot testing of the graphic narratives as pathways to “talking about it.” I will use the Fellowship to produce an initial series of graphic narratives that depict nuanced end-of-life dilemmas in a form in which patients, family members, and medical professionals can easily imagine themselves. These narratives will gently invite the reader to break longstanding silences and begin “talking about it” in comfort, safety, and good humor. Through my ongoing work with “What Matters” and Gundersen’s Respecting Choices program, I would have the opportunity to pilot test these graphic narratives with groups of seniors and families in a relaxed community setting while pursuing a longer-term goal of achieving broader dissemination through Gundersen and other partner organizations.
Narrative Medicine Program Development at Touro University of California College of Osteopathic Medicine
In Fall 2015, I taught a Narrative Medicine elective to pre-clinical medical students and MPH students, at Touro University California College of Osteopathic Medicine (TUCOM). The elective consisted of nine workshops, and engaged in multimedia texts, including hosting a guest filmmaker. In Spring 2016, I facilitated two workshop sessions for third-year osteopathic medical students, in a break between their clinical rotations, and I was a guest speaker in an elective on reproductive health. I will co-facilitate a faculty development workshop in October, and am in the process of planning a CME workshop.
I also created a Narrative Medicine Clinical Distinction Specialty Track, in which clinical students commit to engaging in Narrative Medicine more deeply. Requirements include: participation in the Narrative Medicine elective, engagement in multimedia texts including books, essays, articles, films, radio podcasts, webinars, writing assignments, interview assignments, the opportunity to participate in a Narrative Medicine CME workshop. As a result of this fellowship, I have been invited to be faculty at the new low-residency MFA program at Dominican University, in San Rafael, CA. In addition, I have served as a resource for consultation and professional development to various care providers in the region, including a FNP in Santa Rosa, and a PA in Forestville, CA. I founded an online platform, The Chronix Project, as a way to highlight and share stories of embodied experience, particularly illness narratives that are under-represented in the genre. I am planning a six-week online course in writing illness narratives, as well as one for family caregivers of chronically ill patients.
Patte Jodan Huberman
Narrative Medicine Group Program for Psychiatric Inpatients
I introduced narrative medicine in the hospital where I work, Eastern Long Island Hospital in Greenport. I proposed two methods of introduction: develop a narrative focused patient group on the locked psychiatry unit, and lead narrative medicine workshops for staff groups. In acute care psychiatry, I have worked with many patients who, for their own reasons, are voiceless. Barriers to expression can be imposed on patients by the mandate of a unit, as well as by their own internal obstacles: the circumstances of admission alone can construct a story over which a patient has little control, and limited input. Psychiatric illnesses and symptoms often sound pejorative—grandiose, paranoid, delusional—and we risk boxing individual patients into frameworks based on our own assumptions, our own experiences.
Nurses, social workers, counselors, and nursing assistants are in the front line of care on the hospital psychiatric unit. It is important that these disciplines, as well as physicians, learn the importance of close listening and stories to the healing of their patients, and bring this awareness to their practice. This could promote positive changes in their relationships with patients, and with one another. Helping patients access their own stories and be heard can, I believe, have a positive impact on their experience, and their recovery. This approach could also become part of a framework for reducing reliance on PRN (as needed) medications, and influence long-term outcomes.
Jonathan Chou and Ianthe Schepel
Community-Based Participatory Medical Education: Development of a New Narrative Medicine Intervention
During the Spring and Summer of 2016, we conducted a pilot study of a new narrative medicine workshop method at the Keck School of Medicine of USC. The intervention was a creative nonfiction writing workshop series in which medical students and patients wrote and workshopped personal narratives together. Nine medical students and five patients participated in one of two five-week workshop series. Students were recruited from the Keck School of Medicine of USC. Patients were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology (MCA) at Los Angeles County+USC Medical Center (LAC+USC). Qualitative methods, including focus group interviews, were used to conduct a theory-oriented case study of medical students’ and patients’ experiences participating in the workshop series together. Participants experienced the workshop series as a safe environment in which to self-reflect and arrive at deeper understandings of their personal values. It expanded their sense of agency, humanity, and empathy toward others, enabling them to explore and experience new ideals for therapeutic physician-patient relationships. Participants recognized how narrative work can improve health and well-being and believed that the workshop has the potential to enact meaningful change on the community level. To our knowledge, this is the first example in the literature of a narrative medicine workshop method for medical students and patients in which the two groups contributed equally and the extent of patients’ participation was not limited to sharing their illness narratives.
Supporting Publications and Presentations
Narrative Medicine alumni and students are applying their skills and furthering their research with amazing results, but too often the only people who hear about it are within the program community. This work should be reaching our colleagues in other academic centers, as well as policy makers, thought leaders, and the general public. I had planned to propose becoming a point person for publication. I would research paths to publication and compile a guide that would help students begin to evaluate how best to share their work, perhaps also pointing them toward grants or other support. The ultimate goal is to support alumni and student work to broaden the spread of Narrative Medicine, helping to change the conversation around myriad health-related issues, within academia and in the larger sphere.
Creating a Narrative Medicine Community at Duke University Health System
The goal of this initiative was to create culture change across the Duke Health System, medical school, and undergraduate campus in order to develop a more cohesive, vibrant medical humanities community and supportive humanistic environment for trainees at all levels through incremental, disruptive, community engaged, and vertically integrated projects. For this initiative to be sustainable and create true synergy in arenas with a long history of existing in silos, it needed to coalesce a community of people engaged in this work at Duke around new ideas and projects. For now, this vast community will gather around stories and storytelling as a common theme central to the wide range of humanistic disciplines. This is a theme that tethers the disciplines to the heart of medicine as it is actually experienced by patients who perceive themselves to be healthy as well as the ill, the suffering, and the dying, along with those who care for them.
Plain Talk Workshops
This fellowship supported program development utilizing the perspectives of Narrative Medicine and based on the topics/modules introduced in my recently created animated film, Plain Talk. Seminar-based workshops for professionals, wellness organizations, groups (churches, synagogues, other), and companies (employee assistance) along with programs for hospice, assisted living, and nursing care were developed. Each program was designed for the served venue, with modules chosen for the specific needs and expectations of participants. As appropriate, each module incorporated video introduction, didactic presentation, interactive activities, and workbooks. These programs evolved further into discussion-leader trainings and opportunities for personal growth.
Development of a Longitudinal Narrative Medicine Program for Pre-Clinical and Clinical Medical Students at The Warren Alpert Medical School of Brown University
The objective of this project was to create, implement, and evaluate an elective introducing pre-clinical students to the concepts and practices of narrative medicine undergraduate medical education at Alpert Medical School. We hypothesized two things: 1. participating students would perceive narrative medicine to be an effective means of enriching communication, patient-centered care, collaboration, and professional development and 2. students would develop skills integral to medical practice, consistent with Alpert Medical School’s (AMS) “Nine Abilities” and those mandated by the Liaison Committee on Medical Education (LCME). The overarching goal was to implement a longitudinal curriculum for medical students that included seminars, workshops, and clinical shadowing opportunities to explore the field of narrative medicine, after implementation of the pilot pre-clinical elective.
The Intima, Refreshed
The Intima was created by a group of graduate students in the Narrative Medicine program in Columbia in 2010, and published its first journal in Fall 2011. Some six issues later, it has attracted writers in the literary and medical fields from around the world. After four successful years, The Intima and its staff of 10 editors, has taken on a new challenge: To upgrade the look, navigation, and scope of its website, in addition to bolstering our social media presence. In addition to refreshing the look and function of The Intima, a portion of this fellowship grant would go toward strengthening the scope of The Intima by holding another essay contest and hosting other nights at Bowery Poetry Club.
The Narrative Medicine fellowship funds will be utilized in three areas. First, expand and complete NarrativeNursing.com. Second, to run a research study with a floor or unit of a hospital with nurses who work in areas with high rates of burnout (pediatric oncology, critical care, and emergency department) to measure any fluctuations in the compassion fatigue levels of said nurses. Lastly, if the results do, indeed, help nurses and their levels of compassion fatigue, the remainder of the fellowship monies will be utilized to market NarrativeNursing.com to nurses who may be at high risk for compassion fatigue.
Does close reading lead to close listening?
As practitioners of narrative medicine, we believe—and hope—that it does. I’m trying to answer that question with a brief narrative intervention in the neurology clerkship at the University of Virginia. The students will compare lay and medicalized descriptions of migraine, and then will write their own “parallel chart” on a patient they saw in clinic or in the hospital. I’m looking for differences in the writing style between those who completed a narrative medicine workshop and those who simply read the essays on their own. If our pilot program is successful, the narrative workshop will become a part of the neurology clerkship.
Anoushka Sinha and Lauren Kascak
Palliative Care Narratives
Our project is twofold: to provide a space for patients in the Palliative Care Department of Tata Memorial Centre in Mumbai to share their stories by listening to and documenting their life histories; and to facilitate a series of Narrative Medicine workshops with palliative care staff at the hospital. We will then assess the impact of our presence and work at the hospital by co-authoring an essay that we will strive to publish in a journal and/or present at a conference. The purpose of this project is to use Narrative Medicine as a vehicle for palliative care team building, to explore Indian palliative care professionals’ attitudes towards communicating with their patients, and to allow patients to reflect and give accounts of their lives in the season of their deaths.
Narrative Medicine Course at Case Western Reserve University
I am teaching an introductory narrative seminar for first and second year medical students at Case Western Reserve University in Cleveland, OH. We are working together to build the narrative skills necessary to “recognize, absorb, interpret, and be moved by the stories of illness.” Students who participate in the course will be exposed to many of the fundamental principles and practices of narrative medicine. The focus of this seminar is on exploring what it means to listen and what it means to be ill. The course culminates in a narrative project where each student must place themselves in the role of a chronically ill patient who must tell a new doctor about their specific case.