2011-4-7 7:30 8:30Narrative Medicine

Robert Coles:

http://tw.myblog.yahoo.com/mental-shelter/article?mid=173&sc=1

What is Narrative Medicine?Rita Charon 2000 Narrative medicine

logical-scientific knowledge

narrative knowledge

Rita Charon

Narrative Medicinereductionist

http://tw.myblog.yahoo.com/mental-shelter/article?mid=173&sc=1

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Charon --- Narrative Medicine http://tw.myblog.yahoo.com/mental-shelter/article?mid=173&sc=1

Physician and Patient, Self, Family Patient CarePhysician and Self, Patient Medical Knowledge Physician and Self, Patient, Colleagues, Society Practice-Based Learning and Improvement Physician and Patient, Colleagues, Society Systems-Based PracticeAll Situations Interpersonal and Communication SkillsAll Situations Professionalism

For PatientCoping strategy; facilitates adjustment/ adaptationProcess feelings and reactionsExpression and communicationPromote healing, improved health outcomes

For ProviderProcess reactions to difficult situations/griefProtection against burnoutReduce practitioner stressYamada, S.et al. Medical Student Education, 2003; 35(4), pp.279-283.

Brady, DWet al. Annals of Internal Medicine, 2002; 137(3), pp. 220-223.

Empathystudents practice taking the view of another person (a patient, family member, other healthcare providers)

they see the patient as a person within a family, community, and culture

Halpern J. From detached concern to empathy: humanizing medical practice. New York: Oxford University Press, 2001.

Das Gupta S & Charon R. Personal Illness Narratives: Using Reflective Writing to Teach Empathy. Acad Med. 2004;79:351356.

Narrative Medicine does not make medical students into "writers," but makes them better doctors

supporting their skills of observation encouraging their reflection in a clinical contextshowing the students that their thoughts, feelings, and questions are heard through the responses from the mentors. Narrative Medicine at UNM IRCME Symposium, March 16, 2007

Initiation: first-time experiencesIdentityAweFrustration and disillusionQuestioningValues Narrative Medicine at UNM IRCME Symposium, March 16, 2007

Students say this writing helped them toperceive their clinical work in a thoughtful way

become more observant and analytical

look for recurrent patterns

respond better to patients.

Narrative Medicine at UNM IRCME Symposium, March 16, 2007

Faculty comments: responding to student's reflective writing makes the mentor more reflective

Helps keep me in touch with students at the early stage of training I got a much better insight into how students grow over time. It has made me look closer at my own behavior as a teacher, mentor and clinician.

Narrative Medicine at UNM IRCME Symposium, March 16, 2007Reflective

RESULTS: time well spent

Students and mentors overwhelmingly positive Most mentors returnExplosion of student interest: From a class of 75 students: 9 took Narrative Medicine track in 2005 22 in 2006 54 in 2007 Narrative Medicine at UNM IRCME Symposium, March 16, 2007

CONCLUSION: A Narrative Medicine experience can be:

simple to set up

requires a very modest investment in student and faculty time

rewards the effort with increased reflection and satisfaction for both students and faculty.Narrative Medicine at UNM IRCME Symposium, March 16, 2007

I write the story. The story writes me. ~Watts

TRAINING MODELKNOWLEDGEACQUISITION (Novice)KNOWLEDGEAPPLICATION(Beginner) STORIES = TOOLS TO ASSESS &IMPROVE(Competent)Lawrence & Viken (2004). RAP

Narrative Medicine SkillsObservationActive listeningAbility to tell the patients story

Verghese A. The physician as storyteller. Ann Intern Med 2001;135:1012-7.

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3-43-4

Twenty-four year-old, 28 weeks pregnant.Small abruption, dilated to 4 or 5, s/p mag.Signed out AMA to smoke.Down. Abrupted. Bled. Came up baby dead. Positive cocaine.Stupidity.Irritated.Howis Y. Toler, M.D. The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006

file://localhost/Users/cdhuang/Desktop/Narrative Medicine/.doc - narrative medicine

How to Get StartedCritical ComponentsCurriculum IntegrationApplicationAssessmentHowis Y. Toler, M.D. The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006

Critical ComponentsResident champion/facilitatorSafe faculty member Education about narrative competence, narrative medicine, and core competenciesMotivation Noon conference credit & foodOpportunities to practice & experiment with writingAcceptance, comfort levelWillingness to share, model for othersLiterature, literature, literatureHowis Y. Toler, M.D. The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006

Integrating Narrative Medicine into the CurriculumUse during orientation to help residents get to know one anotherInclude writing exercises in required didactics and seminars Narrative Medicine RoundsHowis Y. Toler, M.D. The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006

Narrative Medicine Rounds

Narrative Medicine RoundsRequirementsComplete pre- and post- self-assessment questionnairesAttend and participate in at least 50% of scheduled Narrative Medicine RoundsKeep a personal journalHave fun!Howis Y. Toler, M.D. The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006

Narrative Medicine Rounds Session FormatBrief 5 to 10 minute didacticReading of the dayTime to writeReaction to readingGuided writingPersonal reflectionTime to shareHowis Y. Toler, M.D. The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006

Planarrative medicine round

ReferencesHowis Y. Toler, M.D., Julie Wood-Warner, Ph.D. Research Medical Center Family Medicine Residency, Kansas City, MO The 27th Forum for Behavioral Sciences in Family MedicineSeptember 2006Ellen M. Cosgrove, MD FACP Senior Associate Dean, Education, University of New Mexico. Narrative Medicine at UNM IRCME Symposium March 16, 2007 http://tw.myblog.yahoo.com/mental-shelter/article?mid=173&sc=1

Take HoME MessagesNarrative Medicine does not make medical students into "writers," but makes them better doctors

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Thank You!

International movement to include reflective reading and writing in physician practicePoetry, stories, memoirs written by doctors, other health care professionals, students and patients

**Improves patient-centered care Yamada, S.et al. Family narratives, culture, and patient-centered medicine, Medical Student Education, 2003; 35(4), pp.279-283.

Reduces practitioner stress Brady, DWet al. "What's important to you?": The use of narratives to promote self-reflection and to understand the experiences of medical residents, Annals of Internal Medicine, 2002; 137(3), pp. 220-223.

**It turns out, as I wrote deeper and deeper into my subject, I revealed more and more about myself. That, I guess, is what literature does. Makes us set aside inhibitions. Makes us find a pathway to the interior.*Howis could also do Mr. White*Read orientation introsCritical incidents/experiencesOpportunities for reflection on learning and developmentImproved understanding of specific competencies