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Narrative Medicine at UNM IRCME Symposium March 16, 2007 Ellen M. Cosgrove, MD FACP Senior Associate Dean, Education University of New Mexico ACKNOWLEDGEMENT: the people who did this work Julie Reichert Directs UNM’s Narrative Medicine program author, independent filmmaker
Ellen M. Cosgrove, MD FACP
Senior Associate Dean, Education
University of New Mexico
Directs UNM’s Narrative Medicine program
author, independent filmmaker
Summers Kalishman, PhD
Directs the Office of Program Evaluation
Brian Solan, MD
Directs the summer preceptorship
What Japanese cultural traditions and literary forms encourage reflection?
What do YOU want to learn from this lecture?
Kimitaka Kaga, MD PhD
TANKA of the DYING
a "crucial process in the transforming of experience into knowledge, skills and attitudes"
Robertson, K. Reflection in professional practice and education, Australian Family Physician, 2005; 34(9), pp. 781-783.
a key step in both life-long learning and the development of professionalism in practice.
Novack DM et al. Calibrating the Physician: Personal Awareness and Effective Patient Care. JAMA. 1997; 278: 502-509.
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, Annalsof Internal Medicine, 2002; 137(3), pp. 220-223.
Verghese A. The physician as storyteller. Ann Intern Med 2001;135:1012-7.
students 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;79:351–356.
Julie Reichert read one work by each student. Major themes:
Many of the students' stories addressed first-time experiences – witnessing birth and impending death, trying hands-on procedures
The students grappled with who they were becoming as they began to take on the role of being a physician
A student's pain as he meditates on how his new medical knowledge and focus on becoming a doctor is leading him away from his working-class family and his roots.
Many students marveled at the sheer beauty of patients and of the practice of medicine:
The "exhaustion filled with love" of a 74-year old father taking care of a 45-year-old developmentally disabled daughter
Some students wrote about problems with preceptors, the limits of medicine, and other difficult topics.
Noticing the contrast in a preceptor's negative attitude in treating a suicide survivor ("voluntarily" ill) with attitude in caring for an older, dying patient
Feeling helpless and angry regarding an aging couple’s losing their independence
Sometimes, students’ experience evoked unexpected thoughts and questions about medical practice.
Observing an interaction between mother/child and physician, questioning how much of medical education should be science, and how much humanities
The paradox of finding sick children interesting and well babies boring
Students questioned themselves when suddenly faced with difficult ethical situations
Feeling ethically challenged in the face of a dying patient who refuses care
Being unexpectedly welcomed to a special dinner in the Zuni Pueblo community
Observing the continuity of care that the preceptor physician has provided over the many years of practice
Appreciating the qualities of the people living in a rural community after observing the stoicism and courage of a disabled member of that community
From a class of 75 students:
9 took Narrative Medicine track in 2005
22 in 2006
54 in 2007