Persistent influence of a narrative educational program on physician attitudes regarding patient care

Abstract

Purpose: Educational approaches involving patient stories aim at enhancing empathy and patient-centered care; however, it is not known whether the influence of such programs on physician attitudes persists beyond medical school.

Materials and methods: The Family Centered Experience (FCE) paired preclinical medical students with patient families over two years and engaged students in reflective dialogs about the volunteers’ stories. This study examined possible long-term influences on attitudes toward medicine and doctoring. Interviews were conducted with former students at the end of or after post-graduate training. All had completed the FCE between 4 and 10 years before the study. Thematic analysis was informed by a constructivist Grounded Theory approach.

Results: Several themes were identified. The FCE made graduates aware of the patients’ perspectives and impacted their clinical practice in specific ways, such as developing collaborative partnerships, conducting family meetings, and breaking bad news. The course had influenced career choices and interest in teaching. Finally, the FCE enhanced appreciation of the human dimensions of medicine, which graduates had drawn upon in subsequent years.

Conclusions: A program based on longitudinal interactions with individuals with chronic illness can have persistent influence by stimulating reflection on the patient’s perspective and humanistic approaches to patient care.

Acknowledgments

The authors would like to thank the volunteers, students, faculty, and staff of the FCE for their commitment to learning and teaching and to M. Madrigal for her work in transcription of the interviews.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Notes on contributors

Jennifer N. Stojan, MD, is an Assistant Professor of internal medicine, University of Michigan Medical School.

Eleanor Y. Sun, MD, is an Assistant Professor of internal medicine, University of Michigan Medical School.

Arno K. Kumagai, MD, is a Professor and Vice Chair for education, Department of Medicine and the FM Hill Chair for Humanism Education at Women’s College Hospital and the University of Toronto.

Glossary

Tacit knowledge: This is knowledge that is implicit, unrecognized and normally inaccessible to consciousness. For example, the familiarity of a friend’s or relative’s facial features. The phrase comes from Polanyi’s concept of tacit knowing: “we know more than we can tell.” (Polanyi M. 1966. The tacit dimension. Chicago: University of Chicago Press)

Additional information

Funding

This project was supported by a Grant on Student Learning from the University of Michigan Center for Research in Learning and Teaching, and AKK is supported by the FM Hill Foundation of Women’s College Hospital, the University of Toronto.