A narrative medicine intervention in pediatric residents led to sustained improvements in resident well-being

Figures & data

Table 1. Survey distribution time points.

Group	T0 Pre-Intervention (April–May 2020 or December 2020)	Intervention (December 2020–April 2021)	T1 Immediate Post-Intervention (April–May 2021)	T2 Six Months Post-Intervention (October–November 2021)
Intervention	PRB-RSC Survey Supplement Survey T0		PRB-RSC Survey Supplement Survey T1	PRB-RSC Survey Supplement Survey T2
Control	PRB-RSC Survey		PRB-RSC Survey	No data

PRB-RSC: Pediatric Resident Burnout-Resilience Study Consortium. Supplement Survey included narrative medicine-specific and open-ended questions.

Table 2. Baseline demographic data of participants in the control and intervention groups.

Category	Group	Intervention n (%)	Control n (%)	p Value
Gender	Male	5 (24)	25 (31)	0.60
	Female	16 (76)	56 (69)
	Total	21	81
Age	<30	18 (86)	62 (79)	0.76
	30+	3 (14)	16 (21)
	Total	21	78
International Medical Education	Yes	1 (5)	0 (0)	0.22
	No	21 (95)	78 (100)
	Total	22	78
Marital Status	Single/divorced	10 (45)	44 (52)	0.64
	Married/partnered	12 (55)	41 (48)
	Total	22	85
Children	Yes	2 (10)	6 (7)	0.67
	No	19 (90)	75 (93)
	Total	21	81
Categorical	Yes	16 (73)	69 (81)	0.39
	No	6 (27)	16 (19)
	Total	22	85
Last Weekend Off	Previous weekend	9 (41)	47 (55)	0.44
	2 weekends ago	8 (36)	21 (25)
	3+ weekends ago	5 (23)	17 (20)
	Total	22	85
Last Vacation	In the past month	9 (41)	25 (29)	0.47
	1–3 months ago	6 (27)	34 (40)
	>3 months ago	7 (32)	26 (31)
	Total	22	85
Last Rotation	Inpatient/Newborn/Nightshift	12 (57)	19 (24)	0.01
	ER/ICU	4 (19)	17 (22)
	Primary Care/Elective	5 (24)	43 (54)
	Total	21	79
Patient Death	Yes	2 (9)	18 (21)	0.24
	No	20 (91)	67 (79)
	Total	22	85

Note: n may not sum to total sample size because of missing data. Percentages may not sum to 100% due to rounding. p-values are bolded and italicized if p<0.05.

Table 3. Baseline well-being measures compared across demographic groups and previous experience with narrative medicine.

			Well-Being Measure Average (Standard Deviation)
Variable	Group	n	PSS-10	CAMS-R	SCS-SF	BRS	IRI-EC	MBI
Intervention vs. Control	Intervention	22	17.0 (5.6)	28.0 (3.5)	3.2 (0.53)	3.6 (0.65)	24.7 (3.1)	5.0 (3.0)
	Control	85	14.4 (5.9)	28.4 (4.7)	3.3 (0.58)	3.7 (0.59)	22.9 (3.7)	3.9 (2.5)
	p-value		0.08	0.73	0.34	0.54	0.04	0.10
Intervention April  vs. December Survey	April	11	17.5 (4.0)	28.1 (2.9)	3.3 (0.30)	3.7 (0.47)	24.4 (3.3)	5.5 (2.7)
	December	11	16.5 (6.9)	27.9 (4.1)	3.0 (0.67)	3.5 (0.81)	25.1 (3.0)	4.5 (3.2)
	p-value		0.68	0.91	0.27	0.63	0.60	0.44
Gender	Male	30	13.8 (6.6)	28.6 (4.8)	3.4 (0.54)	3.8 (0.64)	22.0 (3.2)	4.0 (2.6)
	Female	72	15.5 (5.7)	28.4 (4.1)	3.2 (0.57)	3.6 (0.57)	23.9 (3.8)	4.3 (2.7)
	p-value		0.19	0.78	0.24	0.20	0.02	0.61
Age	<30 years	80	15.6 (5.8)	27.7 (4.2)	3.2 (0.54)	3.7 (0.58)	23.0 (3.9)	4.5 (2.8)
	30+ years	19	13.3 (5.5)	29.2 (5.0)	3.3 (0.65)	3.6 (0.75)	24.0 (2.8)	3.3 (1.8)
	p-value		0.14	0.17	0.41	0.50	0.29	0.07
Marital Status	Single/Divorced	54	15.1 (5.2)	28.0 (3.8)	3.2 (0.53)	3.6 (0.57)	23.4 (3.6)	4.2 (2.6)
	Partnered/Married	53	14.8 (6.6)	28.6 (5.0)	3.3 (0.61)	3.8 (0.62)	23.2 (3.7)	4.1 (2.7)
	p-value		0.81	0.42	0.47	0.20	0.78	0.86
Children	Yes	8	11.0 (3.4)	30.3 (1.8)	3.4 (0.43)	4.0 (0.25)	23.1 (3.0)	3.8 (1.3)
	No	94	15.5 (5.9)	27.8 (4.3)	3.2 (0.56)	3.6 (0.60)	23.2 (3.8)	4.3 (2.7)
	p-value		0.048	0.11	0.30	0.08	0.96	0.60
Categorical Resident	Yes	85	15.4 (6.1)	27.9 (4.6)	3.2 (0.61)	3.7 (0.64)	23.4 (3.6)	4.1 (2.8)
	No	22	13.2 (4.8)	29.8 (3.3)	3.4 (0.39)	3.7 (0.44)	23.0 (4.0)	4.1 (2.1)
	p-value		0.13	0.08	0.38	0.85	0.61	0.95
Last Weekend Off	Previous Weekend	56	14.6 (6.1)	27.9 (4.6)	3.2 (0.62)	3.6 (0.61)	23.0 (4.0)	3.9 (2.6)
	2 Weekends Ago	29	15.7 (5.6)	28.3 (4.2)	3.2 (0.48)	3.8 (0.49)	23.9 (3.1)	4.4 (2.9)
	3+ Weekends Ago	22	15.0 (6.1)	29.3 (4.3)	3.4 (0.53)	3.7 (0.70)	23.3 (3.3)	4.4 (2.4)
	p-value		0.73	0.46	0.29	0.49	0.54	0.56
Last Vacation	In the past month	34	15.3 (6.2)	27.8 (4.8)	3.2 (0.58)	3.6 (0.62)	23.5 (3.3)	4.2 (2.7)
	1–3 months ago	40	14.6 (5.1)	28.9 (4.2)	3.3 (0.50)	3.7 (0.57)	23.6 (3.7)	4.2 (2.4)
	>3 months ago	33	15.0 (6.7)	28.1 (4.3)	3.3 (0.64)	3.7 (0.62)	22.8 (4.0)	3.9 (3.0)
	p-value		0.90	0.57	0.48	0.80	0.65	0.86
Last Rotation	Inpatient/ Newborn/Night Shift	31	14.9 (6.5)	28.5 (4.7)	3.2 (0.67)	3.6 (0.65)	24.3 (3.3)	4.0 (2.8)
	ER/ICU	21	16.9 (7.0)	29.0 (4.6)	3.3 (0.60)	3.8 (0.72)	24.4 (3.2)	4.3 (2.6)
	Primary Care/Elective	48	14.2 (4.8)	28.0 (4.4)	3.3 (0.50)	3.7 (0.53)	22.3 (3.8)	4.0 (2.6)
	p-value		0.25	0.72	0.68	0.71	0.02	0.89
Patient Death in the Last Month	Yes	20	14.0 (5.0)	29.1 (4.1)	3.4 (0.44)	3.8 (0.62)	22.4 (4.0)	4.6 (2.2)
	No	87	15.2 (6.1)	28.1 (4.5)	3.2 (0.59)	3.7 (0.59)	23.5 (3.6)	4.0 (2.7)
	p-value		0.43	0.40	0.26	0.44	0.22	0.37
Previous Experience with Narrative Medicine	None	14	17.6 (6.1)	27.4 (3.2)	3.1 (0.45)	3.7 (0.69)	23.8 (3.1)	5.2 (2.6)
	I have participated in a few workshops	9	16.1 (5.0)	28.9 (3.9)	3.2 (0.65)	3.5 (0.60)	26.1 (2.7)	4.6 (3.6)
	p-value		0.57	0.33	0.67	0.58	0.08	0.61

PSS-10: Perceived Stress Scale-10; CAMS-R: Cognitive and Affective Mindfulness Scale, R; SCS-SF: Neff’s Self Compassion Scale – Short Form; BRS: Brief Resilience Scale; IRI-EC: Davis Empathic Concern Scale from the Interpersonal Reactivity Index; MBI: Maslach Burnout Inventory – Two Item. Note: n may not sum to total sample size because of missing data. p-values are bolded and italicized if p<0.05.

Table 4. Results of one-way ANOVA comparing well-being measures in intervention group at each time point.

	Average Value (Standard Deviation) at Each Time Point
Well-Being Measure	T0	T1	T2	p Value for Fixed Effects
PSS-10	17.0 (5.6)	16.1 (4.7)	15.6 (5.9)	0.26
CAMS-R	28.0 (3.5)	28.7 (5.0)	27.7 (5.3)	0.64
SCS-SF	3.2 (0.53)	3.2 (0.49)	3.2 (0.52)	0.71
BRS	3.6 (0.65)	3.7 (0.77)	3.6 (0.63)	0.70
IRI-EC	24.7 (3.1)	25.4 (2.9)	24.7 (3.5)	0.58
MBI	5.0 (3.0)	4.6 (2.7)	5.3 (3.3)	0.34

PSS-10: Perceived Stress Scale-10; CAMS-R: Cognitive and Affective Mindfulness Scale, R; SCS-SF: Neff’s Self Compassion Scale – Short Form; BRS: Brief Resilience Scale; IRI-EC: Davis Empathic Concern Scale from the Interpersonal Reactivity Index; MBI: Maslach Burnout Inventory – Two Item.

Table 5. Resident perceptions of intervention at T₁ and T₂.

Theme	Subtheme	Representative Quote(s)
Overall Thoughts about the Intervention (Identified at T1 and T2)
Enjoyable and Well-Planned		‘I really enjoyed participating in the Narrative Medicine sessions, and I think this type of intervention could be helpful for all residents. I really appreciate that we could take what we needed from the different exercises, and this flexibility is so important in promoting overall wellness.’
Present and Future Benefits of the Intervention (Identified at T1 and T2)
Building Community	Safe Space	‘I feel like it helped me realize that I can be honest about my feelings and thoughts with those around me.’
	Shared Experiences	‘I feel reassured that I am not alone in my experiences.’
Outlet for Self-Expression		‘Enjoyed thinking creatively. Just writing for fun without any expectations was freeing.’
Emotional and Mental Health Benefits	Reduced Stress	‘I felt more relaxed and at ease after the sessions, and I think this was because I was able to spend time expressing feelings and experiences with peers who often times have gone through similar things.’
	Reflection	‘I feel like it made me think more about the thoughts/feelings that I suppress as we do not have a structured outlet to really understand what all is going on in our minds.’
	Emotional Regulation	‘I feel like talking through tough topics is helpful for decompressing and organizing my feelings. It overall helped me to try to be more thoughtful with all my hard/emotional patient encounters.’
Personal Growth		‘I genuinely loved these sessions. I found them to be strength building for me as a human, and especially so in coping with residency.’
Delayed and Persistent Benefit (Identified at T2)		‘I think it had a lasting impression.’ ‘I thought it helped me later than actually earlier. These past 6 months have been harder and reading and letting myself have my own feelings has really helped me.’
Areas of Improvement (Identified at T1)
Program Expansion	Multiple Settings	‘I would love for these sessions to be included in retreats where you’re among residents in the same year as you.’ ‘Maybe find ways to incorporate this into small sessions while on inpatient?’
	Program Continuation	‘If the program could be expanded so more residents could participate that would be great.’ ‘I would love to see this continued.’
	Protected Time	‘I wish there was protected time for this program. Many of the times I was on service and even if it was at our ‘protected’ 12-1, I was still interrupted and the evening sessions were also interrupted by night shift/other obligations.’
Program Adjustment to Learner Needs	More Intimacy	‘Groups can be made smaller, the session I attended had a lot of people, and I didn’t really feel that comfortable sharing.’ ‘I wish we could have been in person!’
	Increase Accessibility	‘It could be improved by allowing by additional shorter articles to be discussed for those on inpatient medicine and have more small group opportunities.’ ‘Trying to have a curriculum that’s more learner-paced?’

Data availability statement

The data that support the findings of this study are openly available in Open ICPSR at https://doi.org/10.3886/E170961V1, reference number 40 [40].