Background: Imagine opening your patients’ electronic medical record (EMR) and seeing their stories, as told by them. Would that help you understand your patients better, both their resilience and the barriers they have faced? Systemic structures of oppression and health provider unconscious bias are root causes of racial, gender and class-based health disparities. Storytelling is a tool that can connect across socially constructed groups and is a powerful way to both examine structural forces that impact health and tackle bias and racism in healthcare.
Purpose: Our project expanded upon previous storytelling approaches (1) by adding a structural competency framework and facilitated reflection around biases and barriers. We had three goals: 1. For our students to learn about the structures that impact patients’ health from the patients directly. 2. To center our patients’ voices in their own healthcare through a narrative practice and 3. To combat implicit bias in the EMR and healthcare at large.
Description: We piloted the patient narrative project at our academic medical center (AMC) from June 2020 – June 2021 with nine cohorts of students, as a mandatory element of their Medicine Clerkship. We started with a didactic session introducing the curriculum, reviewing key concepts in narrative medicine and practicing applying a structural analysis to an example patient vignette. Next, each student interviewed a patient about their life story and drafted the story in a 1000-word, first-person narrative. Students then reviewed the story with the patient, edited it together, and with the permission of the patient, entered the final version into the EMR where it could be accessed by future healthcare providers. At the end of the rotation, the students completed a written reflection exercise applying structural analysis to their patient’s story. The curriculum concluded with a group reflection session, where students unpacked personal biases that patient stories have challenged and brainstormed around strategies to incorporate the practice of narrative medicine in clinical care and life-long patient advocacy work.In that time period 84 students rotated through the clerkship site, 67 stories were submitted (80%), and 38 (45%) were entered in the EMR. In informal feedback, students shared that the stories allowed them to connect to the reasons they decided to become physicians, at a time when they feared losing this connection due to the high demands on them to learn biomedical and systems processes. Students reflected on the structural forces that influenced their patients’ lives, the barriers and biases their patients faced. Informal conversations from the broader healthcare community, including faculty, nursing, administrative and health educator staff, illustrated how patient narratives allowed them to connect intimately with their patients as people and understand their patients’ values.
Conclusions: This pilot demonstrated that MS3s can play an integral role in re-centering the patient’s story in healthcare while acquiring skills in practicing narrative medicine, applying a structural competency framework, in reflecting on biases in health care. These experiences and skills give our future healthcare providers a foundation for future advocacy for their patients and in the larger healthcare system.