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      Content and outcomes of narrative medicine programmes: a systematic review of the literature through 2019

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          Abstract

          Objectives

          Narrative medicine (NM) incorporates stories into health sciences paradigms as fundamental aspects of the human experience. The aim of this systematic review is to answer the research question: how effective is the implementation and evaluation of NM programmes in academic medicine and health sciences? We documented objectives, content and evaluation outcomes of NM programming to provide recommendations for future narrative-based education.

          Methods

          We conducted a systematic review of literature published through 2019 using five major databases: PubMed, Embase, PsycINFO, ERIC and MedEdPORTAL. Eligible NM programming included textual analysis/close reading of published literature and creative/reflective writing. Qualifying participants comprised individuals from academic medicine and health sciences disciplines. We reviewed and categorised programme goals, content and evaluation activities to assess participant satisfaction and programme efficacy. Two members of the research team assessed the risk of bias, independently screening records via a two-round, iterative process to reach consensus on eligibility.

          Results

          Of 1569 original citations identified, we selected 55 unique programmes (described in 61 records). In all, 41 (75%) programmes reported a form of evaluation; evaluation methods lacked consistency. Twenty-two programmes used quantitative evaluation (13 well described), and 33 programmes used qualitative evaluation (27 well described). Well-described quantitative evaluations relied on 32 different measures (7 validated) and showed evidence of high participant satisfaction and pre-post improvement in competencies such as relationship-building, empathy, confidence/personal accomplishment, pedagogical skills and clinical skills. An average of 88.3% of participants agreed or strongly agreed that the programme had positive outcomes. Qualitative evaluation identified high participant satisfaction and improvement in competencies such as relationship-building, empathy, perspective-taking/reflection, resilience and burnout detection/mitigation, confidence/personal accomplishment, narrative competence, and ethical inquiry.

          Conclusion

          Evaluation suggests that NM programming leads to high participant satisfaction and positive outcomes across various competencies. We suggest best practices and innovative future directions for programme implementation and evaluation.

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          Most cited references96

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          Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis

          A meta-analysis was conducted of the prevalence rates of compassion satisfaction, compassion fatigue and burnout to identify the factors influencing these rates.
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            Personal illness narratives: using reflective writing to teach empathy.

            Reflective writing is one established method for teaching medical students empathetic interactions with patients. Most such exercises rely on students' reflecting upon clinical experiences. To effectively elicit, interpret, and translate the patient's story, however, a reflective practitioner must also be self-aware, personally and professionally. Race, gender, and other embodied sources of identity of practitioners and patients have been shown to influence the nature of clinical communication. Yet, although medical practice is dedicated to examining, diagnosing, and treating bodies, the relationship of physicians to their own physicality is vexed. Medical training creates a dichotomy whereby patients are identified by their bodies while physicians' bodies are secondary to physicians' minds. As a result, little opportunity is afforded to physicians to deal with personal illness experiences, be they their own or those of loved ones. This article describes a reflective writing exercise conducted in a second-year medical student humanities seminar. The "personal illness narrative" exercise created a medium for students to elicit, interpret, and translate their personal illness experiences while witnessing their colleagues' stories. Qualitative analysis of students' evaluation comments indicated that the exercise, although emotionally challenging, was well received and highly recommended for other students and residents. The reflective writing exercise may be incorporated into medical curricula aimed at increasing trainees' empathy. Affording students and residents an opportunity to describe and share their illness experiences may counteract the traditional distancing of physicians' minds from their bodies and lead to more empathic and self-aware practice.
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              Narrative medicine as a medical education tool: A systematic review

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                26 January 2020
                : 10
                : 1
                : e031568
                Affiliations
                [1 ] Boston University School of Medicine , Boston, Massachusetts, USA
                [2 ] Boston University School of Public Health , Boston, Massachusetts, USA
                Author notes
                [Correspondence to ] Dr Ellen Childs; echilds@ 123456bu.edu
                Author information
                http://orcid.org/0000-0002-0130-0326
                Article
                bmjopen-2019-031568
                10.1136/bmjopen-2019-031568
                7045204
                31988222
                9108e657-0f7e-43f7-a4a9-9e6b8eab8bcd
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 09 May 2019
                : 23 November 2019
                : 02 December 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000968, American Heart Association;
                Award ID: 18SFRN34110082
                Award ID: 18SFRN34150007
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: P50HL120163
                Award ID: R01 HL092577
                Award ID: R01 HL126136
                Award ID: R01 HL128914
                Award ID: R01HL141434
                Award ID: U54HL120163
                Funded by: FundRef http://dx.doi.org/10.13039/100000867, Robert Wood Johnson Foundation;
                Award ID: Studying mHealth technologies to help people impro
                Funded by: FundRef http://dx.doi.org/10.13039/100006474, Columbia University;
                Award ID: 2018-2019 Narrative Medicine Fellowship: ‘Peer-l
                Categories
                Medical Education and Training
                1506
                1709
                Original research
                Custom metadata
                unlocked

                Medicine
                medical education and training,medical ethics,education and training (see medical education & training)

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