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Editor: Danielle SimpsonPerformance at a glance button

Narrative-Based Medicine: A Frontier in Medical Education

By Dr. Michael Roberts

The Stethoscope
By Danny Abse

            Through it,
over young women's tense abdomens,
I have heard the sound of creation
and, in a dead man's chest, the silence
  before creation began.

            Should I
pray therefore? Hold this instrument in awe
and aloft a procession of banners?
Hang this thing in the interior
  of a cold, mushroom-dark church . . .

Medical education is excellent at teaching scientific content but what about the capacity to reflect on practice? The term reflective practitioner was coined by Donald Schon to connote training of health professionals that links the subjective (feelings) with the objective (theories) in order to build new insight and informed action in a situation AS it is unfolding. As family physicians we are called to perform this act every day with every patient encounter. How do we effectively teach this to our medical learners?
Narrative-based medicine is “clinical practice fortified by narrative competence—the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness.” Simply, it is medicine practiced by someone who knows what to do with stories.’1

The three elements of narrative-based medicine are attention, representation, and affiliation.

By teaching our learners to pay attention to our patient’s stories, not only with a diagnosis in mind, but with narrative humility, we are encouraging reflection. By encouraging our students to read short stories and poems such as Abse’s The Stethoscope, we create a powerful sense of attentiveness to language, detail and nuance that can have a profound impact on empathy and self-reflection.

Asking our learners to represent their clinical experience through writing in journals or portfolios aids in further metabolizing critically important clinical encounters that might have otherwise have been forgotten or shelved. The act of written representation may assist in stimulating insights into experiences that have the possibility of linking head and heart.

Finally and most importantly, creating a safe space for meeting to discuss our representations allows our learners and our selves to be moved by what we have heard, seen and felt. Creating this space for affiliation enables our role as a teacher/ facilitator/ mentor and fellow traveller to be truly enacted.

Some simple suggestions for teaching: propose some of your favourite short stories, poetry or movies for learners to read or watch. Talk about them and how they may relate to their emerging life of becoming a physician. Encourage students to write about a meaningful or difficult clinical encounter and create a safe space to read their writing to one another.

Anyone interested in Narrative Medicine will find Rita Charon's upcoming lecture in Toronto a kick-start to their literacy in this exciting new field of medical education. She is the living holy grail in the field and besides she's engaging, challenging and fun.

Any DFCM faculty interested in further collaborating in the new frontier of narrative-based medicine in Canada may contact me, Dr. Michael Roberts or Dr. Allan Peterkin.      

Charon R. What to do with stories. Canadian Family Physician, August 2007, 1265-1267.

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