The Necessity of Narrative: Linking Literature and Health Care in Higher Education Curricula

By Essary, Alison C.; Lussier, Mark | Forum on Public Policy: A Journal of the Oxford Round Table, Spring 2014 | Go to article overview

The Necessity of Narrative: Linking Literature and Health Care in Higher Education Curricula


Essary, Alison C., Lussier, Mark, Forum on Public Policy: A Journal of the Oxford Round Table


Introduction

Between 2013 and 2015, medical education will undergo two significant shifts in the admissions process. First, the Medical College Admissions Test (MCAT) will change in 2015, the most significant overhaul since 1991 (Brenner, 2013). The MCAT includes two revised sections that evaluate competencies in the humanities and social science, and social and cultural determinants of health (Kirch, Mitchell, Ast, 2013). One of the signals for revision was the emphasis on the triple aim in health care systems: the provision of high-quality health care for individuals, improving population health, and reducing overall health care costs (Mahon, Henderson, Kirch, 2013). Team-based care, interprofessionalism, cultural competence, and communication are vital to the success of the triple aim. Integrating these concepts early helps solidify success, yet all medical schools are challenged with limitations in time, space and human resources (Mahon, Henderson, Kirch, 2013).

Second, in an effort to assess the overall preparation of medical school matriculants, the Association of American Medical Colleges (AAMC) recommended a shift to holistic admissions, or holistic review (Mahon, Henderson, Kirch, 2013). In 2013, there were 48,010 applicants to allopathic medical school in the U.S. Of those, 21,070 were accepted and 20,055 matriculated (AAMC, 2013). Given the breadth and depth of the changes in the applications and admissions processes, medical schools are pressured to identify future physicians who will best meet the needs of the U.S. patient population. Further challenging the traditional health care paradigm is the momentum to incorporate interprofessionalism, systems thinking, and patient safety and quality improvement. Through holistic review, medical schools may be more effective in evaluating candidate professionalism, communication and patient-physician interaction. Another purpose of holistic review is to enhance population health through a more diverse health care pipeline (Mahon, Henderson, Kirch, 2013).

Narrative medicine integrates these competencies while enriching the experience for both the patient and (future) physician. Thus, modifications in the MCAT and holistic review serve as a sign for a shift in direction by governing boards and as a springboard for discussion on innovative curricular methods to better prepare medical and health professionals, to identify competencies necessary to prepare students for success in medicine and health professions, and to assess critically the importance of humanities within medical practices and for long-term health.

Integrating Humanities in Medicine

Narrative medicine can be used to integrate themes in medical humanities with professionalism, self-assessment, and patient safety and quality improvement. Narrative medicine illustrates the experience shared by a patient with his/her physician or health care provider (Charon, 2001). The narrative is a source of information, but also a method of establishing trust, intimacy, and reflection (Charon, 2001; Ofri, 2014). If established properly, the relationship leads to diagnostic and therapeutic breakthroughs; if not, the relationship may be viewed as transactional in nature and thus, not as rich or meaningful. Narrative relationships may also be shared between the physician-self, physician-colleague, and physician-public (Charon, 2001). Introducing concepts in narrative medicine within didactic coursework (i.e. medical ethics) but exploring other relationships throughout the medical education continuum provides medical educators the opportunity to continually revisit patient safety, professionalism and team-based practice (see Table 1).

As reflected in the published research, the separation between medicine and the humanities recently bridged was actually an already established entrant into what became a broader split between the sciences and the humanities, with the former growing in complexity across the 19th Century (Simon 2012). …

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