Abstract
BackgroundSocial context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work.MethodsFrom 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1–15 months from the experience.Results46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine.ConclusionsHTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact.
Highlights
Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training
Our aims were first to understand how in-depth social medicine consultations conducted by first-year internal medicine (IM) residents for medically and socially complex patients might impact residents’ knowledge, skills, attitudes and subsequent practice of social medicine; and, second, to evaluate whether the narrative process of eliciting, listening, writing and reflecting on social context enhanced connection to complex patients, and fostered meaning in work
Healing Through History (HTH) social medicine consultations Forty-nine first-year internal medicine and preliminary residents participated in the curriculum during the 2017–2018 and 2018–2019 academic years, constituting 70% of the categorical IM program
Summary
Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Social medicine techniques, including the use of qualitative interviews and the formulation of individualized care plans, provide the raw Bradley et al BMC Medical Education (2021) 21:95 care, which consists of “joy and meaning in work”: the idea that when those working in a health care system find joy, a sense of accomplishment, and belief in the importance of their daily work, they are more engaged and better equipped to collaborate in providing daily patient care [6] This notion of meaning in work has emerged as an increasing focus of international health systems dialogues about workforce wellness, engagement and patient care outcomes [1, 2, 6].
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