Survivors’ stories are the teacher: Narrative mapping and survivorship care plans as educational innovation for pre-clerkship medical students.

Abstract

90 Background: The IOM’s recommendation for Survivorship Care Plans (SCPs) has met slow adoption, further hampered by growth in survivorship. Inviting patients into SCP creation supports individualized care goals. Narrative mapping is a visual tool to navigate challenging communicative landscapes. We describe an educational innovation that values SCP completion, engages physicians & trainees to solicit patient narrative, and allows emergence of collaborative care. We hypothesized it is feasible to: provide preclerkship medical students “legitimate peripheral participation” via meaningful use of the electronic health record (EHR) to review an individual patient’s cancer history; engage survivors and learners through narrative mapping to improve the SCP process; provide a student-prepared, clinician/survivor vetted SCP, leveraging UME in support of survivors’ needs. Methods: 170 second-year students at the Uniformed Services University were invited to enroll in a pilot curriculum on cancer survivorship. Oncology providers identified patients without an SCP and interested in sharing their stories since time of diagnosis. Survivors and students (in separate 90 min workshops) created and shared drawn maps of personal health stories. Students received EHR training to inform use of the ASCO SCP template for an assigned survivor. Following student-survivor review of survivors’ narrative maps, triads (student-survivor-oncologist) met to finalize SCPs for EHR upload. Results: Over three months, 18 medical students drafted an SCP on behalf of an assigned survivor. 19 survivors received an SCP following creation and sharing of their narrative map. Post-pilot, 95% of participating students submitted written reflections (uniformly positive) and survivors requested to remain involved in UME, finding meaning in sharing their stories. Conclusions: Survivors are enthusiastic educational partners in complex care environments. It is feasible to engage medical students with cancer survivors to create SCPs, with narrative mapping as a contextualizing approach. UME learning needs dovetail with those of survivors to address the call for SCP adoption.