When it\u2019s needed most: a blueprint for resident creative writing workshops during inpatient rotations

Malathi Srinivasan,Matthew Stevenson,Yeuen Kim,Lauren Michelle Edwards,Nora Sharp,Tyler Johnson,Anna Reisman

doi:10.1186/s12909-021-02935-x

Abstract

BackgroundNarrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.ObjectiveTo evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.MethodsWe developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford’s busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1–7; 3–4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017–2018, weeks 1 and 4), and implementation year (2018–2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.ResultsResidents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.ConclusionsInpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.

Highlights

Narrative medicine has been shown to mitigate physician burnout – emotional exhaustion, depersonalization, feelings of reduced accomplishments – by increasing personal resiliency [1, 2] In narrative medicine workshops, participants are exposed to literary techniques, and guided to write about their own and their patient’s experiences in response to themes, using interpretive literary techniques
We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford’s busiest and emotionally-demanding inpatient rotation
Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years

Summary

Introduction

Narrative medicine has been shown to mitigate physician burnout – emotional exhaustion, depersonalization, feelings of reduced accomplishments – by increasing personal resiliency [1, 2] In narrative medicine workshops, participants are exposed to literary techniques, and guided to write about their own and their patient’s experiences in response to themes, using interpretive literary techniques. Narrative Medicine techniques may increase physician empathy and self-compassion [3], encourage physicians to better connect with their patients’ stories, and even act on their behalf [3,4,5]. Narrative medicine workshops have been difficult to implement on hectic inpatient teaching services, especially during time-intensive and emotionally demanding services, when, arguably, they are most needed [7,8,9]. Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents

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Conclusion