Institute for Professionalism Inquiry

Family Medicine Department 2008/2009

This course is required for all PGY 2 residents in Family Medicine and has been conducted for three consecutive years. All residents, faculty, and nurses are invited to participate in the course. In most sessions, several faculty members attend and occasionally some of the nursing staff are able to attend. The course was developed and taught for the first two years by the Institute for Professionalism Inquiry (IPI) at Summa Health System. In the current year, the third year of the course, faculty members in the department have assumed the teaching with minor support from the IPI.

The course consists of a four-hour workshop to start the year and that is followed by bi-monthly one-hour session for the remainder of the academic year. In the workshop we introduce the concept and practices of narrative health care and through participatory exercises participants get a flavor of the various skills that are covered throughout the course. The course sessions are organized by four key narrative situations: patient & physician; practitioner & self; practitioner & colleagues; practitioner & community. The sessions consist of required readings and participatory exercises that introduce and/or reinforce critical narrative skill sets: practicing compassionate presence & mindful listening; exercising moral imagination & practicing empathy; reading & interpreting complex texts; writing reflectively & telling complex stories; reasoning with stories & engaging in narrative ethics. Each year a formative evaluation is conducted and used to modify the programs for the upcoming year. In this context, we administer a series of psychometric measures, several in a pre- post format, to the residents. What follows is an abbreviated outline of the course workshop and sessions.

For more information please contact

• Lura Pethtel
• John Engel
• Joseph Zarconi
• Sally Missimi

Introductory Workshop - August 2008

Readings

Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001; 286(15): 1897-1902.

Greenhalgh T. and Hurwitz B. Why study narrative? In T. Greenhalgh and B. Hurwitz (eds.), Narrative Based Medicine. London, UK: BMJ Books, 1998.

Launer J. New stories for old: narrative-based primary care in Great Britain. Families, Systems & Health. 2006; 24(3): 336-344.

Launer J. Narrative and primary care. In J. Launer, Narrative-based Primary Care: a practical guide. London, UK: Radcliffe Medical Press, 2002.

Rumi J. The Guest House. In C. Barks, The Essential Rumi. San Francisco, CA: Harper, 1995.

Shapiro J. The use of narrative in the doctor-patient encounter. Family Systems Medicine. 1993; 11(1): 47-53.

Session Outlines

* Assigments to be completed prior to session.

Readings

Bjeridie D et al. Just say Om. Time. August 4, 2003: 49-56.

Borkan J, Reis S, Steinmetz D, and Medalie JH eds. Patients and Doctors: Life-changing stories from primary care. University of Wisconsin Press, 1999. The following stories are used from this collection: The Alternative Cancer Patient; Restoring the Soul; Melanie: The Path to Admiration; Appearances; "Olga": A Quadriplegic and Living Alone.

Brody H. "My Story Is Broken; Can You Help Me Fix It?" Medical ethics and joint construction of narrative. Literature and medicine. 1994; 13(1):79-92.

Brody H. A matter of influence. Health Affairs. 2002; 21(2): 232-34.

Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001; 286(15): 1897-1902.

Combs G and Freedman J. Relationships, not boundaries. Theoretical Medicine. 2002; 23: 203-17.

Connelly JE. Being in the present moment: developing the capacity for mindfulness in medicine. Academic Medicine. 1999; 74(4): 420-24.

Connelly JE. The other side of professionalism: doctor-to-doctor. Cambridge Quarterly of healthcare Ethics. 2003; 12: 178-83.

Coulehan J. I witness, I serve: medicine as community. In: Proceedings of the Fourth Humanism and the Healing Arts Conference. Institute for Professionalism Inquiry. Akron, OH: Summa Health System; 2006.

Coulehan J, Williams PC, McCary SV and Belling C. The best lack all conviction: biomedical ethics, professionalism, and social responsibility. Cambridge Quarterly of Healthcare Ethics. 2003; 12: 21-38.

Donnelly WJ. Righting the medical record: transforming chronicle into story. JAMA. 1988; 260(6): 823-25.

Engel J et al. Narrative in Health Care: healing patients, practitioners, profession, and community. Oxford: Radcliffe Press, 2008.

Epstein RM. Mindful practice. JAMA. 1999; 282(9): 833-39.

Frank AW. The painter and the cameraman: boundaries in clinical relationships. Theoretical Medicine. 2002; 23:219-32.

Gawandi A. When doctors make mistakes. In A Gawandi, Complications: A surgeon's notes on an imperfect science. Holt & Company, 2002; 47- 74.

Hardingham LB. Integrity and moral residue: nurses as participants in a moral community. Nursing Philosophy. 2004; 5: 127-34.

Hilfiker D. Facing our mistakes. NEJM. 1984; 310(1): 118-22.

Hurwitz B. Form and representation in clinical case reports. Literature and Medicine. 2006; 25(2): 216-240.

Hurwitz B. Narrative and the practice of medicine. The Lancet. 2000; 356: 2086-89.

Jung P. No free lunch. Health Affairs. 2002; 21(2): 226-31.

Lamb M. Management. In T. Savitt ed., Medical Readers' Theater: a guide and scripts. University of Iowa Press, 2002; 178-87.

Launer J. New stories for old: narrative-based primary care in Great Britain. Families, Systems & Health. 2006; 24(3): 336-344.

McElroy A and Jezewski MA. Cultural variation in the experience of health and illness. In GL Albrecht, R Fitzpatrick and Scrimshaw, SC eds. The Handbook of Social Studies in Health & Medicine. Sage, 2000.

Novack DH, et al. Calibrating the physician: personal awareness and effective patient care. JAMA. 1997; 278(6): 502-09.

Ofri D. M & M. In D. Ofri, Singular Intimacies. Penguin Books, 2003; 199-207.

Selzer R. Brute. In R. Selzer, Letters to a Young Doctor. Simon and Schuster, 1982.

Shapiro J. The use of narrative in the doctor-patient encounter. Family Systems Medicine. 1993; 11(1): 47-53.

Stone J. Gaudeamus Igitur. In R Reynolds and J Stone, eds. On Doctoring: stories, poems, essays. Simon & Schuster, 2001; 281-85.

Tolstoy L. The Death of Ivan Ilyich. Adapted as a readers' theater by Lura Pethtel and John D. Engel from The Death of Ivan Ilyich and Master of Man by Leo Tolstoy, translated by Ann Pasternak Slater. Modern Library, a division of Random House. 2003.

Verghese A. The calling. NEJM. 2005; 352(18): 1844-47.

Weinberg RB. Communion. In M. A. LaComb ed. On Being a Doctor 2: voices of physicians and patients. ACP, 2000.