Clinical teachers' toolbox article: Harnessing narrative medicine to learn from underserved populations

Abstract

Story telling is a fundamental part of human nature. Yet in health care education, there is often a focus on students learning to condense a person's rich, sometimes messy story about their life, into a flat, aseptic, clinical account of a patient's symptoms. 1 While this approach may help learners handle the complexity of symptomatology, it risks losing sight of the story's central character, as the person is transmogrified into 'the patient'. Excessive focus on fact-gathering diminishes the ability to communicate, 2 and adopting this mind-set risks shifting the emphasis of a consultation from relationship to transaction.Engraining a transactional approach to patient interaction may underpin the attrition in empathy seen during undergraduate medical programmes. 3 Stories, be they written, visual or spoken, are a powerful way to learn. Rita Charon, general internist, literary scholar and originator of the field of narrative medicine, 4 described it as 'a commitment to understanding patients' lives, caring for the caregivers and giving voice to the suffering'. 5 The purpose of narrative medicine is threefold: it can reveal patients' perspectives, facilitate self-reflection among learners and provide emotional support to learners. 6 We contend that narrative medicine can be a particularly potent catalyst for meaningful learning about underserved populations and health inequality, be it racism, ageism, gender bias and sexism, heteronormism, colonialism or stigmatised medical conditions. We believe that narrative medicine can add value to the education of all health care professionals-this is of particular relevance when considering underserved communities, since a multidisciplinary approach is recognised as being central to good care for these groups. 7 In this toolbox article, we outline relevant educational theory, offer a structure for teaching using narratives, signpost and showcase recommended resources, outline potential barriers to implementation and offer strategies to mitigate against these.Narrative medicine can be a particularly potent catalyst for meaningful learning about underserved populations and health inequality 2 | TRANSFORMATIVE LEARNING (TL) THEORY Humans are story telling animals who were teaching and learning through stories long before there was any concept of educational