Article Text
Abstract
Objectives Narrative medicine (NM) incorporates stories into health sciences paradigms as fundamental aspects of the human experience. The aim of this systematic review is to answer the research question: how effective is the implementation and evaluation of NM programmes in academic medicine and health sciences? We documented objectives, content and evaluation outcomes of NM programming to provide recommendations for future narrative-based education.
Methods We conducted a systematic review of literature published through 2019 using five major databases: PubMed, Embase, PsycINFO, ERIC and MedEdPORTAL. Eligible NM programming included textual analysis/close reading of published literature and creative/reflective writing. Qualifying participants comprised individuals from academic medicine and health sciences disciplines. We reviewed and categorised programme goals, content and evaluation activities to assess participant satisfaction and programme efficacy. Two members of the research team assessed the risk of bias, independently screening records via a two-round, iterative process to reach consensus on eligibility.
Results Of 1569 original citations identified, we selected 55 unique programmes (described in 61 records). In all, 41 (75%) programmes reported a form of evaluation; evaluation methods lacked consistency. Twenty-two programmes used quantitative evaluation (13 well described), and 33 programmes used qualitative evaluation (27 well described). Well-described quantitative evaluations relied on 32 different measures (7 validated) and showed evidence of high participant satisfaction and pre-post improvement in competencies such as relationship-building, empathy, confidence/personal accomplishment, pedagogical skills and clinical skills. An average of 88.3% of participants agreed or strongly agreed that the programme had positive outcomes. Qualitative evaluation identified high participant satisfaction and improvement in competencies such as relationship-building, empathy, perspective-taking/reflection, resilience and burnout detection/mitigation, confidence/personal accomplishment, narrative competence, and ethical inquiry.
Conclusion Evaluation suggests that NM programming leads to high participant satisfaction and positive outcomes across various competencies. We suggest best practices and innovative future directions for programme implementation and evaluation.
- medical education and training
- medical ethics
- education and training (see medical education & training)
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Footnotes
CDR and EC contributed equally.
Contributors The authors have made substantial contributions to the manuscript materials as follows: CDR engaging in the conceptualisation and design of the work—and in the acquisition, analysis and interpretation of data. Drafting and critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. EC engaging in the conceptualisation and design of the work—and in the acquisition, analysis and interpretation of data. Drafting and critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. JCP engaging in the conceptualisation and design of the work—and in the acquisition, analysis and interpretation of data. Drafting and critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. LT engaging in the conceptualisation and design of the work—and in the analysis and interpretation of data. Critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. DBF engaging in the conceptualisation and design of the work—and in the acquisition and analysis of data. Critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. SLW engaging in the interpretation of data. Critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. RMB engaging in the interpretation of data. Critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. LBD engaging in the interpretation of data. Critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved. EB engaging in the conceptualisation and design of the work—and analysis and interpretation of data. Critically revising the manuscript in regard to significant intellectual content. Giving final approval to the version of the work submitted for publication. Agreeing to be held accountable for all aspects of the work, including ensuring that any inquiries related to the accuracy and/or integrity of the work are appropriately investigated and resolved.
Funding This research was supported by the: National Institutes of Health (NIH) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) Award Numbers P50HL120163 and U54HL120163-06. NIH/NHLBI Award Numbers R01HL141434, 5R01HL128914, R01HL126136 and R01HL092577. American Heart Association (AHA) Award Numbers 18SFRN34110082 and 18SFRN34150007. Robert Wood Johnson Foundation Grant 74624: ‘Studying mHealth technologies to help people improve their health and share their health information in real time with health care providers’. Columbia University 2018–2019 Narrative Medicine Fellowship: ‘Peer-led Narrative Medicine Workshops for First and Second Year Medical Students’ (US$2000 awarded to BU medical student John Carlo Pasco, coauthor).
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Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.