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The Classroom as Clinical Laboratory: Reflections on Community-Based Participatory Narrative Medicine by Jonathan Chou and Ianthe Schepel

We’re Jonathan Chou and Ianthe Schepel, medical students in Los Angeles and Oxford, respectively. We graduated from Columbia University’s master’s program in Narrative Medicine in 2015, and over the last three years, we’ve been developing a new model of narrative medicine practice called “community-based participatory narrative medicine” (CBPNM). In CBPNM, patients and other community members participate alongside healthcare providers and trainees as colleagues and equal stakeholders in medical education.

Here are some of the lessons we’ve learned along the way:

Lesson #1: Medical school curricula related to the health humanities are in need of an evaluation overhaul.

When operationalized in medical school curricula, the health humanities (including narrative medicine) serve to expose medical students to those aspects of medicine traditionally thought of as falling outside the realm of the biomedical sciences. What often gets said is something like this: to the extent that they foster clinical acumen, empathy, and professional identity formation, these kinds of curricula can make medical students better clinicians. Whether or not this is true, the more pertinent issue seems to be that such a statement is extremely difficult to prove.

What we’ve come to realize is that this may have something to do with how we conceptualize the relationship between the classroom and the clinic in medical education. We want to show that health humanities curricula “work,” but unlike basic science knowledge or clinical skills, the effects of health humanities training (mostly related to how medical students interact with patients) do not translate so simply between the classroom and the clinic.

Lesson #2: Involving patients in health humanities curricula has evaluative potential.

Health humanities curricula, which are concerned with lived experiences and the sociocultural dimensions of illness and health, offer unique opportunities for patients to be involved in medical education as whole persons. What does this do to medical students’ experiences of health humanities curricula? What effects do these curricula have on patients? These questions inspired us to design a novel narrative medicine workshop format for groups comprised of medical students and patients living with HIV, and ultimately led us to develop the “community-based participatory narrative medicine” model.

We found that involving patients in narrative medicine workshops allowed us to directly characterize the knowledge and skills medical students gained related to communication and alliance building with patients. This is not the same as saying that medical students gained clinically meaningful skills, but it does mean that our workshops resulted in real and observable patient effects.

Ultimately, involving patients in health humanities curricula has the potential to disrupt the usual dichotomy between the classroom and the clinic, medical schools and local communities. The classroom becomes a kind of clinical laboratory, where key clinical concepts like the physician-patient relationship and patient empowerment can potentially be modeled and evaluated.

Rad Resources:

  • The 2016 Vancouver Statement outlines nine priorities for patient and public involvement in medical education.
  • Rishi Goyal’s interview offers an accessible introduction to narrative medicine.

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