Joel Bradley1,2,3, David Styren4,5, Abigail LaPlante6,7, John Howe4,8, Sienna R Craig7, Emily Cohen9,10. 1. White River Junction VA Medical Center (10E2E), 215 N Main Street, White River Junction, VT, 05009, USA. Joel.M.Bradley@Hitchcock.org. 2. Geisel School of Medicine at Dartmouth, Hanover, NH, USA. Joel.M.Bradley@Hitchcock.org. 3. Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA. Joel.M.Bradley@Hitchcock.org. 4. Dartmouth Hitchcock Internal Medicine Residency Program, Lebanon, NH, USA. 5. Department of Medicine, The Elliot Hospital, Manchester, NH, USA. 6. Tufts University School of Medicine, Boston, MA, USA. 7. Dartmouth College Department of Anthropology, Hanover, NH, USA. 8. Pulmonary & Critical Care Medicine Fellowship, University of Michigan, Ann Arbor, MI, USA. 9. White River Junction VA Medical Center (10E2E), 215 N Main Street, White River Junction, VT, 05009, USA. 10. Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Abstract
BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work. METHODS: From 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1-15 months from the experience. RESULTS: 46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine. CONCLUSIONS: HTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact.
BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work. METHODS: From 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1-15 months from the experience. RESULTS: 46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine. CONCLUSIONS: HTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact.
Entities:
Keywords:
Co-production; Meaning in medicine; Narrative medicine; Social determinants of health; Social medicine
Authors: Seth M Holmes; Helena Hansen; Angela Jenks; Scott D Stonington; Michelle Morse; Jeremy A Greene; Keith A Wailoo; Michael G Marmot; Paul E Farmer Journal: N Engl J Med Date: 2020-03-19 Impact factor: 91.245
Authors: Marie C Haverfield; Aaron Tierney; Rachel Schwartz; Michelle B Bass; Cati Brown-Johnson; Dani L Zionts; Nadia Safaeinili; Meredith Fischer; Jonathan G Shaw; Sonoo Thadaney; Gabriella Piccininni; Karl A Lorenz; Steven M Asch; Abraham Verghese; Donna M Zulman Journal: J Gen Intern Med Date: 2020-01-09 Impact factor: 5.128