P0564 - Towards a Narrative Medicine Curriculum for Fellows in Hospice and Palliative Medicine

Background/Purpose: Narrative medicine (NM) is a field of practice within the medical humanities that allows its participants to engage with nuanced and challenging topics through a creative medium, and by doing so, be better able to absorb, understand, and be moved by the stories of others. Absorbing the stories of others is also a critical skill within hospice and palliative medicine (HPM), where practitioners are often called upon to help navigate the goals, values, and life-or-death decisions of patients and their families. Given this overlap, narrative medicine could serve as a useful adjunct to the education of HPM physicians-in-training. It is unclear how many HPM fellowship programs are incorporating narrative medicine into their curricula, or if there is a standardized way to do so. The authors surveyed HPM fellowships throughout the United States to find out how many of them practiced narrative medicine, and what their practices looked like.

Methods: We created a survey of 20 quantitative and qualitative questions inquiring about various aspects of a program’s narrative medicine curriculum, such as the stated objectives of the curriculum, how frequently the NM sessions were held, which learners participated in the sessions, and what readings or topics were explored during the sessions. The survey was sent to 151 accredited hospice and palliative medicine fellowship programs in the United States. The creation of the survey and collection of results was done using an online software platform (SurveyMonkey®). We then used qualitative thematic analysis to identify recurring themes and commonalities in the survey responses.

Results: Of the 151 programs queried, we received 15 responses, 13 of which reported having active narrative medicine programs. We found that narrative medicine practice varies widely amongst the fellowship programs, ranging from unstructured open discussion and free journaling, to the more formalized process of using in-class readings and reflective writing to prompt discussion. The respondents also listed a broad range of non-fiction, fiction, poetry, and (less commonly) visual art/media that was explored during the sessions. Some common features between programs included multidisciplinary team member participation in the narrative medicine sessions; the recurrence of certain themes (such as the patient story and death/dying); and the deliberate use of NM as a means of mental and emotional processing, self-care, and bolstering communication skills.

Conclusion: Narrative medicine is being used in HPM educational curricula across the country to develop the humanistic and communication skills necessary for the effective practice of palliative medicine, and to help foster resilience and well-being among learners. Though it is not widespread, the few HPM programs that do practice narrative medicine have generally found that it is met with positive reception by learners.