Abstract
A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore the experience of illness from the patient’s perspective and ultimately to incorporate this perspective in clinical practice. In this qualitative study, we wished to investigate the impact of “diabetes stories”—the stories of FCE volunteers with diabetes—on medical students’ understanding of diabetes and its management. Individual interviews were conducted with medical students who had worked with a volunteer with diabetes to answer the questions: “in what ways was learning through these ‘diabetes stories’ different from that acquired through lectures and textbooks,” and “how did these stories impact the students’ understanding of diabetes and its care?” Thematic analysis of the transcribed interviews was performed using Grounded Theory. Several major themes emerged: There was more to diabetes than the “scientific” knowledge acquired through lectures; the stories challenged students’ assumptions about having or working with people with diabetes and allowed students to see the world through the perspective of someone with diabetes, and the stories motivated students’ development as physicians and influenced their general perspectives of doctoring and medicine. First-person narratives of living with diabetes allow for learning in affective, experiential, and cognitive dimensions, stimulate self reflection and perspective-taking, and enhance growth through the challenging of previous assumptions, beliefs, and perspectives. This type of learning is transformative and may result in a shift in students’ perspectives towards more open, inclusive attitudes towards patient-centered diabetes care.
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References
Anderson, R. M. (1986). The personal meaning of having diabetes: Implications for patient behaviour and education or kicking the bucket theory. Diabetic Medicine, 3, 85–89.
Branch, W. T., Jr., Pels, R. J., & Hafler, J. P. (1998). Medical students’ empathic understanding of their patients. Academic Medicine, 73, 360–362. doi:10.1097/00001888-199804000-00007.
Charon, R. (2001). Narrative medicine: Form, function, and ethics. Annals of Internal Medicine, 134, 83–87.
Cohen, M. Z., Tripp-Reimer, T., Smith, C., Sorofman, B., & Lively, S. (1994). Explanatory models of diabetes: Patient practitioner variation. Social Science & Medicine, 38, 59–66. doi:10.1016/0277-9536(94)90300-X.
Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, Ca: Sage Publications.
Duggan, P. S., Geller, G., Cooper, L. A., & Beach, M. C. (2006). The moral nature of patient-centeredness: Is it “just the right thing to do”? Patient Education & Counseling, 62, 271–276. doi:10.1016/j.pec.2005.08.001.
Freeman, J., & Loewe, R. (2000). Barriers to communication about diabetes mellitus. Patients’ and physicians’ different view of the disease. Journal of Family Practice, 49, 507–512.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory; strategies for qualitative research. Chicago: Aldine Pub. Co.
Greiner, A., & Knebel, E. (Eds.). (2003). Institute of medicine. Health professions education: A bridge to quality. Washington, DC: National Academies Press.
Habermas, J. (1990). Moral consciousness and communicative action. Cambridge, Mass: MIT Press.
Hoffman, M. L. (2000). Empathy and moral development: Implications for caring and justice. New York: Cambridge University Press.
Kegan, R. (2000). What “form” transforms? In J. Mezirow (Ed.), Learning as transformation: Critical perspectives on a theory in progress (pp. 35–70). San Francisco: Jossey-Bass.
Kleinman, A. (1988). The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.
Kohlberg, L. (1981). The philosophy of moral development: Moral stages and the idea of justice. San Francisco: Harper & Row.
Kumagai, A. K. (2008). A conceptual framework for use of illness narratives in medical education. Academic Medicine (in press).
Kumagai, A. K., White, C. B., & Schigelone, A. (2005). The family centered experience: Using patient narratives, student reflections, and discussions to teach about illness and care. Annals of Behavioral Science and Medical Education Journal, 11, 73–78.
Laine, C., & Davidoff, F. (1996). Patient-centered medicine. A professional evolution. The Journal of the American Medical Association, 275, 152–156.
Loewe, R., & Freeman, J. (2000). Interpreting diabetes mellitus: Differences between patient and provider models of disease and their implications for clinical practice. Culture, Medicine & Psychiatry, 24, 379–401. doi:10.1023/A:1005611207687.
Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.
Mezirow, J. (2000). Learning to think like an adult. In J. Mezirow (Ed.), Learning as transformation: Critical perspectives on a theory in progress (pp. 3–34). San Francisco: Jossey-Bass.
Piaget, J. (1985). The equilibration of cognitive structures: The central problem of intellectual development. Chicago: University of Chicago Press.
Ritholz, M. D., & Jacobson, A. M. (1998). Living with hypoglycemia. Journal of General Internal Medicine, 13, 799–804. doi:10.1046/j.1525-1497.1998.00243.x.
Strauss, A. L., & Corbin, J. M. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications.
Wear, D., & Nixon, L. L. (2002). Literary inquiry and professional development in medicine: Against abstractions. Perspectives in Biology & Medicine, 45, 104–124. doi:10.1353/pbm.2002.0019.
Acknowledgments
The authors would like to thank Drs. Casey White, Rachel Perlman and Joseph C. Fantone for many important discussions and the volunteers, students, and faculty of the Family Centered Experience for their efforts. AKK is supported in part by National Institutes of Health Grant RPO60DK-20572, which supports the Michigan Diabetes Research & Training Center.
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Kumagai, A.K., Murphy, E.A. & Ross, P.T. Diabetes stories: use of patient narratives of diabetes to teach patient-centered care. Adv in Health Sci Educ 14, 315–326 (2009). https://doi.org/10.1007/s10459-008-9123-5
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DOI: https://doi.org/10.1007/s10459-008-9123-5