Abstract
For patients at the end of life, it is crucial to address the psychological, existential, and spiritual distress of patients. Medical education research suggests trainees feel unprepared to provide the whole person, humanistic care held as the ideal. This study used an empirically based narrative intervention, the dignity interview, as an educational intervention with first year residents. The interview helps patients tell and make meaning of their life story. The intervention was aimed at addressing trainee perceived gaps in the non-physical aspects of end-of-life care. It was also intended to stimulate broader reflection on lessons learned in medical education about the value of narrative as part of humanistic care. Twelve first year residents administered a 1 h interview to dying patients. The resident returned to read the transcribed story back to the patient. Semi-structured interviews of the residents were transcribed and analyzed using the constant comparative method to identify emergent themes. This experience was seen as distinct from the ‘traditional” medical interview. Residents reflected on lessons learned from patients and on their own professional and personal lives. Residents felt conversations with dying patients, and more broadly the art of soliciting a patient’s story are poorly taught and modeled. More concerning, the hidden curriculum seems to be sending messages that learning a patient’s story is not the domain of a physician and that it is not valued like the curing and technical imperatives. These findings have implications for medical education’s ongoing attempts to better produce humanistic physicians.
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Acknowledgments
The authors would like to thank Drs. Dori Secceracia and Jeff Myers, palliative care physicians, for helping identify patients and residents. Thank you to Dr. Shannon Poppito for providing training in dignity therapy and to Dr. Harvey Chochinov for arranging the training. Thank you to Dr. Lorelei Lingard for her helpful feedback on the paper. Finally, thank you to the patients who shared their lives and allowed us the privilege to learn from their stories. This work was funded by a Royal College of Physicians and Surgeons of Canada Medical Education Research Grant and by the Sociobehavioral Cancer Research Network, with funds received from the National Cancer Institute of Canada.
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Tait, G.R., Hodges, B.D. Residents learning from a narrative experience with dying patients: a qualitative study. Adv in Health Sci Educ 18, 727–743 (2013). https://doi.org/10.1007/s10459-012-9411-y
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DOI: https://doi.org/10.1007/s10459-012-9411-y