Combating ageism in medical education with narrative medicine.

Ageism is common in medical trainees and difficult to overcome. The My Life, My Story program has been shown to be an effective tool for increasing empathy. We explored its use as an instrument for combating ageism by implementing it in a Geriatrics clerkship for fourth year medical students. During our evaluation, 151 students interviewed patients about their lives using a semi-structured question guide. Students completed the UCLA Geriatrics Attitudes Scale and the Expectations Regarding Aging Survey pre-and post-clerkship. We also facilitated 9 student debriefs and 5 faculty interviews. After completing My Life, My Story, students were more likely to disagree with "I would rather see younger patients than elderly ones" and "it's normal to be depressed when you are old". In qualitative analysis of the debriefs, we identified a key summative theme: "impact of the intervention on care teams". Within that, we describe three subthemes: an awareness of richness of the lives led by older people, their current value to society, and the social determinants of health they have faced. After participating in My Life, My Story, students' attitudes toward aging changed. A narrative medicine program using life stories can be a practical tool for addressing ageist stereotypes.

Content and outcomes of narrative medicine programmes: a systematic review of the literature through 2019.

OBJECTIVES: Narrative medicine (NM) incorporates stories into health sciences paradigms as fundamental aspects of the human experience. The aim of this systematic review is to answer the research question: how effective is the implementation and evaluation of NM programmes in academic medicine and health sciences? We documented objectives, content and evaluation outcomes of NM programming to provide recommendations for future narrative-based education. METHODS: We conducted a systematic review of literature published through 2019 using five major databases: PubMed, Embase, PsycINFO, ERIC and MedEdPORTAL. Eligible NM programming included textual analysis/close reading of published literature and creative/reflective writing. Qualifying participants comprised individuals from academic medicine and health sciences disciplines. We reviewed and categorised programme goals, content and evaluation activities to assess participant satisfaction and programme efficacy. Two members of the research team assessed the risk of bias, independently screening records via a two-round, iterative process to reach consensus on eligibility. RESULTS: Of 1569 original citations identified, we selected 55 unique programmes (described in 61 records). In all, 41 (75%) programmes reported a form of evaluation; evaluation methods lacked consistency. Twenty-two programmes used quantitative evaluation (13 well described), and 33 programmes used qualitative evaluation (27 well described). Well-described quantitative evaluations relied on 32 different measures (7 validated) and showed evidence of high participant satisfaction and pre-post improvement in competencies such as relationship-building, empathy, confidence/personal accomplishment, pedagogical skills and clinical skills. An average of 88.3% of participants agreed or strongly agreed that the programme had positive outcomes. Qualitative evaluation identified high participant satisfaction and improvement in competencies such as relationship-building, empathy, perspective-taking/reflection, resilience and burnout detection/mitigation, confidence/personal accomplishment, narrative competence, and ethical inquiry. CONCLUSION: Evaluation suggests that NM programming leads to high participant satisfaction and positive outcomes across various competencies. We suggest best practices and innovative future directions for programme implementation and evaluation.

Visionary medicine: speculative fiction, racial justice and Octavia Butler's 'Bloodchild'.

Medical students across the USA have increasingly made the medical institution a place for speculating racially just futures. From die-ins in Fall 2014 to silent protests in response to racially motivated police brutality, medical schools have responded to the public health crisis that is racial injustice in the USA. Reading science fiction may benefit healthcare practitioners who are already invested in imagining a more just, healthier futurity. Fiction that rewrites the future in ways that undermine contemporary power regimes has been termed 'visionary fiction'. In this paper, the authors introduce 'visionary medicine' as a tool for teaching medical students to imagine and produce futures that preserve health and racial justice for all. This essay establishes the connections between racial justice, medicine and speculative fiction by examining medicine's racially unjust past practices, and the intersections of racial justice and traditional science and speculative fiction. It then examines speculative fiction author Octavia Butler's short story 'Bloodchild' as a text that can introduce students of the medical humanities to a liberatory imagining of health and embodiment, one that does not reify and reinscribe boundaries of difference, but reimagines the nature of Self and Other, power and collaboration, agency and justice.