Making space for stories: promoting physician and medical student well-being through successful medical education storytelling events.

Storytelling events in medical education settings are a powerful way to share stories, build community, promote resilience, and foster well-being, but many educators are unsure how to go about creating an event. This paper outlines practical tips to empower readers to plan and carry out a successful, impactful storytelling event.

Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions.

Breast cancer poses a significant global health challenge, with Iran experiencing particularly high incidence and mortality rates. Understanding the adaptation process of Iranian breast cancer survivors' post-treatment is crucial. This study explores the health perceptions, barriers, and coping mechanisms of Iranian survivors by integrating Stress-Coping Theory (SCT) and the Health Belief Model (HBM). Semi-structured interviews were conducted with 17 survivors, and a grounded theory approach guided the deductive content analysis of the data. The findings reveal key themes, including perceived susceptibility, benefits, barriers to care, cues to action, self-efficacy, and appraisal of action. Perceived susceptibility highlights diagnostic challenges stemming from practitioner errors and symptom misconceptions. Perceived benefits underscore the importance of early detection and support from healthcare providers and families. Barriers include cultural and financial obstacles, while cues to action reflect the influence of media, family, and personal experiences on healthcare-seeking behavior. The study also examines coping strategies, such as problem-focused and emotion-focused approaches, along with family support and external stressors. To address these barriers and enhance support systems, the study suggests specific strategies for healthcare providers, including targeted training to improve diagnostic accuracy and patient communication. Culturally sensitive awareness campaigns can correct symptom misconceptions, while financial counseling can mitigate economic barriers. Establishing community-based support groups and involving family members in care plans can enhance emotional and psychological support. These strategies aim to overcome the identified barriers and improve support systems for Iranian breast cancer survivors, ultimately fostering better recovery outcomes.

Medical Error: Using Storytelling and Reflection to Impact Resident Error Response Factors.

Introduction: Medical error is common and has a significant impact on physicians, learners, and patients' perception of the medical system; however, residents receive little formal training on this topic. This curriculum aims to foster sharing of personal medical error stories, review and practice error management and coping strategies, and impact error response factors. Methods: Faculty identified factors related to effective physician error management and recovery in order to develop a targeted curriculum for family medicine residents. The curriculum consisted of three 1-hour didactic sessions in a medium-sized, urban program. Instructional methods included guided reflection after mentor storytelling, small-group discussion, role-play, and self-reflection. Results: Twenty-two out of 30 (73%) residents completed the premodule survey, and 15 out of 30 (50%) residents completed the post module survey. Fewer than half of residents reported they knew what to do when faced with medical error, but this increased to 93% after curriculum delivery, as did rates of reported error story sharing. Resident reported self-efficacy (I can be honest about the errors I make as a doctor.) and self-awareness (I acknowledge when I am at increased risk for making errors) also increased following the curriculum. Discussion: Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief curriculum can impact the culture around disclosure and support. Future iterations should focus on the impact of targeted curricular interventions on patient-oriented outcomes related to medical error.

Transforming science communication through storytelling.

Science communication is an important skill. It is easier for nonacademic audiences to remember stories that resonate with their imagination rather than facts and figures. To help early-career researchers develop their skills, the EU-LIFE Science Communications Working Group (SCWG) developed a training course based on the experience from previous workshops held at a research institute in Denmark. The stories crafted in the workshops proved impactful, with some integrated into broader campaigns and featured in science magazines. The initiative holds potential for transformative change, helping researchers promote their findings and increasing awareness of emerging research topics among the public. Recently, the initiative has been customized for a summer school aimed at medical doctors pursuing a PhD, marking a step forward in the SCWG's mission to equip researchers with essential communication skills.

Beyond trauma: a review of content and linguistic characteristics of nontrauma narratives in posttraumatic stress disorder.

Background: Using narratives to reflect on experiences, emotions, and thoughts is associated with better health, enhanced mood, and improved symptoms of posttraumatic stress disorder (PTSD). Prior research examining narrative characteristics thought to reflect cognitive styles associated with PTSD has focused on trauma narratives, but the characteristics of nontrauma narratives in relation to PTSD are not fully understood.Objective: We reviewed the PTSD literature examining linguistic characteristics of nontrauma narratives, focusing on affective content, personal pronouns, and cognitive processing words.Method: We searched online databases for both laboratory and social media studies examining these characteristics of nontrauma narratives in relation to PTSD diagnostic status and/or PTSD symptom severity.Results: Following SWiM guidelines [Campbell et al., 2020. Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. British Medical Journal, 368, l6890], there was moderate evidence for differential use of emotion words in nontrauma narratives in relation to PTSD symptom cluster severity. More severe avoidance/numbing symptoms were associated with greater use of negative emotion words and less use of positive emotion words. Results were mixed for other linguistic elements reviewed.Conclusions: Differential use of emotional language in trauma narratives generalises to nontrauma narratives in individuals with PTSD. Additional research is needed to elucidate the use of personal pronouns and cognitive processing words in nontrauma narratives.

Posttraumatic stress disorder (PTSD) is characterised by negative cognitive styles that not only influence narratives of traumatic events but have the potential to affect the content of narrative generation more broadly.Findings of this synthesised review provided moderate evidence that more severe avoidance/numbing symptoms are related to more negative and fewer positive emotion words in nontrauma narratives.Alterations of narrative content in PTSD extend beyond trauma narratives to nontrauma narratives, which has implications for thinking and communications styles in PTSD.

The Effect of Sampling Context on Preschoolers' Finite Verb Morphology Composite Scores.

PURPOSE: The finite verb morphology composite (FVMC) is a valid measure for charting children's tense development and for differentiating children with and without language impairment during preschool and early elementary years. However, it is unclear whether FVMC scores vary as a function of language sample elicitation contexts. The current study evaluated the performance on FVMC in preschool-aged children across different language sampling contexts. METHOD: Participants were 38 English-speaking children who were between the ages of 3 and 4 years and below the mastery level of tense usage in three language sampling contexts, including conversation (free-play), picture description, and narratives (story retell). FVMC from each sampling context was computed by calculating the overall accuracy of copula be, auxiliary be, third-person singular present -s, and past tense -ed combined. A linear mixed-effects model comparison was carried out to determine the effect of sampling context on FVMC scores. RESULTS: After controlling for child age, mean length of utterance, and the number of obligatory contexts for FVMC scoring, FVMC scores were significantly higher in conversation than in picture description and narratives. In addition, FVMC scores across the three sampling contexts were significantly correlated (rs ≥ .62, p < .001). CONCLUSIONS: Although children's performance on FVMC relative to each other was quite stable across sampling contexts, FVMC scores may vary with sampling contexts. As compared to picture description and narratives, conversation may not adequately capture the limitation in preschoolers' tense development that is important for therapeutic planning.

A Coffee Conversation.

This article uses storytelling, poetry, and findings from a humanbecoming inquiry on sadness to explore a humanuniverse living experience involving change and loss.

Top-down attention shifts behavioral and neural event boundaries in narratives with overlapping event scripts.

Understanding and remembering the complex experiences of everyday life relies critically on prior schematic knowledge about how events in our world unfold over time. How does the brain construct event representations from a library of schematic scripts, and how does activating a specific script impact the way that events are segmented in time? We developed a novel set of 16 audio narratives, each of which combines one of four location-relevant event scripts (restaurant, airport, grocery store, and lecture hall) with one of four socially relevant event scripts (breakup, proposal, business deal, and meet cute), and presented them to participants in an fMRI study and a separate online study. Responses in the angular gyrus, parahippocampal gyrus, and subregions of the medial prefrontal cortex (mPFC) were driven by scripts related to both location and social information, showing that these regions can track schematic sequences from multiple domains. For some stories, participants were primed to attend to one of the two scripts by training them to listen for and remember specific script-relevant episodic details. Activating a location-related event script shifted the timing of subjective event boundaries to align with script-relevant changes in the narratives, and this behavioral shift was mirrored in the timing of neural responses, with mPFC event boundaries (identified using a hidden Markov model) aligning to location-relevant rather than socially relevant boundaries when participants were location primed. Our findings demonstrate that neural event dynamics are actively modulated by top-down goals and provide new insight into how narrative event representations are constructed through the activation of temporally structured prior knowledge.

Exploring Bias in Health Care: Using Art to Facilitate a Narrative Medicine Approach among Third-Year Medical Students.

OBJECTIVES: Teaching medical students about biases in health care poses challenges due to the complexity of modifying preexisting beliefs and the possibility of triggering strong emotional reactions. Narrative medicine fosters reflection and discussion among healthcare providers, and visual thinking strategies (VTS) enable providers to improve diagnostic ability through close and methodical examination of art. This study investigated the effectiveness of a session integrating narrative medicine and VTS to enhance third-year medical students' understanding of bias in health care. METHODS: A 90-minute "Narrative Medicine Rounds" session was implemented in the Family Medicine clerkship for all third-year medical students in the Florida International University Herbert Wertheim College of Medicine class of 2024. The session included a faculty-facilitated discussion of Robert Colescott's painting Emergency Room, an overview of narrative medicine principles, and a sharing of student narratives related to bias experienced in the healthcare setting. After the session, students wrote and submitted their narrative essays. Students also completed an anonymous, optional, computer-based evaluation with Likert-type and free-response questions. Likert questions were analyzed using descriptive statistics. For the short-answer questions, teams of two researchers (D.G. and S.E.S., E.E. and M.S.) analyzed responses for themes and subthemes, met to reach consensus on a codebook through discussion, and recoded data as needed until frequencies of themes were mutually determined. RESULTS: Of 101 students, 87 (86%) provided responses to the Likert questions. Seventy percent of respondents agreed that Robert Colescott's Emergency Room was a useful tool for discussing bias in medicine, whereas 25% were neutral. Fifty-one percent of respondents agreed that the session enhanced their understanding of bias in patient care, with 33% being neutral. Forty-seven percent of respondents agreed that the session made them more familiar with narrative medicine as a tool that they can use in patient care, with 28% being neutral. Students identified five themes for recognizing bias: empathy (16%), self-reflection (60%), active listening (17%), communication (13%), and education (7%). When addressing bias, students outlined five strategies: drawing from personal experiences (1%), self-reflection (64%), communication (29%), education (15%), and advocacy (26%). CONCLUSIONS: Combining narrative medicine and VTS in a single session offers a promising approach for discussing bias in healthcare education. Through reflective experiences and art interpretation, students demonstrated an awareness of often interconnected strategies to identify and mitigate bias while caring for patients. Future next steps for this study involve exploring longitudinal impacts and integrating narrative medicine strategies throughout the medical school curriculum.

The Encounter of Two Worlds: Divided Narratives of Decision-Making on Cancer Treatment Between Physicians and Patients.

INTRODUCTION: Divided narratives pose long-standing difficulties in physician and patient communication. In decision-making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision-making on treatments, it is necessary to investigate the similarities and differences in these divided narratives. METHODS: This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings. RESULTS: Both physicians and patients were concerned about goals and obstacles to their decision-making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients. CONCLUSION: Cancer treatment decision-making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision-making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision-making approach, whereas patients generally adopt a relational decision-making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision-making. The results of this study provide a new perspective to treatment decision-making, emphasizing the importance of narrative integration in reaching mutual agreement. PATIENT AND PUBLIC CONTRIBUTION: The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments.

Temporal asymmetries in inferring unobserved past and future events.

Unlike temporally symmetric inferences about simple sequences, inferences about our own lives are asymmetric: we are better able to infer the past than the future, since we remember our past but not our future. Here we explore whether there are asymmetries in inferences about the unobserved pasts and futures of other people's lives. In two experiments (analyses of the replication experiment were pre-registered), our participants view segments of two character-driven television dramas and write out what they think happens just before or after each just-watched segment. Participants are better at inferring unseen past (versus future) events. This asymmetry is driven by participants' reliance on characters' conversational references in the narrative, which tend to favor the past. This tendency is also replicated in a large-scale analysis of conversational references in natural conversations. Our work reveals a temporal asymmetry in how observations of other people's behaviors can inform inferences about the past and future.

"It changed my whole entire thinking": Identifying narrative elements in medical affidavit writing for asylum seekers.

The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.

Exploring the Efficacy of Several Physiological Synchrony Methods During Collaborative Recall of Stories.

In this study, we assessed the efficacy of various linear and chaotic physiological synchrony methods during collaborative emotive recall of stories, examining how physiological synchronization impacts dyadic interaction in tasks involving emotionally charged narratives. Eighty-two young individuals, forming 41dyads, participated in a task requiring the recall of stories with varying emotional content. We analyzed physiological data using the Lyapunov coefficient, cross-correlation, and coherence indices. Our statistical approach included concise applications of the student's t-test, Pearson's correlation, and notably, the receiver operating characteristic (ROC) curve. The results highlighted significant differences in physiological synchrony between emotional and less emotional situations, revealing increased synchronization in collaborative remembering of emotional stories. The integration of the Lyapunov coefficient with other indices was crucial for identifying emotional conditions, underscoring its significance in exploring emotional engagement in group memory activities. This study provides valuable insights into the dynamics of physiological synchrony in emotional interactions, its implications in cognitive and social domains, and suggests potential applications in understanding collective behavior and emotional processing.

Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis.

BACKGROUND: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. OBJECTIVE: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. METHODS: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. RESULTS: From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. CONCLUSIONS: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps.

Hidden: A Baker's Dozen Ways in Which Research Reporting is Less Transparent than it Could be and Suggestions for Implementing Einstein's Dictum.

The tutelage of our mentors as scientists included the analogy that writing a good scientific paper was an exercise in storytelling that omitted unessential details that did not move the story forward or that detracted from the overall message. However, the advice to not get lost in the details had an important flaw. In science, it is the many details of the data themselves and the methods used to generate and analyze them that give conclusions their probative meaning. Facts may sometimes slow or distract from the clarity, tidiness, intrigue, or flow of the narrative, but nevertheless they are important for the assessment of what was done, the trustworthiness of the science, and the meaning of the findings. Nevertheless, many critical elements and facts about research studies may be omitted from the narrative and become hidden from scholarly scrutiny. We describe a "baker's dozen" shortfalls in which such elements that are pertinent to evaluating the validity of scientific studies are sometimes hidden in reports of the work. Such shortfalls may be intentional or unintentional or lie somewhere in between. Additionally, shortfalls may occur at the level of the individual or an institution or of the entire system itself. We conclude by proposing countermeasures to these shortfalls.

A model proposal for qualitative data analysis, interpretation, and reporting: contextuality, reflectivity, and narrativity.

RATIONALE: From education to healthcare and management processes, it is important to address the experience in health within its own complexity, context, and uniqueness. At this point, qualitative studies come to the fore and this increases the need for practical guides and models for qualitative studies. Qualitative studies have a paradigm that is different from quantitative research and its paradigm ontologically, epistemologically, and methodologically. These differences are reflected in the design of the research as well as the analysis, interpretation, and reporting of qualitative data. From such a point of view, this paper first briefly outlines the design process of qualitative studies and then proposes a model for the analysis, interpretation, and reporting of qualitative data. CONCEPTUAL/THEORETICAL FRAMEWORK: The three core concepts of the model are 'contextuality', 'reflectivity', and 'narrativity'. Such a conceptual/theoretical framework transforms qualitative data analysis, interpretation, and reporting processes into processes that are carried out with a reflective approach within their specific contexts. MODEL: Taking this into account, by considering a contextual, reflective, and narrative approach, two frameworks, namely, the 'Contextual (Multiple) Reading and Analysis Framework' consisting of three stages and seven steps, and the 'Contextual Understanding, Interpretation and Reporting Framework' consisting of four stages, were developed. This provides a practical guide to contextual and reflective data analysis, interpretation, and reporting for the use of those conducting qualitative studies.

Barriers and facilitators to narrative nursing implementation for junior nurses: A qualitative study.

This study aimed to explore the experiences of barriers and facilitators to the implementation of narrative nursing by junior nurses. Participants were recruited using purposive sampling. Semi-structured interviews were conducted from October 2023 to February 2024. Data were thematically analyzed using the Colaizzi seven-step method. Five barriers and 3 facilitators to the implementation of narrative nursing by junior nurses emerged in the study. Relevant barriers include lack of practical skills related to narrative nursing, neglect of the concept of humanistic care, negative events, high workload for junior nurses, restricted implementation environment. The facilitators contain patients' and family members' trust, training related to knowledge and skills, as well as harmonious and cooperative working atmosphere. There is still room for improvement in the implementation of narrative nursing for junior nurses, and the systematic training of narrative nursing knowledge and skills should be enhanced; the medical humanistic environment should be optimized; and the psychological resilience of junior nurses should be improved, so as to encourage them to actively implement narrative nursing at the early stage of their careers, and to deepen the high-quality development of nursing humanism.

Experimental evidence on the role of framing, difficulty and domain-similarity in shaping behavioral spillovers.

Does prompting people to volunteer for the climate spur or hamper further environmental engagement? We address this question in an online experiment with 10,670 German respondents. First, respondents read a text explaining how to help scientists fight climate change. Second, participants choose whether to do a real-effort task, like the behavior emphasized in the text. Third, respondents can sign a petition against climate change. In Study 1, we manipulate the narrative of the texts. We compare narratives condemning inaction or praising climate action against a neutral narrative (control) and an unrelated article (placebo). In Study 2, we investigate how the difficulty of the first behavior moderates behavioral spillovers. In Study 3, we test if the similarity between the domains of the two behaviors (e.g., environment, health) moderates spillover effects. None of our narratives increase the uptake of the real-effort task. Doing the real-effort task does not increase the likelihood of signing the petition either. Difficulty and domain-similarity do not moderate these effects.Protocol registration The stage 1 protocol for this Registered Report was accepted in principle on January 1, 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/JPT8G .

Disrupting the Master Narrative in Academic Biology as LGBTQ+ Ph.D. Students: Learning, Teaching, and Conducting Research.

LGBTQ+ individuals face discrimination and stigma in academic biology. These challenges are likely magnified for graduate students. However, there have been no studies documenting the experiences of LGBTQ+ life sciences graduate students. To address this gap, we conducted an interview study of 22 biology PhD students from 13 universities across the United States who identify as LGBTQ+. We used the master narrative framework to interpret our findings. Master narratives are guidelines that dictate the "expected" and "normal" way one is supposed to navigate life. We considered how graduate students engage with the societal master narrative that treats cisheterosexuality as the norm, as well as the master narrative that expects biology to remain an objective, apolitical space. We found that LGBTQ+ PhD students recognize the anti-LBGTQ+ narratives in academic biology, which can result in instances of discrimination and encourage them to conceal their identities. However, participants pushed back against these master narratives. Graduate students described creating alternative narratives by highlighting how their LGBTQ+ identity has allowed them to become more inclusive instructors and better researchers. Some also purposely reveal their LGBTQ+ identity in academic biology, violating the master narrative that non-science identities should not be discussed in the life sciences.