Narrative medicine challenges med students to discover the person within the patient
July 13, 2020
Backpacks and shoes are dumped at the door. Plates are filled with food, and the long dining table with extra chairs is soon crowded with conversation. It doesn’t take long for the plates to empty again. Containers of Play-Doh are dropped on the table and students grab them, creating something with the dough that represents a unique interest or story.
The scene is a stark juxtaposition from what these medical students were doing earlier that day – studying a patient’s medical case, learning biomedical research fundamentals, or dissecting a cadaver to learn the intricacies of human anatomy. And that’s exactly the point.
The narrative medicine elective they are taking seeks to use stories and creative response to build listening skills, empathy, and reflectiveness. “The ultimate goal is to help students understand themselves better, but also to develop empathy and connect with patients on a deeper level,” said Cyndy Unwin, assistant professor of interprofessionalism at the Virginia Tech Carilion School of Medicine.
“My hope is the student can find the patient in the disease,” added Brian Unwin, professor of internal medicine as well as family and community medicine. “If we can keep our humanity in very challenging work, all will be better for it, both the patient and the provider.”
Brian and Cyndy Unwin are spouses and team-teach the elective. Brian spent almost three decades in the military, earning his medical degree from the Uniformed Services University, with a focus in family medicine and geriatrics. Later, he served as faculty at the military medical school for nine years. Cyndy’s background is in elementary and reading education. “I’ve spent most of my career working with children with literacy difficulties,” Cyndy Unwin said. “About 20 years ago, I started thinking I might also like to write books for kids.” Since then, she has published several children’s books and continues her involvement in children’s literacy.
In 2013, Brian retired from the U.S. Army and the Unwins moved to Roanoke, Virginia, so he could practice with Carilion Clinic and serve as faculty at VTCSOM. Four years ago, Cyndy also began working with the medical students in an advisory role to help them fine-tune their personal statements for residency applications.
When the school began exploring the idea of adding a narrative medicine elective three years ago, leadership asked the Unwins to lead the course, recognizing the couple’s mix of strengths and backgrounds. It is one of three electives at the school that students can take during the first two years of study. Successful completion of an elective gives students extra credit hours to use in their fourth year, allowing more time to travel for residency interviews or use for vacation. The other two electives are "Mindfulness” and “Medical Spanish.”
The electives have been popular for students. “I joined narrative medicine because I want to remember why I am doing this, make sure that I develop the skills to always pull my head up from the specifics, and remember that the connection with a patient can be just as important as the medicine provided,” said Abra Roberts, a second-year VTCSOM student.
The narrative medicine elective has had three cohorts of students. In addition to reading assignments and class discussion, students complete three narrative projects. The first is a personal memoir. The other two are focused around patient interviews. Students have completed the projects using diverse types of media, including writing, art, music, and drama.
“Understanding a patient’s health narrative is important and part of what it means to take care of someone,” said Kian Tehranchi, a fourth-year student at VTCSOM. “I think this class will push me to prioritize getting my patients’ stories in the future.”
While medical students receive training in other coursework on how to complete a patient interview in the context of medical care, these assignments require students to dig deeper and reveal more about the patient as a person.
The projects challenged students to apply that idea later in their practice. “I learned how to better view a situation from the patient's perspective and not to shy away from the difficult questions,” said fourth-year student Keri Godbe.
"This course has made me realize just how deep the doctor-patient relationship can be and how important it is in the context of care,” said third-year student Jacob Hartman-Kenzler. “I feel like we were given the chance to pull back the curtain and talk about aspects of medicine that doctors usually aren't exposed to until much later in their careers. This course has helped me realize how I want to practice medicine, regardless of specialty, and how I want my patients to feel when they're in my care.”
The Unwins host every class session in their home and always start each class with a meal, sometimes prepared by the Unwins and other times by the students.
“It’s important that we be open and vulnerable in our own way. Being a parent of 20-somethings, these young adults come into our home, pile their shoes, backpacks, and coats at the front door and they know where to find a cup to get some tea,” Cyndy said.
“They polish off the ice cream. It’s a moment to get out of medical school mode and it’s more like coming home for the evening,” Brian added.
Like the rest of the university and medical school, the elective had to make the switch to virtual around mid-March due to the COVID-19 pandemic. While the Unwins made the best of the situation, they hope they can return in person later this year, even if they gather outside. They will follow guidance from the university in addition to gauging the students’ comfort level.
The intimacy of the class has made an impression on students who have taken the elective. “The Unwins are so welcoming and inspiring,” said Mallory Blackwood, a third-year student. “Getting to hear their thoughts on how a person stays fresh and empathetic after decades-long careers is a privilege. This class is a great reminder, especially during these first two didactic years, of why I got into medicine and how I can be happy amidst the workload.”
The Unwins say they have gained just as much through the course as the students. “The class is a true highlight for me,” Brian said. “I was expecting resistance from students to be more creative. People who are driven and scientifically minded – a stereotype of medical students – they tend to have more linear thinking. I expected difficulty with the creative aspect of the class, but that is not the case. They’ve blown us away with the quality of their work.”
Students who have completed or are still participating in the course volunteered to share some of their completed projects to launch a new Virginia Tech Carilion School of Medicine creative publication. The online publication, titled Articulation, is housed on the Virginia Tech Carilion School of Medicine website.
“This course can’t be the end of it. We’ve got to share it with students and faculty and community members, so everyone has the opportunity to be creative,” Cyndy said.