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A Call for Storytelling in Family Medicine Education William Ventres, MD, MA; Paul Gross, MD

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A Call for Storytelling in Family Medicine Education William Ventres, MD, MA; Paul Gross, MD SPECIAL ARTICLE Getting Started: A Call for Storytelling in Family Medicine Education William Ventres, MD, MA; Paul Gross, MD BACKGROUND: In this article we introduce family medicine edu- conclude by presenting the basic cators to storytelling as an important teaching tool. We describe components of effective stories and how stories are a critical part of the work of family physicians. We describing how to integrate the prac- review the rationales for family medicine educators to become tice of storytelling into family medi- skilled storytellers. We present the components of effective sto- cine education. ries, proposing two different perspectives on how to imagine, con- struct, and present them. We provide a list of resources for getting Background and Rationale started in storytelling and offer two personal vignettes that ar- Stories, Clinical Practice, and ticulate the importance of storytelling in the authors’ respective professional developments. We point the way forward for family Professional Development medicine educators interested in integrating storytelling into their The practice of family medicine (and, repertoire of teaching skills. in fact, all the generalist medical dis- ciplines) is integrally involved with (Fam Med 2016;48(9):682-7.) the telling of stories.1 Numerous practitioners and scholars from psy- chology, narrative studies, the medi- tories make differences in our medicine. It also reminds us just cal humanities, medical ethics, and care of patients. They help us how challenging it is for family med- medical education have discussed Sthink about our patients and icine educators to teach the skills of the crucial role that the telling, in- their family members. They help listening to and telling stories in cur- terpretation, and reconstruction of us integrate our understandings of rent training environments. Unfor- stories play in the process and out- symptoms, laboratory tests, and dis- tunately, as well, instruction about come of clinical encounters: patients ease. They help us translate those un- how to cultivate skills as storytell- relate their illness experiences in derstandings into the way we care for ers in family medicine education is terms familiar to them; clinicians lis- other patients. virtually nonexistent. ten to these presentations, draw out It would mean a lot if we could We admit there exist significant details through their questions, and convince medical students and resi- barriers to integrating stories, either reformat them as medical informa- dents of the essential nature of sto- as listeners or as tellers, in contem- tion by way of SOAP notes (having ries and storytelling in the practice porary medical education. Accord- added objective data from physical of family medicine. Expecting them ingly, in this article we describe how examinations, laboratory tests, and 2-7 to listen to, relate, and create stories stories play a critical part of the clin- diagnostic procedures). isn’t just wishful thinking: it is a ical work and the educational de- The net result is the creation of learned skill, just as are all the other velopment of family physicians. We therapeutic strategies that attend learned skills that go into the mak- introduce family medicine educators ing of a family physician. to storytelling as a valuable teach- ing tool and review the rationales From the Institute for Studies in History, Anthropology, and Archeology, University of A Family Physician Educator, 2015 for them becoming skilled storytell- El Salvador, San Salvador, El Salvador, and ers. In two vignettes we illustrate Department of Family Medicine, Oregon This opening comment tells us how storytelling has become part Health & Sciences University (Dr Ventres); and Department of Family and Social Medicine, much about the importance of stories of our educational philosophies and Montefiore Medical Center and Albert Einstein in the day-to-day practice of family repertoires of teaching habits. We College of Medicine, Bronx, NY (Dr Gross) 682 OCTOBER 2016 • VOL. 48, NO. 9 FAMILY MEDICINE SPECIAL ARTICLE to the traditional goals of curing team, and stories help them han- by patient- and relationship-centered and caring.8 That stories contribute dle their grief, find solace in one an- care—is foundational to generalist to this progression—they are the raw other, and develop resiliency. (After practice theory; bringing connection material from which practitioners the death of a patient, team mem- to teaching through storytelling re- and patients refine clinical paths— bers might share among themselves inforces its parallel power in clinical has consistently been considered a their connections with the deceased encounters.23 Third, if you don’t tell hallmark of high-quality generalist or how the patient’s death has influ- your story, someone else will—and medical care.9 Stories help family enced them.) they will set the priorities for how physicians and others understand • when faculty members want to we define and accomplish the work the interplay of biomedical and so- model for learners how they have we do.24 cial determinants of disease while managed (with varying degrees of they are attending to critical transi- success) the same challenges that How to Tell Stories: First Steps tional moments in the course of pa- learners are struggling with, and sto- There are many recommendations tients’ lives.10 ries are able to “show,” rather than for how to construct and relate sto- As to professional identity de- “tell,” the way forward. ries, regardless of mode of presenta- velopment,11 many physicians-in- Storytelling may also be useful in tion (oral, written, or audio-visual). training have used stories to tell of opening learners’ clinical imagina- Some are centuries old and drawn overcoming clinical challenges and tions, fostering reflective practice, from traditional storytelling prac- managing steep learning curves.12-14 and enhancing clinicians’ abilities to tices in existence prior to the writ- Yet few narratives explore the in- understand the complexities of mod- ten word.25 Others, like the five-step tentional use of stories by educa- ern medical care.17 Sharing stories, plot line common in Shakespeare’s tors of physicians or others involved especially when framed in terms works—exposition, rising action, in health care.15 However, we sus- of crisis and resolution, is thought turning point, falling action, and con- pect that many readers can recall to encourage professional empa- clusion—got their start in theater.26 when teachers’ stories have helped thy in response to the vulnerability Still others have come out of new- shape their career development. We and loss that commonly accompa- er technologies, like movies, digital can personally attest to their sub- ny illness experiences.18 In addition, documentaries, and podcasts.27 Ad- stantial influence on our profession- stories are useful for purposes of per- ditionally, there are a wide variety of al growths. suasion.19 As such, storytelling from ideas on building and telling stories a family medicine perspective is im- that have philosophical foundations Storytelling as an Important portant in an era when tales of sub- (though well beyond the scope of this Teaching Tool subspecialist- and technology-driven introductory article): the hero’s sto- Due to this recognition, we rec- care dominate over those related to ry, the heroine’s story, and stories ommend that teachers of family comprehensive, accessible, patient- of collective memory and reconcili- medicine expand their skills at story- oriented care.20 ation are but a few illustrative ex- telling, regardless of whether or not amples.27-29 they believe they currently possess Implementation For family physicians interested in the knack to tell stories effectively. Preliminary Considerations incorporating storytelling into their By crafting and telling stories, they Family medicine educators interest- repertoires of teaching strategies, can model the many dimensions of ed in cultivating their oral, written, we suggest two possible introduc- patient care that form the basis for or digital storytelling skills will be tory approaches for getting started, our discipline.16 By including story- well served by keeping the follow- approaches that have served as our telling in their teaching repertoires, ing adages in mind. First, good pre- guides in our own growths as story- they can help their learners grow senters are good storytellers. There tellers. The first, described in Table 1, into thoughtful, capable, and confi- are many ways to share knowledge, follows several process- and outcome- dent generalist clinicians, adroit in but teachers of medicine are often oriented themes. These themes con- embracing both the science and art guilty of pushing facts out to our dense the fine art of storytelling into of medicine as therapeutic tools. audience. Pulling students and res- five manageable dimensions, each a Storytelling, whether oral, written, idents in with stories helps concepts series of three associated steps. The or by way of digital documentaries, stick more firmly and is more satis- second approach, noted in Table 2, is particularly useful in such fam- fying (or at least less boring) to both follows a sequence of questions to be ily medicine educational settings as: tellers and listeners alike.21 Second, used as prompts for considering how • when teaching biomedical infor- storytelling is about connecting to to construct and tell stories. These mation, and stories give the infor- other people and helping
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