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Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents

BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially comple...

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Autores principales: Bradley, Joel, Styren, David, LaPlante, Abigail, Howe, John, Craig, Sienna R., Cohen, Emily
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869072/
https://www.ncbi.nlm.nih.gov/pubmed/33557815
http://dx.doi.org/10.1186/s12909-021-02505-1
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author Bradley, Joel
Styren, David
LaPlante, Abigail
Howe, John
Craig, Sienna R.
Cohen, Emily
author_facet Bradley, Joel
Styren, David
LaPlante, Abigail
Howe, John
Craig, Sienna R.
Cohen, Emily
author_sort Bradley, Joel
collection PubMed
description BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work. METHODS: From 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1–15 months from the experience. RESULTS: 46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine. CONCLUSIONS: HTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-021-02505-1.
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spelling pubmed-78690722021-02-08 Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents Bradley, Joel Styren, David LaPlante, Abigail Howe, John Craig, Sienna R. Cohen, Emily BMC Med Educ Research Article BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work. METHODS: From 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1–15 months from the experience. RESULTS: 46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine. CONCLUSIONS: HTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-021-02505-1. BioMed Central 2021-02-08 /pmc/articles/PMC7869072/ /pubmed/33557815 http://dx.doi.org/10.1186/s12909-021-02505-1 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Bradley, Joel
Styren, David
LaPlante, Abigail
Howe, John
Craig, Sienna R.
Cohen, Emily
Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
title Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
title_full Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
title_fullStr Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
title_full_unstemmed Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
title_short Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
title_sort healing through history: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869072/
https://www.ncbi.nlm.nih.gov/pubmed/33557815
http://dx.doi.org/10.1186/s12909-021-02505-1
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