The Narrative Exercise: Introduction to Therapeutic Communication in the Psychiatry Clerkship
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Patients' stories, the ways in which they describe illness and the meaning of illness in the context of their lives, form the core of both the contemporary discipline of narrative medicine and the traditional practice of psychotherapy. The ability to elicit and shape patients' narratives requires specific skills, essential to the implementation of humanistic values in medicine. Students need guidance in cultivating the capacity to communicate in ways that make patients feel accepted, cared for, empowered, and hopeful within the constraints of their medical conditions.
The psychiatry clerkship directors at the University of Rochester School of Medicine and George Washington University School of Medicine have developed parallel clerkship activities that teach the skill of constructing narratives in doctor patient communication. These exercises structure student/patient interactions according to the principles of narrative medicine, narrative therapy and psychotherapy.
Much medical school time is spent teaching students to elicit disease-centered histories from their patients. The narrative exercise supplements this traditional focus by requiring students to develop a person-centered narrative for one patient under their care. The ultimate test of a diagnosis is the verification of the diagnosis by tests or treatment outcome. The ultimate test of a patient-centered narrative is whether the patient accepts it as a legitimate characterization of his or her experience. Recognizing this principle, each school requires the students first to elicit a patient's life story, then to write it out, present it to a preceptor, and finally to present it directly to the patient for comment.
This submission presents the basic elements of the Narrative Exercise jointly developed at the University of Rochester and the George Washington University, along with the specific modifications each school makes to integrate the exercise into its overall curriculum.
Garrison D, Frank J. The Narrative Exercise: Introduction to Therapeutic Communication in the Psychiatry Clerkship . MedEdPORTAL; 2010. Available from: www.mededportal.org/publication/7765
Contains Information Suitable for Patient Education
- To be able to describe the elements of therapeutic communication, including the common factors of psychotherapy
- To be able to conduct and document interviews that incorporate elements of the narrative approach
- To be able to describe the differences between diagnostic and narrative interviewing
- To be able to experience an analog to a psychotherapeutic encounter by sharing with a patient an empathic narrative that highlights the patients' own values and concerns and fosters hope
- Psychotherapy (MeSH), Narrative
- Interpersonal & Communication Skills
- Patient Care
- Basic Sciences
- Psychology/Behavioral Science
- Communication Skills
- Instructional Materials/Methods
- Medical Ethics
- Physician-Patient Relationship
- Quality Improvement
- Professional School
- Medical Student
- Professional School Post-Graduate Training
- Independent Study
Authors & Co-Authors
David Garrison, MD
University of Rochester School of Medicine and Dentistry
Julia Frank, MD
George Washington University Sch of Med and Health Sciences
Sponsorship or Funding Source
Time to develop the project was provided to the UR clerkship director through the Dean's Teaching Fellowship
Effectiveness and Significance
This is available in Attachments five and six as well as the Debriefing and Feedback section and Conclusion in the primary submission.
Special Implementation Guidelines or Requirements
These are discussed extensively throughout the primary submission.
This is described in the Debriefing and Feedback section and Conclusion in the primary submission.
This information is made available under the Creative Commons license.
This publication has been formally peer reviewed elsewhere
The UR Evaluation data was a part of a submission to Academic Psychiatry in the late summer of 2007. The submission was sent back with revisions, but was not resubmitted.
Publications, Presentations, and/or Citations for this Publication
Both authors presented posters on their respective exercises at the annual ADMSEP meeting, the UR clerkship director in 2007 and the GWU clerkship director in 2008