During the second Congress of the Italian Society of Narrative Medicine (SIMeN), I participated to the workshop on Narrative Medicine educational programs, a very important topic for the ISTUD Foundation Health Care Area and for who applies to this discipline and agrees with the necessity to convey the narrative competences to the future health care providers.
The objective of the workshop was the sharing of the educational experiences applied to different contexts, so thus to benefit from this knowledge exchange and to define common methods of training processes, to reach the goal of “complicity in care” evoked by the title of the Congress.
It is not easy to balance all the necessary ingredients for a good educational program: each training process implies a relational involvement, originating from the encounter of values and emotions shared in a classroom; on the other side, the knowledge and the methods have to be always present. The education in Narrative Medicine must be a project, with specific objectives, and cannot be improvised. Otherwise, there is the risk to create inconsistent and useless events, without any significant impacts on the clinical practice.
To educate in Narrative Medicine, a mixture of characteristics is required: competence in the subject; a strategy blended with creativity, to be able to adapt the contents for people in the classroom; an ethics of narrative is necessary, since stories have to be used with awareness, caution, sensitivity, for the strong emotional impact which might emerge writing and reading a narrative.
So, how to educate in Narrative Medicine? As teachers, we have to educate ourselves continuously and to maintain a network, these are the first answers from our group. Nowadays, there are several possibilities to increase the knowledge and competences in Narrative Medicine, everyone with peculiar approach: however, the important thing is maintaining the complicity of the language, and sharing the experiences and knowledge. This is a continuous cross-fertilization work.
Who are the students and the attendees of the educational programs in Narrative Medicine? It is already shared the necessity to include Narrative Medicine and Medical Humanities in the academic programs for future health care providers, physicians, nurses, social workers and other careers. The carried out experiences say that the earlier this kind of education is integrated to clinical competences, the better are the results. “The Devil is in the third year” is the beginning of the title of an interesting research published on Academic Medicine; it demonstrates how students of Medicine start to erode their empathy already since the third year of their academic learning path; however, we know that empathy is a competence which can be developed and strengthened, starting from education on medical humanities. The results coming from the international and national universities which have included programs in Narrative Medicine are very positive and encouraging. The increasing number of sound thesis dedicated to this discipline is also a major outcome. This is the correct direction to follow, through more structured and knowledgeable courses and master – not just some optional seminars – and, if possible, to intervene even earlier than this decisive third year.
Considering that empathy is under a continue risk of erosion, together with motivation, the educational programs on Narrative Medicine not only for students but also addressed to health care professionals are fundamental. ISTUD has been dedicating a big effort in offering to providers of care this kind of programs. We can testimony how narrative competencies can help them to find new stimuli and new tools to improve the clinical practice, for themselves, their colleagues and their patients. Multidisciplinary is a common word shared in the workshop talking about these educational programs, since the whole teams of care must be trained to narrative competences; the added values of multidisciplinary courses are not comparable to the programs for a single speciality. All the definitions of Narrative Medicine, and Trisha Greenhalgh confirmed this during the Congress, talk about “inclusion” and “integration”; so, Narrative Medicine is not only what happens between the patient and the physician, but it involves many other worlds: the teams of care, the family members, the health care facilities, the communities, the citizenship.
Another common word emerged from the working group is network. For ISTUD, this word is so important to be considered among the objectives of our educational programs. The result of a Narrative Medicine course and, better, a long lasting master, is a network of expert and aware professionals, able to apply and disseminate this discipline in the contexts of care. For me, the Congress was the chance to see what a network can do: I could meet and work with several ex-participants of our master and courses. They came to ISTUD for different reasons, some of them had specific objectives from the beginning, some were living personal reflections, some others were just curious; now, all of them are carrying out complex projects. The network nourishes and strengthen the experiences, guides and fosters who feels alone, inspires, stimulates, creates new opportunities of exchange.
Educating to Narrative Medicine, but also disseminating: this is the fresh proposal from ISTUD Foundation to the workshop. Recent interesting experiences of integration between schools and health care facilities lead to this further way; it is possible to address educational programs also to the high schools, through narratives and Medical Humanities. The big aim is to build a common culture of health, belonging not only to health care providers, but also to the ill and healthy people, their family members, and all the society. In these years of research and education, reading and listening to many stories of care, I learnt that the inefficient heath system is not the only reason to invalidate the quality of cares; sometimes, stigma, well-established certainties, the lack of a common culture of health between health care professionals and patients, but also in the society, can damage the pathways of care. Narrative Medicine has a very important role in this cultural process, and the educational programs are the key tools.
For sure, a one day workshop cannot be enough to define common methods, but I wish this occasion could be the first step, to reach the real complicity and transparency among who dedicates to Narrative Medicine, both in education and research, following the same direction through organic educational events. As coordinator of the Master in Applied Narrative Medicine, each of the ex participants met at the Congress represented a confirmation and a stimulus to continue the effort for sharing promoted by the Health Care Area of ISTUD. Personally, I realized once more how much I learnt from them and how much they gave to me, since educating, for me, is a both sided permeable process.
 Hojat M. et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school”. Academic Medicine, Vol.89 n.9, 2009