Diabetes stories: use of patient narratives of diabetes to teach patient-centered care

Abstract

A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore the experience of illness from the patient's perspective and ultimately to incorporate this perspective in clinical practice. In this qualitative study, we wished to investigate the impact of "diabetes stories"--the stories of FCE volunteers with diabetes--on medical students' understanding of diabetes and its management. Individual interviews were conducted with medical students who had worked with a volunteer with diabetes to answer the questions: "in what ways was learning through these 'diabetes stories' different from that acquired through lectures and textbooks," and "how did these stories impact the students' understanding of diabetes and its care?" Thematic analysis of the transcribed interviews was performed using Grounded Theory. Several major themes emerged: There was more to diabetes than the "scientific" knowledge acquired through lectures; the stories challenged students' assumptions about having or working with people with diabetes and allowed students to see the world through the perspective of someone with diabetes, and the stories motivated students' development as physicians and influenced their general perspectives of doctoring and medicine. First-person narratives of living with diabetes allow for learning in affective, experiential, and cognitive dimensions, stimulate self reflection and perspective-taking, and enhance growth through the challenging of previous assumptions, beliefs, and perspectives. This type of learning is transformative and may result in a shift in students' perspectives towards more open, inclusive attitudes towards patient-centered diabetes care.

Exploring communications around medication review in community pharmacy

“…Thus, students introduced identified life-world problems to GPs as part of an overall assessment of the patient's current state of disease thereby enabling an increased understanding on the part of the GP of the everyday life of the patient. The potential of home medication interviews to explore life-world problems has also been demonstrated by medical students [30].…”

Conjunctive group therapy: A case study of an adult type I diabetes mellitus patient

“…Research data was obtained with the use of focused interview by Merton and Kendall (Cohen and Manion, 1994) at two different times (before and after the intervention), and the patient's answers were content-analyzed using Grounded Theory methodology (Kumagai et al, 2009;Lundin, 2008;Strauss and Corbin, 1998). Grounded theory seeks to derive thematic categories from initial data.…”

Arts, literature and reflective writing as educational strategies to promote narrative reasoning capabilities among physiotherapy students

“…Narrative reasoning helps practitioners to be more capable of recognizing, interpreting and being moved to action by the individual stories of illness (Charon, 2004(Charon, , 2006, which impact their approach to reasoning and practice, as well as the outcomes of that practice (Hall et al, 2010;Kumagai, Murphy, and Ross, 2009;Resnik and Jensen, 2003). Accordingly, research in this area has associated these capabilities with expert practitioners (Edwards, Jones, Carr, and Jensen, 2004;Jensen, Gwyer, Shepard, and Hack, 2000;May, Greasley, Reeve, and Withers, 2008;Resnik and Jensen, 2003).…”

“…Therefore, several different educational strategies have been proposed to develop students' clinical reasoning capabilities, ranging from empirico-analytical approaches associated with the development of hypotheticodedutive reasoning, to interpretative approaches focused on the development of narrative reasoning capabilities Parry, 2008;Ross and Haidet, 2011;Swisher et al, 2012). With regard to narrative reasoning, research has suggested that the use of narratives increases students' understanding about the patient illness experience and promotes the implementation of patient-centered practice (Hurwitz, Greenhalgh, and Skultans, 2004;Kumagai, 2008;Kumagai, Murphy, and Ross, 2009;Lévesque, Hovey, and Bedos, 2013).…”