Research Impact: Stories Doctors Tell
A collaborative paper co-authored by scientists at the Centre for Education Research and Innovation (CERI) was recently published in the Journal of the American Medical Association (JAMA). "Stories Doctors Tell" explores the role of reflective writing and physician narratives in medical education and practice.
The research team – Tracy Moniz, PhD, assistant professor at Mount Saint Vincent University; Lorelei Lingard, PhD, director of CERI; and Dr. Chris Watling, scientist at CERI and associate dean of postgraduate medical education – answered a few questions about their research, highlighting what physicians’ stories tell us about the current health care climate and the need for creating space for these conversations within continuing medical education.
What inspired you to take this project on?
This project grew out of our interest in reflective writing and how it is used in medical education and practice. Medical journals regularly publish physicians’ narrative reflections, and we thought that these narratives could offer a rich, untapped resource for understanding how physicians perceive their personal and professional challenges. We wanted to study these stories—to explore the nature of these writings, to understand the meaning that physicians make of their patient care experiences through these stories, and to understand what purposes these narratives may serve for the physicians who write them and for those who read them.
In our study, we analyzed the stories that physicians chose to tell about the practice of medicine in narrative sections of three leading medical journals, focusing on the lessons conveyed, the narrative strategies used to convey them, and the relationships between the two.
What were the primary findings from this analysis?
We found that physicians largely wrote laments about flaws in the health care system and stories of awakening to the importance of humanity in medicine. This suggests that both are prominent and consistent challenges for physicians and, interestingly, neither has prominence in any of the traditional continuing medical education opportunities available to physicians looking to address their learning needs. Physicians need more outlets for these types of discussions.
The patterns identified in our analysis also resonate with current discussions regarding healthcare quality and physician wellness. That physicians shared their stories as awakening and laments shows that they recognize and experience with emotion the challenges and limitations of the health care system and that they remain affected and changed by their patient-care experiences. Physicians’ stories offer insight into their humanity and their place within the ‘flawed’ system they write about.
What do these findings tell us about the current approach to continuing medical education?
The fact that physicians recurrently write —and leading medical journals regularly publish—laments about flaws in the health care system and stories of awakening to the importance of humanity in medicine suggests an educational and existential need in medicine that is not met by conventional continuing medical education offerings. There are few venues for physicians to express and share the kinds of stories they write about in the narrative sections of scholarly journals, and this may be one reason physicians turn to narrative and then choose to share their stories with colleagues by publishing them. Just as physicians need professional development to increase knowledge and update skills, so too do they need more spaces where they can share, discuss, reflect on and navigate the struggles they face around humanity and professional identity throughout their medical careers. We have an opportunity to expand how we approach postgraduate training and continuing medical education curricula.
What do you see as the solution?
Our research speaks to the important social function served by the narrative sections in medical journals. These narrative spaces offer a safe—and rare—venue for physicians to reflect on and share their struggles and the lessons they learn as a result. The need for these conversations is clear, and the profession could benefit from creating more spaces for these conversations to take place across continuing medical education.
What’s next with this line of inquiry for you?
We continue to study reflective writing and learn from what it can teach us about the meaning people make of their illness and care experiences. We currently work on a scoping review to better understand the areas of intersection and of disconnection among patient, family caregiver and physician narratives of their respective illness and care experiences. Our hope is that by exploring the relationship between these narratives, we may be better positioned to strategize around enhancing patient-centred care.
We are also reflecting on the positive feedback received from colleagues around the world in response to the publication of “Stories Doctors Tell” in JAMA and further strategizing about how we may build on these insights in our future work.