Qualitative Analysis of Medical Student Impressions of a Narrative Exercise in the Third-Year Psychiatry Clerkship

PURPOSE: Clinical clerkship directors and faculty undertake the challenge of teaching patient-centered communication to students who face the enormous doctor-centered task of learning diagnostic medicine. The authors examined students' written reactions to the narrative exercise, which, drawing from narrative medicine and narrative therapy, challenges students to be more patient-centered by writing a patient's life story and sharing it with that patient. METHOD: During one-half of an academic year (2008-2009), the authors used qualitative methods to explore the range of medical student experiences with the narrative exercise in the psychiatry clerkship. RESULTS: During the study period, 46 medical students completed the exercise, and 44 (96%) submitted 367 comments for the research team to analyze. Four broad categories emerged: (1) communication, (2) insight, (3) hope, and (4) mixed or negative reactions. The most common theme was improved communication, which comprised the subcategories of enhanced active listening, opening up, and relationship building. Improved insights included student insights into their patients, as well as the facilitation of patient insights into themselves, especially regarding their own strengths and relationships. The exercise was well received by students: Only five comments were categorized as negative, and all of these related to difficulties selecting patients. CONCLUSIONS: Students reported many examples of improved patient-centered communication facilitated by the exercise. The narrative exercise may also promote a greater understanding of patients as complete human beings rather than diagnostic entities. The approach may be useful in educational settings beyond the psychiatry clerkship.