A Narrative Medicine Curriculum for Third Year Neurology Clerkship Students to Combat Moral Distress

February 8th, 2019
Title: A Narrative Medicine Curriculum for Third Year Neurology Clerkship Students to Combat Moral Distress
Author: David A. Lapides, Assistant Professor, Associate Clerkship Director, Department of Neurology and Center for Bioethics and Humanities, University of Virginia, Charlottesville, VA
Medical students are particularly susceptible to moral distress, when they perceive a power differential which prevents them from acting according to what they believe to be morally correct (Jameton, 1984). This power differential between medical students and their supervising physicians is inherent to medical education and particularly pertinent in neurology given increasing neurologic sub-specialization, complexity of neurologic diseases and the associated ethical ramifications of complex decision making. Additionally, moral hazard, the separation of decision makers from those who suffer the consequences of those decisions, contributes to moral distress in the healthcare environment (Brunnquell & Michaelson, 2016; Marshall & Epstein, 2016). Ultimately, moral hazard and moral distress contribute to clinician burnout, a particular issue amongst neurologists (Rushton, 2015; Bernat, 2017). Wellness programs have become ubiquitous as burnout is increasingly recognized, and there are a wide variety of investigational techniques investigated to improve this systemic issue (Marchalik, 2018). Here we lay out a proposal to investigate the effect of a narrative medicine curriculum on moral distress in third-year neurology clerkship students.
The University of Virginia (UVA) Department of Neurology residency program has instituted a narrative medicine curriculum with very positive feedback (Harrison & Chiota-McCollum, 2019). The program integrates various forms of creative expression, poetry, short stories, art, and film to engender connection with individual patient narrative, in contrast to the disease centered focus of the neurology wards. One hour per month, residents do a close reading in group discussion, followed by free writing with a prompt. As the associate neurology clerkship director, I began encouraging our third year medical students to attend these sessions and saw significant impact on their morale. Students seemed refreshed and ready to re-engage in their clinical duties following these sessions.
But can narrative medicine decrease moral distress amongst medical students? I plan to facilitate a narrative medicine session for the third year neurology clerks, having taken part of the residency curriculum as a faculty facilitator for the last year. This once monthly session will be worked into an existing education time. I have selected a neurologically themed passage from the “The Diving Bell and the Butterfly,” which will be read aloud. Following a 30-45 minute discussion of the passage, students will be given a writing prompt, “write about an encounter you witnessed on the neurology clerkship and describe it from the point of view of one of the participants.” In order to quantify moral distress, we will use the Moral Distress Scale-Revised (MDS-R), validated amongst physicians, nurses and allied health professionals (Hamric & Epstein, 2012). We plan to administer the scale to students at the beginning of their neurology
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