Type of Course: Professional

Worlds Apart Facilitator’s Guide

This is a thorough facilitator’s guide on how to facilitate class discussions on the cross-cultural healthcare documentary Worlds Apart (a detailed summary can be found in the Search for Stories tab). In brief, Worlds Apart is a documentary split into four 10-15 minute sections that each focus on a different cross-cultural health experience, including a Muslim man’s journey with stomach cancer, a Lao woman with a hole in her heart, a Black man waiting for a kidney transplant, and a Puerto Rican woman with diabetes, hypertension, asthma and depression. This documentary showcases narratives that illuminate the limits of Western medicine and expand our ideas of how the American medical system can grow to be more inclusive, equitable, and sensitive. The facilitator's guide provides background on the filmmakers and their intentions. It includes suggestions for facilitators such as setting ground rules for discussion and asking students to jot down notes during the documentary. The four-part narrative-driven documentary is summarized, and then each section is broken down in great detail, so even someone who did not watch the film could understand the exact circumstances of each family and individual being featured. After each synopsis we also receive medical background information and a variety of discussion questions specifically tailored to different issues discussed in the stories. Each section has a separate “focus” also outlined, ranging from language barriers to explanatory modules to informed consent to racial/ethnic healthcare disparities to non-adherence to medications. This guide was created “to give health care professionals an engaging experience through which to explore ideas about cross-cultural issues in health care and to learn from the actual experiences of both patients and clinicians,” but could also easily be adapted to a university classroom setting to guide student discussions. The guide does not include any assignments, but any of the issues headlining the discussion topics could work well as research essay prompts.

He was not the first dead man I X-rayed

The author had this to say about the poem: “I have X-rayed thousands of people over thirty years, but this one still come backs to me. It’s the story I tell when people ask me for ‘hospital stories,’ so it’s no surprise that I eventually wrote the story in a poem. I can still so vividly see him and me alone in that cold room.” " Content warning : Gun violence, some graphic descriptions of bodily harm This is a short poem written from the perspective of the author as a X-ray technologist. It describes one particular experience he had caring for a man with a gunshot wound who dies during the treatment and the poem. Provides an opportunity to talk about death and the impact experiencing death may have on healthcare providers. The brevity and personal quality of this piece leaves room for students to interpret and discuss their own thoughts and reactions. There is a complex story in a brief poem, with lots to unpack, accessible to all audiences.

Teaching with “The Nocturnist”

Podcast series created by physician Emily Silverman that focuses on humanizing medical practice through healthcare workers' storytelling. Some topics: interview with author of a book on forced sterilization, "Black Voices in Healthcare" and "Post-Roe America". Episodes run 35-55 minutes; first 10-15 is story, the rest is wide-ranging interviews about (e.g.) why did you become a doctor? With related interview (see Farrell, 2022) could be used both to discuss storytelling as a way to address burnout, and to introduce oral history interviews.

In need of a prayer

Physician's story of visit to a suspected-COVID patient from early days of pandemic. Details the stress of not knowing how to protect herself, patients' isolation from his family, lack of treatment options, frantic pace of ER when infections and frequent deaths taxed medical professionals' emotional and physical stamina. Relates patients' conditions to her own father. Vivid starting point to discuss burnout (contrast with simple exhaustion and overwork), remind all audiences of what early months of uncontrollable COVID were like as memories fade. Ends by evoking a Celine Dion/Andrea Bocelli song about prayer that could contribute to discussion of music in healing.

(Not so) golden years

Daughter describes the stress of caring for her aging parent from geographically distant place. Details many issues that created burnout in her caregiver role, including feeling isolated and embarrassed about her struggle until she found out all of the problems she faced were very common for caregivers in her position. Useful to discuss how difficult it is to care for elderly parents, especially from a distance, and caregiver burnout.

Close reading a Twitter thread: Blind on the NHS

2 page (total) text presented here is a health narrative presented as a Twitter thread that raises issues that could be connected to several themes in courses related to health communication, reproductive justice, public health, narrative medicine, or more general writing courses to which the instructor wanted to add a health component. The outline includes detailed instructions for close reading the text, a central form of inquiry in narrative medicine. The goal of this instructional strategy is to can help participants attend closely to the narrative and find a point of personal connection to it. The format of the health narrative - a thread of about 20 tweets - lends itself to analyzing the role or impact of the medium on circulation of the message. Short enough to read aloud in a 45-50 minute class and work from there; could also be used in a workshop or storytelling group centered on prenatal care and/or disability.

Honoring and Witnessing Stories

This is an outline for a 90 minute undergraduate class on narrative medicine. It draws on readings by Arthur Frank and Rita Charon to talk about the importance of patient stories for patients to make sense of illness and for health care providers to provide care. It also addresses the importance of witnessing stories as a means of addressing power inequalities and health disparities. In addition to excerpts from classic works by Frank and Charon, the class session incorporates essays by a medical student (Ali) and a practicing physician (McMullen) on the significance of stories in their practice. The outline is from a practicum class, and so the class session includes narrative medicine practices of close reading and reflective writing, as well as class discussion of the assigned readings.

Listening to Patient Narratives Exercise: Anju’s Breast Cancer story

This is an outline for a class exercise utilizing a video from the Look Now Project. The short documentary tells Ajnu's story of treatment for breast cancer. The class exercise is part of a one-hour session entitled "Between the Lines," part of a training by the Northwest Narrative Medicine Collaborative in collaboration with Lewis & Clark College, which brought together undergraduate students, medical students, and medical professionals for a one-day workshop. In the "Between the Lines" session, we examined how clinical interactions are framed by medical scripts and encourage changing these frames to make room for patient stories. Then we engage in practicing listening closely to patient stories for what is said, how it is said, what is not said, and how our own experiences and identities shape what we hear.

Creative writing as a medical instrument

"Writing stories can create better doctors." Baruch is convinced that narrative medicine - focusing on close reading - isn't enough to prepare physicians to deal with ambiguities, confusions and conflicts inherent in medical practice. He urges teaching them to write stories so they can hear their patients' stories better. References and describes courses he has taught (one with an MFA creative writer) to teach medical students about characters, conflict, selecting key details ... storytelling elements often emphasized in creative writing. The goal is to encourage them to struggle with words on the screen (or page) to prepare to more deeply understand the fragmented, often confusing stories presented by patients. Good preparation for a teacher contemplating a narrative assignment; maybe less so for the students themselves.

The Almost Right Word: The Move From Medical to Health Humanities.

Concise summary of the history of medical humanities and how a distinct understanding of health humanities (using disability studies as an example, emphasizing how much of living with disabilities does not happen in medical contexts) contributes to analyzing and understanding human factors in health. Useful as background for undergraduate courses; expanding conversation for pre-health and health professional students.