Type of Teaching Material: Class Exercise/Activity

Narrative Medicine activity using Rearranged: An Opera Singer’s Facial Cancer and Life Transposed

Rearranged: An Opera Singer's Facial Cancer and Life Transposed is Kathleen Watt's memoir of her diagnosis and treatment for osteosarcoma. In an article in Teaching and Learning in Medicine, medical student Emmanuel Greenberg and internal medicine hospitalist Elizabeth Lahti provide a narrative medicine activity using Watt's book. Greenberg and Lahti provide a brief summary of the work, noting how Watts' short chapters narrate jher movement through the healthcare system as well as the day-to-day realities of her illness and the ways it impacts her identity and relationships. Greenberg and Lahti each reflect on their own responses to Watts' work. They note that clinicians' own life stories are part of any clinical encounter and they explore (and model) how this kind of self-reflection can improve understanding and patient care. Their article concludes by identifying a passage from Watts' book and providing brief instructions and writing prompts for a narrative medicine activity.

Depression Quest

This is a choose-your-own adventure game that aims to illustrate what having depression is like, specifically for those who have not experienced or have not been diagnosed with depression. The creators stress on the opening page that the game is not representative of everyone’s experience with depression, but is an amalgamation of different or shared experiences from people with depression. Each “level” has a different description of what the character, you, do or can do throughout the day. You then have the opportunity to choose between a few options that lead to different results or storylines. Some of the options are portrayed as beneficial while others are harmful. Some levels, specifically when the character’s depression is particularly extreme, show answers that are red-lined and unavailable to us, although we can read them. There are many different endings that appear depending on what choices you make throughout the game, meaning that everyone in the class who plays could have a different outcome or experience, which can lead to an opportunity for discussion. The creators end the game with this message : “Instead of a tidy ending, we want to just provide a series of outlooks to take moving forward. After all, that's all we can really do with depression - just keep moving forward. And at the end of the day it's our outlook, and support from people just like you, that makes all the difference in the world.” This narrative experience could be used to discuss themes such as immersive and experiential learning, including controversial learning models such as disability simulations It can also be used to discuss what we value in narratives: does the ability to act as the character immerse us more? Do we feel distanced without an author to connect with? The game play could be supplemented with other reading materials to compare and contrast different uses of narrative. When the game was released, it was also caught up in the “gamer-gate controversy” (described in a New Yorker feature article: https://www.newyorker.com/tech/annals-of-technology/zoe-quinns-depression-quest). This larger context for the game could prompt discussion about stigma associated with depression, and the appropriateness of using a “game” to educate in this way. Users have the option to "play for free" or "pay what you want."

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.

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.

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.