Using Narrative Medicine Workshops to Improve Empathy and Emotional Intelligence and Address Burnout Among Medical Students

Purpose: Recognizing that a supportive environment can mitigate the negative psychological effects that occur in training, educators seek to develop programs that cultivate empathy and interpersonal skills, while reducing burnout. 1 Narrative medicine is a pedagogical approach that facilitates the development of interpersonal and noncognitive aspects of medical professionalism, and potentially strengthens relationships. 2 In 2019, Baylor College of Medicine (BCM) School of Medicine developed a mandatory Narrative Medicine (NM) course. The course spans spring of second year through fall of third year of medical school. Sponsored in part by an AAMC grant, our research assesses how participation in the NM course affects burnout, empathy, and emotional intelligence. This study was approved by the IRB at BCM. Approach: Between March and October 2021, 5 cohorts of medical students were divided into small groups (4–12 students/group; mean 8.5 students/group) to engage in six, 1- to 1.5-hour narrative medicine workshops following their surgery clerkship. Faculty facilitators led these workshops primarily through Zoom. All faculty members were given training in both narrative medicine and workshop facilitation before leading the sessions. During the workshops, participants were asked to closely read creative pieces, write freely in response to prompts, share their written reflections, and respond thoughtfully to one another’s work. Students were emailed pre- and post-surveys with program evaluation questions, along with study-related scales with evidence of validity/reliability (Interpersonal Reactivity Index 3 (IRI) to measure empathy, Maslach Burnout Inventory General Survey for Students 4 (MBI-GS[S]), and Trait Emotional Intelligence Questionnaire-Short Form 5 (TEIQue-SF). Statistical analyses included paired samples t tests, reliability (Cronbach’s alpha), and effect size (Cohen’s d) for differences between pre- and postintervention measures using SPSS version 27. Outcomes: One hundred fifty-three out of 162 students (94.4%) across 19 small groups met inclusion criteria for our survey study. Scales demonstrated adequate reliability (alpha = .61–.92). Across the 3 constructs, there were statistically significant improvements for the following scales/subscales: IRI – Total Score (P = .001), Empathic Concern (P = .008), and Perspective Taking (P = .001); MBI-GS(S)—Professional Efficacy (P = .035); and TEIQue-SF—Total/Global Emotional Intelligence (P = .015), Emotionality (P = .042), Self-Control (P = .005), and Well-Being (P = .005). Several subscales showed no improvement. The effect sizes (Cohen’s d) for significant differences between means were small, ranging from 0.116 to 0.339. Significance: This project provides evidence that a relatively short (approximately 9 hours of workshop time per group) narrative medicine intervention for second-year medical students can have a positive impact on their self-reported empathic concern and perspective taking, professional efficacy, and emotional intelligence. Despite the lack of improvement on some subscales and the small effect size, the “dose” of narrative medicine was itself fairly small yet produced positive results. As a “proof of concept,” the study demonstrates the potential and measurable contribution of narrative medicine to the medical school curriculum. While the narrative medicine course was a short, concentrated experience, future investigation includes testing additive effects of multiple activities targeting wellness, empathy, and emotional intelligence longitudinally across the continuum of medical education. These findings show that narrative medicine is an effective pedagogical tool for teaching students how to deepen their emotional connection to patients. By developing skills of close reading and attention, students learn to take on others’ perspectives and develop empathic concern for others’ feelings. These skills easily translate into the clinical environment where students will be able to draw on their emotional intelligence and empathy to improve their communication with patients and colleagues. Acknowledgments: The authors wish to thank the students who participated in the narrative medicine workshops for their thoughtful engagement with the material.