Nigel
Agree Tom's framework is excellent for an academic approach, but wonder if
registrars would be up to this given their lack of background in the
theoretical stuff. Here's a more rough and ready approach. It's dead easy.
Docs tell stories all the time. The problem is drawing out the learning
points, for which you need to impose a structure.
Get them to share a story in small groups (you or they set the topic, but
have all groups covering the same topic), then stop them and ask them to
draw out learning points on a structured sheet. A very simple way of doing
this is to use questions like:
How did the main characters FEEL at key events during the story?
Give the story a different ending. What has changed?
What are the learning points for you as a clinician? (could use PUNs =
patient's unmet needs or DENs = doctor's educational needs)
What are the learning points for practice and policy more generally?
---
You could then get groups to feed back to the wider group - NOT blow by
blow, but by asking "has any small group got a really good story that they
think we all should hear?" That question is I find a good one for group
work in general, and seems to allow the 'good teaching material' to rise to
the surface.
Looking at Tom's suggestion, I suspect you could link all this with video
work as well.
Trisha Greenhalgh
Professor of Primary Health Care
University College London
Room 410, Holborn Union Building
Highgate Hill, London N19 3UA
Tel 00 44 20 7288 3246
Fax 00 44 20 7281 8004
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-----Original Message-----
From: Researching and evaluating the use of narrative in health and
related fields [mailto:[log in to unmask]]On
Behalf Of Tom Wengraf
Sent: 04 November 2001 15:11
To: [log in to unmask]
Subject: Re: GPVTS Residential
Nigel Roper wrote:
> Dear All, I am contemplating how to develop the interest of my
>Colchester GPSHOs and GP >Registrars in narrative based madicine. We
>intend to have a 2 day course residential in Feb 2002. >Has anyone got
>any ideas about ways in which we can use experiential and collaborative
>learning >styles to foster an interest in Narrative Based Medicine?
>Yours sincerely, Nigel With Colchester >Course Organiser Hat On Today
Some ideas (even though as a non-medic I have to guess at the meaning of
your initials!):
Your short account doesn't clarify your purpose for the particular
categories you mention, so suggesting techniques to fulfill such
under-clarified purposes is hazardous. But here are some hastyu suggestions:
1) Training in eliciting narratives in interview by asking
narrative-focused questions. Chapter 6 of my 'Qualitative Research
Interviewing' tries to indicate the nature of such work. The more
experienced those at the workshop are in other types of questioning (e.g.
medical history extraction, counselling), the more difficult it will be for
them to learn 'questioning for narrative'. But considerable advance could
well be made in this experential learning task, especially if you have
somebody competent in this very specific interviewing practice.
2) Exploring how the same 'objective events' can be selected from and quite
different narrations made of them depending on what the narrator feels is
'safe' to tell. This can be done with trained actors -- or with videos of
selected narrative scenes -- or with selected sequences of 'objective
events' and exercises to multiply alternativew ways of telling them.
'Narrative therapy' particularly discusses ways in which new narrations
about old events can be fostered (not imposed). Chapter 12 of my
'Qualitative Research Interviewing' addresses the distinction between the
'lived life' and the 'told story' in a way which -- though much too
detailed for your current purposes -- might be suggestive. You could look
at p.272 for an example.
3) You could also look at examples of 'medical case histories' and consider
how a patient might want some different narrative to have been told about
him/her. Elliot Mishler has worked on 'medical interviews', but I haven't
read his early 'The discourse of medicine: dialectics of medical
interviews' (1984 Ablex).
4) Those involved in the residential could be asked to give 'short
narratives' of critical incidents in their professional lives which were
particularly 'striking' for whatever reason, and left them feeling that
they had learned something special from this or needed to learn something
special in order to understand that incident better and handle such
incidents better in the future. People can then be asked to take different
parts in the 'incident' and get some aspect or moment of the incident
'played differently'. You need something like a drama-therapy facilitator
to get the most out of such a powerful operation.
5) Experential learning can be fostered by (if you have easy access to
video-camera and playback facilities) by a process of Instant (Interview)
Process Recall. A narrative is elicited for 5-7 minutes and is videoed; the
two participants then play it back and either interviewer or interviewee
can stop the tape at any point, and ask a question to the other, or say
what was going on for them at that point, etc. This leads to a high level
of reflexivity and could certainly be applied to 'narrative in medicine'.
I hope (some of) these ideas are of some use.
Best wishes
Tom
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Tom Wengraf
24a Princes Avenue
Muswell Hill
London N10 3LR
UK
(44)/(0) 20 8883 9297 / 8444-4322
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