Impact of Early Implementation of Narrative Medicine Techniques on Patient Centered Attitudes of Medical Students

Teach MHP Students about obtaining the illness story and narrative medicine. This will be
done during the curriculum of the Medical Humanities class in the fall of 2016.

Recruit patients on units and floors in Shands University of Florida (UF) Health that may
potentially have patients that will be good candidates for enrollment in the patient
narratives. These may include pediatric hematology and oncology patients, adult hematology
and oncology patients, patients with diabetes, organ transplant patients, cystic fibrosis
patients, and rheumatologic disorder patients. Investigators will communicate with child
life/social workers, as well as faculty medical providers on these inpatient services to help
identify appropriate patients for referral and recruitment. These faculty members will obtain
authorization from the patient for the investigators to approach the patient regarding
recruitment.

Once a patient has been identified, a co-investigator will introduce the project to the
patient, review examples of the types of questions to be asked by the MHP student, provide
opportunity for questions, obtain informed consent, and provide them with the
patient-practitioner orientation scale (PPOS) for completion.

A MHP student will meet with the co-investigator, fill out the PPOS, and then interview the
patient. The co-investigator will be present for the interview, but the investigator would
like the MHP student to conduct the interview. The interview will be voice recorded with
encryption for later transcription.

Following the interview, a co-investigator will lead a discussion to determine patient and
student observations/opinions about such conversations. The co-investigator will address
differences in PPOS responses from patient vs student, without specifically revealing the
personal answers of each, and allow for discussion of how scales can be aligned to better the
patient-physician relationship. This discussion will be voice recorded for transcription and
qualitative analysis by the investigators

Following the interview, the MHP students will transcribe the patient narrative. During the
interview, the student and patient will agree on whether the narrative is written from the
first or third person point of view.

The initial informed consent will have a specific series of check boxes to address whether
the patient approves of dissemination of their story. This initial consent will specifically
state that this narrative will not be published prior to their approval of the final product.
The patient will also have the opportunity to declare which patient identifiers, if any, will
be changed for the publication. The narrative will be presented to the patient, who will then
have the opportunity to make changes and edits. If extensive edits are necessary, a
subsequent narrative will be presented to the patient for final approval prior to
publication. The investigators will make every effort to get the patient approval in person,
however because of the possibility of the patient being discharged before the narrative has
been composed, investigators will identify an acceptable method of communication with the
patient outside of the hospital (email, phone call) for this purpose. In the case of the
patient being discharged and needing to obtain approval, verbal approval over the phone will
be obtained by a co-investigator and a witness, and will keep this documentation in a binder
locked in the PI's office.

Following the completion of the interviews, the MHP students will meet for a focus group to
discuss as a group their observations from their patient encounters. This focus group will be
audio recorded and transcribed by the co-investigators for qualitative analysis

After all patient narratives have been completed, narratives may be published in an online or
book format, following the consent that the patient provided.

Inclusion Criteria:

- Patient inclusion criteria:

- Patient of Shands UF Health or Shands Children's hospital

- Children must be at least 8 years old

- Patients diagnosed with chronic or potentially life-limiting illnesses

- Patients must be English speaking

- Student Inclusion criteria

- UF students enrolled in the Medical Honors Program

- Medical Honors students must be up to date on HIPAA training and Confidentiality
statement agreement

- Students must take the Medical Humanities course

- UF college of medicine students

Exclusion Criteria:

- Patient exclusion criteria:

- Anyone that the medical social worker or Child life specialist feels would be
unwilling or unable to participate in the study

- Patients who at the time of interview are unfit to communicate (ex. Ventilated,
comatose)

- Patients less than eight years old

- Patients that do not speak English

- Student exclusion criteria:

- Students not enrolled in the UF College of Medicine

- Students not enrolled in the Medical Humanities course