Narrative surgery: an innovative approach to surgical training

Purpose Narrative Medicine (NM) curricula have never been formally tailored to meet the needs of the general surgery resident. In this study we report on the creation, implementation and evaluation of a “Narrative Surgery” (NS) curriculum. Methods Forty- eight residents at an academic general surgery residency program participated in the NS curriculum. Twenty- eight narrative prompts with associated art/ literature were sent by email every 1–2 weeks between 08/2020 and 05/2021. Two 2- hour NS discussion sessions were held during protected teaching time. Focus groups for evaluation were held at the end of the academic year, led by impartial facilitators. Transcripts of the focus groups were analyzed by 3 independent reviewers. Results Twenty-two residents participated in the focus groups and were divided between 8 facilitators. Transcripts were analyzed by 3 reviewers. They created a codebook consisting of 21 codes and definitions based on resident responses. These codes were grouped during a second analysis phase into common themes using an inductive approach. Three primary themes emerged. One theme was “exploration of surgical culture” which was often affiliated with “bridging social differences.” Comments centered around how the NS curriculum helped participants identify the unique realities of surgical culture, the interplay between their own lives, and how to humanize their experiences. Another theme was a “shared sense of community” with affiliated themes of “increased conversations with resident peers,” “affiliation with shared experiences,” and an “increased sense of belonging.” Comments in this category pertained to camaraderie and commonality as a result of the NS curriculum. The last primary theme identified was “reflection on practice,” with the affiliated codes and ideas of “internal,” “reframing”, “seeing things differently”, “taking a step back”, and “validating emotions.” Comments within this theme dealt with residents processing their role in surgical culture and learning from their shared experiences. 86% of residents found the curriculum beneficial to their education. Thirty- two% stated they found the discussion sessions especially helpful. Sixty- eight % stated they would be interested in further coursework. Sixty- four % stated their participation was limited to reflection or discussion with peers. When asked how the curriculum could be improved, 45% of respondents desired more discussion sessions. Conclusions A NS curriculum can be successfully integrated into a general surgery residency program. This curriculum was warmly received, with high rates of satisfaction among participants.