Enacting the Behavioral and Social Sciences in the Clinical Setting: Institution-Wide Teaching of Effective Team-Based Care The College of Physicians and Surgeons of Columbia University and the Weill- Cornell Medical Colleges propose to partner in a project to enhance what medical students learn about social sciences and behavioral sciences in their clinical training. The project will accomplish these aims in three broad ways: 1. Increase the amount of teaching offered to students in such topics as doctor- patient relationships, ethics and professionalism, understanding patients'lived experiences, and reflecting on their own practice. The schools plan to adopt innovative narrative methods to help medical students examine their own and their patients'experiences through reading, writing, and hearing the stories of others. These teaching efforts will take place in the hospital where students are themselves providing medical care to individual patients. 2. Increase the teaching skill of physicians and other medical school faculty in an intensive Faculty Scholarship Core. Committed teachers of social, cultural, interpersonal, and ethical dimensions of health care will be invited to work closely with their peers in developing effective teaching methods, creating new teaching approaches, pursuing their own scholarship and research in how medical students learn this material and how best it can be taught. They will be trained in scholarly and research methods so that they have the capacity to disseminate what they learn in academic presentations and publications, thereby improving the teaching of these materials widely. 3. Since the setting of care and the partners of care determine the nature of care, this project will pay great attention to the institutional culture of the teaching hospital in which the students train. Columbia and Cornell share the use of the NewYork-Presbyterian Hospital. The proposers of this project are already collaborating with nurses, social workers, public health professionals, and dentists who work in this hospital to improve team work and patient-centered care. The project would engage medical students in on-going team-based efforts throughout the hospital. Instead of being disillusioned by the indifference and greed of the """"""""real world"""""""" of the hospital, this project will expose medical students to the idealism and commitment that most health professionals hold to patients'well-being. A rigorous evaluation plan is proposed, relying on in-depth interviews with faculty and students, careful systematic description of the hospital culture by students in narrative writing and questionnaires, focus group methods to learn what groups of health care professionals think about the care they give. The project anticipates that its work will improve the education of medical students, strengthen the scholarship and pedagogy of faculty, and enable the hospital to deepen its commitment to team- based, respectful, patient-centered care.

Public Health Relevance

This proposal describes the continuation/renewal of the K07 grant awarded to Columbia University to enhance social and behavioral science teaching in medical school curricula. Columbia has partnered with Weill-Cornell Medical College in this five- year project. The aims, briefly, are to enhance the clinical teaching to medical students in the teaching hospital environment of NewYork-Presbyterian, the hospital these two medical schools share. The methods include introducing innovative clinical teaching methods-to attending rounds, bedside rounds, for example-and also to amplify the small group teaching done for students on clinical clerkships and fourth-year electives. Both Cornell and Columbia are inaugurating Scholarly Projects within concentration tracks, and several of the concentration tracks available for students'study are in such social and behavioral science areas as global health, population and community health, and ethics and narrative practice. A Faculty Scholarship Core will be instituted to further faculty's ability to design and evaluate innovative pedagogic methods. This Core will be the think-tank for the educational enhancements, while also serving as a professional development training program for the faculty. Among many pedagogic research projects to be taken up is the effort to design and evaluate an assessment scale for the narrative writing that students are coached to do. Narrative analysis of students'writing may offer a powerful means to track developments over time and to learn fresh knowledge about how our hospital and schools work. Finally, the project partners directly with NewYork-Presbyterian Hospital to identify and modestly support efforts at team-based and patient-centered care. Instead of considering the institutional culture as a negative force disillusioning students with real world indifference or greed, this project believes that most health care professionals who work in our hospital are deeply committed to quality care and dignified care. The project will engage medical students directly with these efforts so as to expose the idealism of health care professionals to their view. At sites of team-based care, the project will initiate narrative medicine sessions in which interdisciplinary teams can gather to look seriously at the work they do, using reflective writing as a door into perception and understanding. The project will be evaluated with a rigorous and careful multi-pronged strategy relying on in-depth interviews, focus groups, student surveys, and students'narrative descriptions of the hospital and of the work they do.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Education Projects (R25)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-BBBP-D (51))
Program Officer
Stoney, Catherine
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Fiscal Year
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Indirect Cost
Columbia University (N.Y.)
Internal Medicine/Medicine
Schools of Medicine
New York
United States
Zip Code
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Charon, Rita (2017) To See the Suffering. Acad Med 92:1668-1670
Charon, Rita; Hermann, Nellie; Devlin, Michael J (2016) Close Reading and Creative Writing in Clinical Education: Teaching Attention, Representation, and Affiliation. Acad Med 91:345-50
Devlin, Michael J; Richards, Boyd F; Cunningham, Hetty et al. (2015) ""Where Does the Circle End?"": Representation as a Critical Aspect of Reflection in Teaching Social and Behavioral Sciences in Medicine. Acad Psychiatry 39:669-77
Charon, Rita (2014) Narrative reciprocity. Hastings Cent Rep 44:S21-4
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Charon, Rita (2013) Narrative medicine in the international education of physicians. Presse Med 42:3-5
Hurwitz, Brian; Charon, Rita (2013) A narrative future for health care. Lancet 381:1886-7

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