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Primary Care Training Enhancement

Expanding Narrative Reflection to Students and Colleagues Session Overview

This module, which involves reflection and discussion, is intended for faculty of medical learners such as physician residency, nurse practitioner (NP) or physician assistant (PA) programs. It seeks to cultivate empathy in order to reduce burnout and improve personal wellness. Following a brief introduction on patient-centered history taking, discussion centers around images of medical trainees and clinical colleagues with participants writing imaginative narratives to explore the full story of the individuals in the images. The discussion that follows prompts participants to explore how being more student-centered and/or more cognizant of team dynamics and team culture can make primary care delivery more functional. This module fits well after a session about Narrative Medicine and before a session about Self-Compassion.

Session Length: 80 minutes

Prerequisite(s): Introduction to narratives in medicine

Learning Objectives - After completing this session, participants will be able to:

  • Explain the 5-step beginning to the patient-centered interview

  • Describe the differences between a symptom story, emotional story, and personal story in the context of a patient giving their history of present illness (fuller story)

  • Recall the NURS mnemonic for empathetic responses

  • Relate the full story approach to medical trainees and colleagues on the medical team

  • Reflect through a narrative exercise

  • Discuss how cultivating empathy for others impacts us

  • Develop ideas for how greater empathy can help transform primary care delivery


Author:  Vanessa Worley, MPAS, PA-C

School: University of Mount Union

Expanding Narrative Reflection - Session Facilitator Guide

Presentation - Expanding Narrative Reflection

Literature Sources for Students

Prior to the session, participants should read two articles:

  1. Empathy Decline and Its Reasons: A Systematic Review of Studies with Medical Students and Residents by Melanie Neumann, et al (doi: 10.1097/ACM.0b013e318221e615)  

  2. How to Create a Culture of Well-Being in Your Practice by Mark H. Greenwald (

Literature Sources for Instructors

In addition to the article above, helpful resources include:

  1. Narrative in Health Care: Healing Patient, Practitioners, Profession, and Community by John D. Engel, Joseph Zarconi, Lura L. Pethtel, and Sally A. Missimi

  2. Smith’s Patient-Centered Interviewing: An Evidence-Based Method by Auguste H. Fortin IV, Francesca C. Dwamena, Richard M. Frankel, and Robert C. Smith 

  3. The 5 Step Patient-Centered Beginning of the Medical Interview by Auguste H. Fortin IV