Collecting stories of illness experience. An undergraduate medical curriculum to develop connectedness and togetherness with patients

In Western culture, medicine is currently conceived as a complex discipline (Berlin et al., 2017), based both on biological and human aspects, related respectively to hard and human sciences. All of these aspects are considered crucial, when caring for a patient (Zannini, 2008). The development of Western medicine (Foucault, 1969) has progressively emphasized the biological and “hard” component of medicine, focusing physicians’ competencies on identification and management of physical disease, namely on the sick part of the patient’s body. Thus, that development was based on separation of body from mind and on division of body in smaller and smaller parts. As a result, disconnection from emotions and therefore discontent were often registered in the medical practice. Soft skills, related to the ability of setting up a relationship with patients, were often relegated to the personal characteristics and private background of the physician. Consequently, in the Sixties, during the development of hard medicine, little attention was paid to the improvement of those competencies useful to create togetherness and connectedness with patients and other professionals, with evident consequences on patients’ and professionals’ discontents. For example, healthcare professionals’ burn-out and depression have been lately related also to their incapacity of remaining connected to the patients, the others, and themselves (McKenna et al. 2016). In the last decades, a renovated interest for human aspects of medicine has been registered (Cowen et al. 2016): developing “soft” skills is currently considered crucial in the medical education literature. Diverse pedagogical strategies could be chosen to develop those skills, including both emotional and cognitive elements. Enhancing the consideration of patients’ life stories and their illness experience can be a way to develop soft skills in medical students and therefore the competencies useful to develop connectedness (Charon, 2014; Arntfield et al., 2013). Moreover, training narrative abilities (West et al., 2007) will help future doctors give meaning to their experience (Bruner, 1990), without losing human aspects in clinical practice (West, 2001). Literature points out that remaining connected with personal and emotional experience is a key element to develop resilience (McKenna et al. 2016). The contribution will present a curriculum for 2nd year medical students (University of Milan, San Paolo Teaching Hospital). Started in 2009, the course is specifically oriented to develop soft skills during the preclinical years. During the second year, students are requested to go to the ward and gather a patient’s story of his/her illness experience, more similar to constructing an “illness biography” than “taking a history”. Then, they have to write the collected story using the first person: in this way, the biographical collection exercise is enriched by the effort of writing and identifying themselves with the patients, hopefully promoting empathy. Gathering illness stories is intended as a chance for students to gain an insight into patients’ world, experimenting a situation where they are requested to create togetherness with them (Engel, 2005). This paper will comment and discuss the students’ learning emerging from this writing experience, highlighting how it can contribute in creating connectedness with patients.