The Impact of a Four-Year Integrated Longitudinal Reflective Practice and Narrative Medicine Curriculum for Medical Students in the United States

Reflective Practice (RP) is a continuous process of analyzing one’s experiences to inform or change future practice. Narrative Medicine (NM) uses humanities-based methods like close reading and writing to enhance one’s ability to recognize, understand, and respond to patients’ and clinicians’ stories. Both RP and NM have been shown to professionally benefit medical trainees and healthcare providers. However, there is a paucity of published studies that describe the impact of longitudinal RP/NM curricula in medical schools. The Oregon Health & Science University (OHSU) School of Medicine curriculum includes a required four-year RP/NM curriculum. It consists of nine required sessions (seven small-group and two large-group sessions) across four years. Curricular activities include responding to prompts about patient care experiences via written notes and analyzing visual art pieces and poems. Two cohorts of medical students (Class of 2023 and 2024) completed two online surveys that assessed perspectives about RP (Survey A) and NM (Survey B) at five different timepoints during medical school. More than 600 (n = 617) post-session surveys (Survey A) were completed before didactics (Time 1), after didactics (Time 2), and after clinical rotations (Time 3), with a 66.7% response rate. Of these, 95.7% of respondents agreed that RP was an essential activity for physicians, and 85.7% indicated it was essential for medical students. We found a statistically significant increase in students practicing RP from the start of medical school compared to later time points. Survey B (response rate 81.7%) was completed during the clinical phase and indicated that students regard NM as a tool that improves their clinical skills (76.5%) and well-being (79.1%). Our study demonstrates a feasible, required, longitudinal RP/NM curriculum in undergraduate medical education that fosters students’ ability to understand and engage with narratives of self and other, to enhance personal and professional identity, and to meet the national standards of developing self-directed, lifelong, and reflective learners.