Online Certification of Professional Achievement Courses

In this course, students will learn the signature methods of narrative medicine: close reading paired with creative writing. The close reader takes all aspects of form and content of the text into account—plot, time, space, metaphor, narrative strategies, mood, and more. Close readers can become close listeners, able to recognize the meanings of what another person tells them. The goals are to strengthen participants’ capacity to listen with skill to patients as they tell of their experiences, to develop clinically-active empathy, and to form sturdy partnerships with patients throughout their care. Through the dynamics of joining in close reading and creative writing, the course participants will develop interpersonal professional relationships with one another that allow growing understanding of one another’s perspectives. At the same time, these methods lead powerfully to gradual self-understanding as health care professionals, teachers, readers, and writers. Such learning provides a model for health care team relationships, relationships with patients and families, and wider relationships with communities of health and health care.

Effective Narrative Medicine pedagogy depends on several related skills: teaching of close reading, guiding of creative writing, and developing of respectful climates of shared learning. Narrative Medicine is typically taught in small groups with continuity, establishment of trust, shared practices, and shared discovery. Not group therapy, effective narrative medicine pedagogy requires the facilitator to have sensible and sensitive skills in guiding groups toward cohesion and trust. This course guides participants in tailoring Narrative Medicine pedagogy to specific learners–health care professionals, students of the health professions, clinical trainees, patients, families, and those outside of health care settings. It will enable participants to articulate the goals of pedagogy of a particular learning project, to specify learning objectives, and to design a curriculum with the potential to reach its goals. Each participant in this course will be required to work on a project to design a specific learning experience during this course, stating its goals, articulating its learning objectives, and proposing a curriculum of texts and exercises.

As students learn the principles and practices of Narrative Medicine, qualitative research methods become essential tools in assessing their impact. The nature of most narrative medicine work–group process around writing, group facilitation, attentive listening, formulating probing questions to move conversations in more layered directions, sharing and responding to text–lends itself to qualitative research investigation and evaluation. Thus, this course will focus on qualitative methods of inquiry and analysis, including semi-structured in-depth interviews, focus groups, and participant observation. Students will read and discuss examples of qualitative studies and will have practical experience in executing some of the methods. They will learn how to choose research methods appropriate for evaluating particular narrative practices. Throughout the course, students will acquire the skills to delineate the connections between qualitative research methods and practice and those of Narrative Medicine, and to learn how to use qualitative methods in evaluating their Narrative Medicine workshop practice.

Stories are the primordial means through which we make sense of and convey the meaning of our lives. It is to this that the philosopher Paul Ricoeur points when he speaks of "life as an activity and a passion in search of a narrative." Indeed, for Ricoeur, a life is “the field of a constructive activity, by which we attempt to discover ... the narrative identity which constitutes us.” Narrative medicine arises from the awareness of this relation between narrativity and identity. Our principles and practices of intersubjectivity and relationally, our election of close reading as a signature method, our elevation of creativity in the work of healthcare, our collaborative teaching methods, and our narrative clinical practices all bear the mark of this centering commitment to comprehend and live in the light of this narrativity/identity reciprocity. Since illness and injury are among the most exposing experiences of the mortal life, the experiences that lift the veil on the large objects in the room of one's life, narrative medicine is present when a person urgently comes to face, or question, or embrace his or her identity. Who am I now suffering, now recovering, now dying? What matters to me now? In the face of this illness or injury, what is the best way forward in my life?

In this elective course we will investigate the reciprocity between narrative-understood as the form and means of storytelling-and ethics, particularly in the domain of illness, bioethics, and medical practice. This investigation will center on narrative ethics, a subdiscipline of bioethics that starts with the narrative accounts patients give of their singular situations-the tangle of values, meanings, choices, desires, and loves in this particular life or this particular death-in order to help them envision and then choose among the alternative futures ahead. We will position narrative ethics with respect to other bioethical frameworks, then study the work of theoreticians who have established the theoretical underpinnings of this field, highlighting the nature and limits of our ability to give a narrative account of ethical dilemmas. At the end, we will investigate the ways that narrative ethics brings attention to self-care as an ethical demand.

Narrative Medicine’s ultimate goal is to improve patient care for all. The inequities in health care access and effectiveness across populations are vast. As wealth inequalities increase, so do health disparities. Bias and prejudice influence health care at every level of organization from the private clinician-patient interaction to national decisions about research funding. Narrative Medicine offers multiple contributions to the movement toward health care justice. Through narrative means, this course will familiarize students with the concept of structural competency. Close reading of texts and films and responsive writing exercises offer effective ways to think together about how race, ethnicity, social class, ability, and sexual orientation, and other forms of difference (or sameness) can shape interactions between clinicians and patients. Texts and films are chosen that represent rich contextualizations, foreground and background, of interpersonal relationships and dynamics, in the clinic and outside it. 

What is creative writing for? Why do we do it, and how might we conceive of it in ways relevant to our practice of narrative medicine? This course explores the act of creative writing: how it is done, what it is for, how it works on our minds and bodies, and how it can be used to engender meaningful change in the clinical context. What really happens to one in the act and wake of writing? We will explore these questions by examining the craft of select creative writers and thinkers and through our own practice and close study of the craft.

Writing Creatively: Craft Lab and Workshop is one of the elective courses in the Narrative Medicine Certification of Professional. In particular, it provides hands-on guided experience in creative writing which—along with close reading and attention to telling and listening—is an essential element of the signature method of narrative medicine. Different to the discourses of literary theory and criticism, the immersion in creative writing seeks to arm the narrative medicine practitioner with an “inside out” experience of generating work, writing, revising, and responding to the work of others at a craft level. It complements and extends the process of prompted with the inclusion of the long-range revision process and in-depth exploration of craft—understanding how the writing does what it does.

The course will offer practice in reading and writing in three genres—poetry, creative nonfiction, and fiction. Each week there will be a discussion of select work of published writers along with a workshop of student-written material. Students are expected to engage with each other and with the instructor and to offer their questions, comments, insights, and analysis on all the assigned texts, on their own writing processes, and on the student workshop material brought to class. There are no prerequisites required in order for students to take this course.

This course examines questions such as: What does the telling and reading of narratives do for the ill or disabled individual? How can clinicians effectively elicit, interpret, and act upon such narratives? Who owns a story, and what is the role of co-authorship, power and witnessing in story-telling and story-listening? Whose voice do we hear?  What are the roles of power and hierarchy in story-telling and listening? What is the impact of familial, cultural, social, institutional, political contexts on the individual story? And finally, how can personal stories be translated to political advocacy and action? Texts assigned weekly will be broadly interdisciplinary – drawing from memoir, poetry, essays, fiction, feature and documentary films, narrative theory, and disability studies, exploring the relationship between disability/illness experience and narrative, and how this is an essential, practically applied element of narrative medicine study and how it is exemplary as a way to illustrate the impact of narrative study in shaping experience, opening awareness, and highlighting the need for change and new stories. Students should be prepared to engage with each other and with the instructor and to offer their questions, comments, insights, and analysis.

This workshop provides an intense immersion in the methods and skills of narrative medicine. Lectures will open up themes of how stories work, creativity, ethics, bearing witness, and empathy, while the small groups practice rigorous skills in close reading, creative writing, and responding to the writings of others. The learning objectives of the on-site workshops are to 1) provide personal contact to introduce and solidify intersubjective relationships among participants; 2) to ignite use of methods that have been and will be utilized in the online component, e.g., writing to prompts from literary texts and responding to both form and content of colleagues’ writing; 3) plenary lectures from the architects of the discipline of Narrative Medicine in the foundational theories to be studied; 4) scheduled cultural learning opportunities of New York City (music, museums, literary readings) for shared creative experiences; 5) contact with Master of Science in Narrative Medicine graduate program for certification participants toward their understanding of the breadth of the field and the potential for their continuing to study NM after the CPA; 6) introduction to the national and international reach of Columbia Narrative Medicine so that participants grasp the value and magnitude of the community they have entered as certification program students. Participants will be given the chance to present their own works-in-progress to assembled participants and faculty as a jump-start to collaborative projects during and after the participation in the certification program.