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Medical Education
Bridges Curriculum

Bridges Curriculum Group Explores Power of Story in Leadership

by Pooja Shah, UCSF Medical Student pshah@ucsf.edu

When J was diagnosed with lymphoma a decade ago, she sought care at an academic medical center. She was treated by exceptionally trained doctors who were able to provide the newest and most scientifically advanced treatment options. The treatment was rough, and her care felt impersonal, but in the end her lymphoma was in remission. Recently, nearly ten years later, the lymphoma returned and J sought treatment once again. Rather than returning to the impressive academic hospital, this time she went to a small community hospital closer to home. She was more comfortable with her care team, feeling that they listened to her concerns and addressed them at every step of her treatment. However, the facility lacked the means to provide cutting edge treatment. This choice, between technically expert and patient-centered care, is not unique to J. In 2013, why must individuals make this choice about their healthcare, and what does this say about the way physicians are trained to operate in the health system?

Last January, members of the UCSF Bridges Leadership and Design (BLD) committee, which included 41 clinicians, scientists, educators, students and leaders in health care, were assigned the charge of designing the successful 21st century physician. After many months of dialogue, the committee designed a list of activities and values to represent the changing role of the physician in the 21st century. Items on this list include, among others, accountability for continuously improving health systems and the ability to make use of data and technology in clinical decision-making. They reflect changes in our modern health system which medical education has been slow to adopt. They will serve as a framework upon which the UCSF Bridges Curriculum will be designed.

Randy Nelson, Director of Apple University
On October 30th, the UCSF Office of Medical Education held a capstone event to mark the end of the first phase of UCSF Bridges Curriculum development, and to celebrate and conclude the hard work of the BLD committee. Special guests Joel Podolny and Randy Nelson from Apple University, a division within Apple designed to develop leadership, in addition to other skills and knowledge among Apple employees, were invited to lead BLD committee members in a workshop titled “The Power of Story”.

Storytelling has been an important aspect of the BLD committee since the beginning of their work to create a motivation or sense of urgency for change.  Early in their work, members of BLD were asked to tell a story about a time they or a family member experienced a gap in the health care system. The group mapped the health systems gaps found in each story, and used these maps to determine the characteristics the successful 21st century physician would need to close these gaps. 

Podolny and Nelson, who are Dean and Director of Apple University, respectively, offered a perspective on the role of storytelling as a leadership tool from outside the healthcare field.

“Story is humankind’s oldest change management technique,” Nelson said. He explained that in any industry, from healthcare to technology, leaders are looking for ways to amplify their potential for change. “Storytelling is about shared experiences and humanity. If you can craft better stories, you have more leverage to make powerful change with the actions you take.”

Nelson’s comments were relevant for the audience of scientists, clinicians and health care providers, not only as a tool to garner support for the UCSF Bridges Curriculum, but also as a reminder that storytelling is at the heart of all patient encounters.

“One of the things that forms professional identity is the story we tell about ourselves,” Phaedra Bell, Director of Undergraduate Medical Education, said. “The 21st century physician needs to recognize who the protagonist is in these stories. We need to shift from writing the physician as the protagonist, to writing the patient as the protagonist.”

Joe Derisi, PhD, Professor of Biochemistry and Biophysics and Howard Hughes Investigator tells his team's version of a health care story along with Maxine Papadakis, MD, Associate Dean for Student Affairs
During the event, BLD members participated in an activity in which they revisited the stories they had written in January. In the process of restructuring the stories to frame the patient as the protagonist, they found that the narrative often shifted to reflect some of the values they had identified as characteristic of the successful 21st century physician. It became clear that patient-centered care was consistent with making the patient the hero – the character the reader identifies with the most in the stories we tell about our health system.

A story of a physician, frustrated from a decade of not being able to improve the health of a chronically ill opioid addict, became a narrative of a patient who was supported by a robust team of clinicians and healthcare workers. A story of a young woman who benefitted from modern lymphoma treatment, only to later succumb to metastatic breast cancer from radiation exposure, became a narrative about a system in which care that is scientifically advanced and patient-centered is not mutually exclusive.

This idea of the shared experience is one of the principal components of a compelling story, as told by Nelson. “An audience will respond to story if they learn something about their own human experience.”

Yet the practice of writing the patient’s experience as universally human asks the storyteller to think of the patient differently than the healthcare system has traditionally done. It makes the physician’s motivations and limitations secondary to the patient’s, and as some attendees of the event noted, completely reframes the physician-patient interaction.

“Every person has stories about what brought them to the healthcare setting, both providers and patients,” Helen Loeser, Director of the Academy of Medical Educators, said. “If we don’t learn how to listen to our patient’s stories, we cannot be a part of their healing.”

One of Nelson’s take-away messages of the event was that great stories differ from transient ones in the attention that the storyteller pays to developing the details of the world in which the story takes place.

“Every story’s world has rules. The rules of the world provide limits to what our characters can do,” he said.

Although patient-centered medicine is not an idea novel to UCSF or the Bridges Curriculum, the development of Bridges is driven by the idea that the rules of the current healthcare “world” may limit the way physicians are able to achieve patient-centeredness. The activities of the 21st century physician developed by the BLD committee, namely continuous systems improvement and interprofessional teamwork, herald a changing framework for medical education which trains physicians to operate in a healthcare system that truly puts the patient first. Moving forward, it remains to be seen how students and educators will adapt to a culture and system in which physicians are cast as supporting characters, rather than the heroes, in our healthcare stories.