Original Articles

The Power of Story Slams: A Mixed-Method Analysis of Narrative Medicine Connecting, Encouraging and Comforting Healthcare Trainees and Professionals

Amy D Stringer¹, Lisa Liu², Julia Marino³, Archana Mupparapu⁴, Anelisa Fergus⁴, Naomi Rosenberg⁵, Michael Vitez⁶, Brian Tuohy⁷

doi: http://dx.doi.org/ijms.2024.2182

Volume 12, Number 3: 239-245
Received 17 07 2023; Rev-request 17 10 2023; Rev-request 17 04 2024; Rev-recd 19 11 2023; Rev-recd 08 07 2024; Accepted 14 07 2024

ABSTRACT

Background:

Narratives convey information and emotion, evoke understanding, empathy, and connection. Healthcare professionals can use narratives to reduce burnout, benefiting them, patients, and colleagues. Story slams are narrative sharing events used for group reflection, providing an opportunity for participants and listeners to improve their well-being by processing complex emotions and identities. Story slams have traditionally been popular with creative writers and nonprofit organizations.

Methods:

Following a local event hosted by The Moth, the Temple University Lewis Katz School of Medicine (LKSOM) Narrative Medicine program hosted nine story slams over five years with 93 presenters including students and health systems staff. Through a mixed-method analysis, the authors examined the stories for thematic patterns and surveyed presenters to investigate how the experience had impacted markers such as job satisfaction, stress levels, and connection to patients. Eleven presenters were interviewed to provide additional information about the impact they experienced.

Results:

Patient-centered care, resilience, and the value of learning comprised over half of all themes presented. Following the event, many presenters experienced improved connections with patients, and everyone reported feeling neutral or increased satisfaction with their profession. The interviews conveyed participation, created a lasting impact, fostered a sense of community, and increased appreciation for diversity.

Conclusions:

Overall, story slams nourish humanity and promote diversity, enthusiasm, and encouragement. This study and others suggest that story slams are inexpensive and effective events that can help reduce burnout and provide academic medical centers with a way to restore and cultivate community among students, physicians, and staff.

Introduction

Stories convey information, understanding, insight, and wisdom while evoking emotion, compassion, and connection.^1,2 Stories are fundamental to medicine as patients communicate symptoms, feelings, and experiences to their provider. In turn providers relay vital information to patients and peers. Narrative Medicine aids healthcare professionals in understanding patients' conditions as it allows for a deeper comprehension of the patient's symptoms and diagnoses along with the impact their condition has on their lives, connecting providers to a shared mission that is focused on healing.^1,3 This approach to medicine strengthens the patient-doctor interaction by creating a relationship and increasing the provider's efficacy in addressing the patient's illness.^1,4,5

Furthermore, Narrative Medicine can be used to help combat burnout, a state of depersonalization and demotivation that is widely experienced in the medical community.⁶ Burnout among physicians is leading to increased negative patient outcomes, medical errors, and lower efficiency.⁷ Today's conventionally cognitively and emotionally demanding practice environment often leads to exhaustion in many specialties and across levels of training and experience with the rate of resident physician suicide estimated to be as high as four hundred per year.^7–11 Although harmful and widespread, burnout is partially preventable; more consideration, options, and resources must be supplied to combat it.

Interventions - both physician-directed and at the organizational level – have attempted to increase mindfulness, enhance job satisfaction or performance, and reduce work volume.^12,13 However, a 2017 review found some methods to be too brief, not widely used, costly, time-consuming to implement, and ineffective.¹⁴ Burnout is recognized as a problem, but with little information available about how to effectively address it.¹⁵

The incorporation of humanities into medical practice through the form of Narrative Medicine is therapeutic, ana potential avenue to aid in this dilemma.¹⁶ Expressive writing exercises have improved post-traumatic stress disorder symptoms, depression, and global psychopathology symptoms in healthcare workers impacted by the COVID-19 pandemic.¹⁷ Narrative-provoking interviews of resident physicians have been correlated with an improved sense of empathy for patients and treatment agency.¹⁸ A family medicine residency program found storytelling to be an easily implementable and effective way to enhance physicians' long-term well-being.¹⁹ All this evidence suggests that incorporating shared stories into a medical setting can be powerful.

Story slams are an example of a form of Narrative Medicine, originally created by the National Public Radio (NPR) program The Moth as open-mic storytelling events.^20,21 Story slams have been used by students and professionals in academic medicine as safe spaces to share their experiences in front of an audience of their peers. With the aim of decreasing burnout, LKSOM and other institutions, including University of Vermont's Larner College of Medicine (UVCOM), University of Massachusetts School of Medicine (UMSOM), University of Minnesota Medical School (UMN), and the American College of Physicians, have held these events for several years within their health systems and conducted post-event surveys of attendees with positive findings.^22–24 Research with an additional aspect beyond post-event surveys such as interviews of participants could permit more elaboration about the significance of their experience. This new source of data would allow for further analysis of the impact and aid in gathering information and suggestions for effectively implementing them across academic health systems.

Through a mixed-methods investigation that includes interviews, thematic analysis, and surveys, this research provides detailed information about the personal impact participation in story slams has on healthcare professionals and students. We aim to contribute further data to demonstrate the potential of story slams as an inspirational way to provide an effective and inexpensive avenue for reducing burnout and applying Narrative Medicine principles in busy medical centers. LKSOM hosted nine story slams between 2017 and 2022, with 93 individual storytellers. The intention of this study was to discover the themes that healthcare professionals presented and to learn how sharing stories affected them in a variety of domains, including empathy, patient care, physician wellness, humanity, listening ability, and sense of community. We sought to further enrich the argument for the role and value of story slams by obtaining a better understanding of the significance of these events for presenters.

Methods

Study Design and Sample

This was a mixed-method study involving survey response collection, thematic analysis, and semi-structured interviews with story slam event presenters. Presenters for each story slam were recruited through emails sent to faculty, staff, and students across Temple University Health System. All those who volunteered to present were both current and former students, faculty, staff, and physicians. (About the story slam: each event had a one-word theme (e.g. “strength”) to provide direction. Presenters were offered a workshop to help craft their story, which could be read from notes or memorized. Stories were about five minutes long and the events were about 2 hours long. Presenters were introduced by name, brief biography, and the title of their piece. At the end of each event, the audience voted for favorites and the top three presenters received a small prize. Food was provided. The population of interest for this investigation was presenters, therefore attendees were not surveyed or interviewed. We evaluated 93 stories presented, analyzed 52 survey responses, and interviewed 11 presenters. A schematic representation of our methodology with demographic information can be seen in Figure 2.

Thematic Analysis

To develop a list of themes, ten stories were randomly assigned to each team member. One main theme was assigned to each piece, based on the subjective opinion of the stories content, a list of present themes was then compiled, and definitions were created for each theme. These original ten pieces were reviewed by a different member to agree or disagree on the presence of a theme based on these definitions. From then on, each piece was viewed by two team members and had a theme assigned from the created list. The definitions are shown in Table 1 below. If novel themes emerged during the reviewing process, they were appended to the list. These definitions were refined as needed while reviewing stories.

Survey

We surveyed 96 participants via REDCap (Research Electronic Data Capture) (Vanderbilt, TN, USA), a secure web application for online surveys and databases, to investigate how the experience of presenting in a story slam had affected job satisfaction, feelings of community, sense of compassion, empathy and humanity, ability to listen, and interactions with patients. We asked if and how stress levels had changed, why they participated in the story slam, and how listening to other stories impacted them. For a confidence level of 95% and a maximum margin of error of 10% with a population size of 96, our target was a minimum of 49 completed surveys, we received 52 completed surveys. For data analysis, “Professionals” are defined as residents, attending physicians, nurses, and other staff, and “Students” are medical students from all four years of medical school training and post-baccalaureate students.

Interview Approach

We conducted 11 virtual semi-structured interviews lasting approximately 30 minutes each to acquire additional information about the impact of participating in a story slam. One team member conducted the interview for each participant while another acted as a recorder. An interview guide was designed to provide structure and consistency between interviews. Interviews elicited participants' open-ended opinions and assessments of the value of the story slam event and each interviewers' responses are represented in the results. Ethical approval for exempt, minimal risk human subjects research was obtained. This project was approved on Aug 31, 2021 by the Temple University IRB, protocol # 28591.

Results

Thematic Analysis

Of 114 individuals signed up to present, four (3.5%) were absent and 17 (14.9%) did not have recordings. The remaining 93 stories were viewed, and 16 themes were identified as defined in Table 1. Patient-centered care was found to be the most common theme, representing 25.6% of the total. Resilience was second-most common at 16.7%, followed by the value of learning at 10%. These three themes together sum to more than half of all themes identified. See Figure 1 for a breakdown of the total representation.

Figure 1.

Breakdown of the Story Themes.

Legend: 16 themes found from 93 stories. Analysis was done in 2022 at Temple University, PA, USA.

Figure 2.

Flow Diagram of Study Methodology

Survey

In 52 completed surveys, about 94% experienced neutral or improved connections with their patients, and 67% felt improved satisfaction with their current profession or schooling. All professionals reported feeling neutral or increased satisfaction with their profession. 92% reported acknowledging that their patients are humans not defined by their disease experience. 90% reported spending equal or more time listening to their patients' concerns, with 44% reporting more time. 90% experienced an equal or increased feeling of empathy for patients, 40% reporting an increase. About 77% of respondents reported feeling equally or less stressed at work. At the end of the survey individuals reported why they participated; some shared that “listening to others' stories was healing” and “participating allowed [them] to relate to other professionals in medicine.” They found the experience “rewarding and cathartic,” and listening to others' stories evoked feelings of “humility, amazement, pride, excitement, connection, inspiration, and empowerment.” Some claimed it helped to accentuate the humanity behind medicine and remind them why they chose this profession. These responses illustrate the role of story slams in improving well-being and fostering community.

Interviews

Several dominant themes emerged from the interviews: first, that participation had a lasting impact on the day-to-day life of the presenter; and second, that the events created a sense of community by uniting individuals within and across disciplines. In addition, interviewees reported that story slams increased their appreciation for diversity by exposing them to new perspectives.

Lasting Impacts

We found that lasting impacts were reported in a variety of ways, each unique to the individual presenters. One physician reported that his participation sparked his desire to write, resulting in the composition of autobiographical stories and reflections. Another faculty member who presented a story about a mentor who impacted her career as a woman in medicine later published her piece in a medical journal. After the event, one presenter was invited to speak at organizational and interdepartmental meetings and had her work published in a city newspaper. Another presenter was inspired to attend a creative writing class.

Commenting:

“I really loved the experience… I'm used to giving talks and lectures, but this was almost like stand-up comedy, and so it was very new to me and…it was the highlight of 2020…It was so revealing to me about my own feelings. It was kind of like this introspection…a safe place to explore and express my emotions."

These individuals not only went on to participate in further creative endeavors, but also gained an enhanced ability to reflect on their own experiences and present them to others. Participation in story slams encouraged introspection and thoughtfulness, and motivated these presenters to expand their public speaking and leadership experiences. The impact also appears to be enduring, with multiple respondents reporting effects several years after the event.

A Sense of Community

We found that a sense of community was fostered among presenters and their audience, bringing together practitioners of multiple disciplines and training levels. Some presenters directly connected with others during the event and recalled colleagues and classmates approaching them after the story slam to talk about their own experiences. One clinician said coworkers he had never met approached him for weeks after the event to thank him for sharing. These experiences provided many presenters with a chance to feel heard, recognized, and supported, which fostered a sense of comfort and belonging.

A Student Commented:

“I felt like everybody was rooting for me… You look in the audience and you see the connection that you have with people. You see them smile and laugh at your jokes; you see their heart literally full."

A Senior Doctor Commented:

“The idea of sharing stories… is healing. And it's connection. So often [physicians] look for validation and understanding. And storytelling does that. It connects us to one another. Watching others react to what we're sharing is where that validation occurs."

In addition to feeling connection, many individuals felt encouraged by their peers, decreasing feelings of isolation and burnout. Healthcare settings can often feel isolating, an effect which was amplified during the COVID-19 pandemic.²²

One Clinician Noted:

“It's a reminder we're all in this together. Particularly in such a lonely time, the idea of building community and trust is really important. Honestly, it's the best. I've been here for 12 years. This has been the best experience for pulling people together that I've seen.”

In addition, story slams have the potential to reach across generations, encouraging sympathy, empathy, community, and unity through the sharing of common experiences. One doctor, who had shared a deeply personal story about the death of his brother, said:

“A lot of our trainees have to sacrifice a lot of who they are as individuals in order to accomplish becoming a physician, particularly a good one. Dealing with personal grief and loss, while trying to do all this, is something that we all are doing and I figure there's a lot of suffering in silence and sadly there just probably isn't enough discussion. We all have lots of stories and we all learn from each other through those stories.”

Another Presenter Emphasized:

“I think in both medicine and medical education, you do a lot of studying and working… Events like this break that up and force people to move from their computer… and enjoy the company of others, enjoy the stories of others… That inherently builds community. Sharing stories, sharing feelings, sharing perspectives allows people to remember that they're not alone… Coming together when the world is online and being separated, there's a lot of value in that… Medicine sometimes feels very clinical, very scientific, very cold… Telling stories… about people's feelings, about people's experiences, challenges some of those expectations.”

Story slams help to relay the wisdom of senior physicians, who have already experienced the tolls and expectations of medical training, to students and other staff. Many medical professionals report that during medical training and practice, insufficient time is devoted to emotional processing - especially during training, when this emotional toll is profound.²³ By sharing intimate experiences with peers, healthcare students and professionals can begin this necessary emotional processing. There was an agreement among presenters that the experience restored them and helped them heal, and that they were inspired by shared vulnerabilities.

One Student Said:

“So many things are…stripping the humanity and subjectivity of medicine away. And I think storytelling allows us to restore that. There's a level of intimacy that you cultivate with an audience when you're sharing your work… and you're inviting people into your inner thoughts, your emotions, sometimes very vulnerable moments in your life.”

Story slams provide opportunities for validation and connection between individuals across many disciplines, bringing together students, senior physicians, teaching faculty, nurses, staff members, technicians, and social workers. These shared experiences provide belonging, understanding, and stress relief among healthcare professionals and students, with great potential to reduce burnout.

Appreciation for Diversity

Story slams foster an appreciation for diversity in age, race, background, specialty, and experience level. Many presenters considered story slams one of the few times in a hierarchical profession when faculty, students, attendings, residents, and other staff could come together as equals. Older faculty appreciated students' stories as a chance to reflect on past experiences and rejuvenate their spirits. Post-baccalaureate students were able to share experiences about their transitions. Senior faculty shared wisdom: one relayed the challenges of taking care of a patient at the beginning of the AIDS epidemic:

“[I wanted to] provide the audience with a perspective they had not heard, [such as] what you had to go through to get a patient taken care of… and contrast that with today… I think about [her] every time I offer a newly diagnosed patient with HIV a single-tablet option: “Take this and you will live for decades.”

Story slams are a valuable opportunity for presenters and audience members to hear stories from individuals in various stages of their careers.

Discussion

Participation in story slams significantly enhances the sense of community, connection, and humanity among medical professionals and students, which in turn improves patient care. Patient-centered care, resilience both in life and the healthcare environment, and the value of learning from our mistakes and peers are important topics for all professionals and students in healthcare. Our findings showed, bringing personal stories about these topics to an event during which they are shared contributes to a sense of belonging, community, and purpose. Moreover, they demonstrated that hearing the experiences of others informs us that we are not alone in our own experiences, providing comfort which leads to a reduction in feelings of isolation and despair, the core contributors to burnout.

The aforementioned institutions have been conducting story slams and have published results of post-event surveys. UMN found these events increased connectedness and fulfillment experienced by medical communities and personnel and that they are a way to positively impact wellbeing while fostering resilience and a sense of community throughout graduate medical education.^23,27 UVCOM's results indicated improved quality of work and reduction in feelings of burnout among healthcare professionals.²⁴ UMSOM's results demonstrated a decrease in emotional exhaustion and depersonalization, as well as an improved sense of professional development.²² All of these institutions demonstrated the utility, impact, and importance of story slams. Our work builds upon these studies and found through our survey that story slams have the potential to reduce burnout, increase job satisfaction, improve job performance, and improve patient outcomes. Our responses indicate increased feelings of connection, decreased stress, and improved satisfaction with medical training.

Beyond the survey responses, further detail was provided by the testimonials of interviewed presenters, who were able to elaborate upon the positive impact of participating in a story slam. These effects were not limited to storytellers; presenters recounted experiences of being approached by listeners, who often thanked them and wanted to further discuss what was shared, hence conveying a reduced sense of isolation and increased feelings of encouragement, creativity, community, unity, and connection.

Abstraction from our findings suggest that these inexpensive, simple events are powerful tools that can contribute to decreasing burnout in the academic healthcare community. Since 2017, LKSOM has experimented with annual or biannual events, which were optional to attend and had the added benefit of catered food. In 2020 and 2021, virtual events were held; in 2022, the organizers decided to return to an in-person event. We acknowledge that this study is produced by one institution, and results from events such as these can vary significantly and depend on many factors, such as attendance, educational level and demographic composition of participants, the number and size of institutions participating, and the atmosphere preceding and during the event. The measurement of impact from a survey or interview is potentially biased by the way the questions are phrased, therefore we attempted to control for this by using neutral language and a script for team members conducting interviews. It is imperative to keep in mind the intention of story slams is to bridge generations, disciplines, and professions, encouraging unity among participants. They bring people together, underscoring their humanity, helping them confront feelings of isolation, and creating a welcoming atmosphere. While other interventions may require weeks, multiple attempts, and involve complex coordination,²⁸ story slams are one-time events that are inexpensive and simple to plan and execute. Moreover, story slams have the potential to impact a large group with a single event, and to impact a diverse group of physicians and other medical community members. Instating these events regularly, either annually or more frequently, can provide these positive impacts not only immediately but also over time. For these reasons, we recommend their implementation in all academic medical facilities. Future research could focus on surveying and interviewing both presenters and listeners, in addition to creating a simple guide to be used by institutions interested in holding their own events.

The organizations that have implemented and analyzed the results from story slams have reported generally positive feedback and lasting impacts on their participants.^22–24,27 These studies together demonstrate wide applicability and the power of their implementation. Shared narrative events counter the traditional secrecy of generations trained the past, where there was an implication of weakness for seeking connection. Story slams can leave an impact that is personal and meaningful, reducing the feelings of isolation, despair, and meaninglessness characteristic of burnout.

Summary – Accelerating Translation

The Power of Story Slams: Connecting, Encouraging and Comforting Healthcare Trainees and Professionals sought to study narrative medicine events called story slams, for their effect on people within an academic medical facility. This was a mixed-method study involving survey response collection, thematic analysis, and semi-structured interviews with story slam event participants. We found that story slams are a means of nourishing those in healthcare, encouraging goodwill, community, and enthusiasm, and helping people feel valued. These one-time or annual events are inexpensive, simplistic, short-duration, and effective ways of decreasing burnout within the academic medical community, thereby benefiting not only physicians and staff but also the patients they serve.

Acknowledgments

The authors wish to thank Jillian Jatres for reading and editing our initial protocol for this project.

Conflict of Interest Statement & Funding

The Authors have no funding, financial relationships or conflicts of interest to disclose.

Author Contributions

Conceptualization: LL, JM, NR, MV. Methodology: ADS, LL, JM, NR, MV. Formal Analysis: ADS. Investigation: ADS, LL, JM, AM, AF, MV. Data Curation: MV. Writing – Original Draft: ADS, MV, BT. Writing – Review & Editing: ADS, LL, JM, NR, MV, BT. Visualization: ADS, LL, JM. Supervision: NR, MV, BT. Project Administration: NR, MV, BT.

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Amy D Stringer, 1 MS. Third year medical student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Lisa Liu, 2 Fourth year medical student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Julia Marino, 3 MS. Fourth year medical student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Archana Mupparapu, 4 Third year medical student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Anelisa Fergus, 4 Third year medical student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Naomi Rosenberg, 5 MD. Assistant Professor, Clinical Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Michael Vitez, 6 Assistant Director, Narrative Medicine Program, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

Brian Tuohy, 7 PhD. Assistant Professor, Center for Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.

About the Author: Amy Stringer is currently a third-year medical student at Lewis Katz School of Medicine in Philadelphia PA.

Correspondence: Amy D Stringer. Address: 3500 N Broad St, Philadelphia, PA 19140, USA. Email: amy.stringer@temple.edu

Editor: Francisco J. Bonilla-Escobar; Student Editors: Diego Carrion Alvarez, Rachna Shekhar & Eugenia M. Ramos-Dávila; Proofreader: Laeeqa Manji; Layout Editor: Julian A. Zapata-Rios; Process: Peer-reviewed

Cite as Stringer AD, Liu L, Marino J, Mupparapu A, Fergus A, Rosenberg N, et al. The Power of Story Slams: A Mixed-Method Analysis of Narrative Medicine Connecting, Encouraging and Comforting Healthcare Trainees and Professionals. Int J Med Stud. 2024 Jul-Sep;12(3):239-245.

Copyright © 2024 Stringer, Lisa Liu, Julia Marino, Archana Mupparapu, Anelisa Fergus, Naomi Rosenberg, Michael Vitez, Brian Tuohy

This work is licensed under a Creative Commons Attribution 4.0 International License.

International Journal of Medical Students, VOLUME 12, NUMBER 3, September 2024