BACKGROUND: Social context guides care; stories sustain meaning; neither is routinely prioritized in residency training . Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients . The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital . Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work .
METHODS: From 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019 , 1-15 months from the experience .
RESULTS : 46 (94 %) completed HTH consultations, of which 40 (87 %) were approved by patients and published in the EHR . 12 (46 %) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2 . Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine .
CONCLUSIONS: HTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work . Integration throughout training may further enhance impact.
Index: Co-production, Meaning in medicine, Narrative medicine, Social determinants of health, Social medicine