From Telling to Teaching: Storytelling as a Training Method

1. From Telling to Teaching:Storytelling as a Training Method

2. A word is dead When it is said, Some say. I say it just Begins to live That day. Emily Dickinson

3. What this workshop is not • Evidence based • Medical model with high value on data • Linear • Objective • Based on traditional science • A therapy session

4. What This Workshop Is • Right-brained • Non-linear • Subjective • Perceptive • Connecting • Emotional • Storytelling is ephemeral, subjective, personal

5. “Medicine is not a science. Instead it is a rational, science-using, inter-level, interpretive activity undertaken for the care of a sick person” Kathryn Montgomery Hunter Doctors’ Stories The Narrative Structure of Medical Knowledge

6. Rules of Storytelling • Usual rules of confidentiality • Have fun • Embrace uncommon thoughts • Make eye contact • Be sincere and humble • Be vulnerable • Don’t resist connections

7. Snake vs. Squirrel

8. How do you obtain stories?

9. Exchanging stories • Listening • Reading • Writing • Media

10. How many times today have you told someone a story and they’ve told you a story in return?

11. Traditional elements of a story • A protagonist the listener cares about (Are we always the hero of our own stories?) • A catalyst compelling the protagonist to take action • Trials and tribulations • A turning point • A resolution

12. Storytelling Practice • Choose a story from your life, or a patient’s. • Think of the story in terms of the traditional elements: protagonist, catalyst, trials, turning point, resolution (if there is one). If no resolution think of what it might be. • Tell that story to your partner or group. Try to include what made the patient do something, what trials and tribulations resulted, what was the turning point, how did the patient resolve the story.

13. The storyteller: Whose story are you telling? • A first person story (an “I” story) is always about the “I.” • “When I first met John I didn’t think he’d live another week. I saw a thin man, looking much older than his stated age. I heard loud breath sounds. I…….” • The person telling the story is always in the listener’s line of vision.

14. Another point of view Narrative (Third person): “John was a 34 year old man who looked close to death. His skin was pale. His respirations were wheezy and labored. He stated he had been ill for about 2 weeks.” The third person narrator has all the information and puts the focus on the protagonist.

15. It’s Awkward • Avoiding full responsibility for the story (or action in the story) “After the abdomen was prepped and draped we made an incision….” “This social worker completed the ADAP form and submitted it….” The attempt to take yourself out of the story serves to focus the story on you

16. “The stories people tell have a way of taking care of them. If stories come to you, care for them and learn to give them away where they are needed. Sometimes a person needs a story more than food to stay alive. That is why we put these stories in each other’s memories.” Barry Lopez

17. The functions of stories…… • Make something difficult approachable • Build trust and support • Engage • Educate • Create a connection • Create empathy • Foster thinking out of the box • Bring meaning – “All suffering is bearable if it can be seen as part of a story.” • Containers of history (nation, tribe, family, individual, religion)

18. Story creates context. The context sets events in a time and place. “It was a dark and stormy night…” • When the context is set, the story begins to happen to real people who have relationships. • As a story is told we begin to put ourselves into it.

19. How will we use stories in the context of our HIV work?

20. To learn about a patient • To teach a patient or family • To teach each other • To provide information • To convey history • To explain

21. The time it takes……. • Sometimes stories are episodic and take a long time to emerge. • How do we keep the door open? • How do we remain patient? • Are we contributing to blocking the story?

22. More than wounded legs

23. Using stories for changeThe Yellow Leaf

24. Storytelling Exercise • Tell a story about a patient, yourself, family member or….. in which there is a negative outcome or no resolution. • Now, retell the story giving a more positive outcome or a resolution. This part may be done as a collaboration. • How might the new story be taught to the patient so it becomes part of his ongoing story ( For example: medication adherence, correct injection technique, diet changes)

25. An exercise about teaching

26. You are in a room full of people who know very little about HIV. • Rather than just giving facts, tell them a story (protagonist, catalyst, trials, turning point, outcome) about how HIV is transmitted and how it can be prevented.

28. TEN PATIENTS, AND ANOTHER I. Mrs. G. The patient is a sixty-odd-year-old White female, who presents with fever, cough, And shaking chills. No further history Could be elicited; she doesn’t speak. The patient’s social history was non- Contributory: someone left her here. The intern on the case heard crackles in Both lungs. An EKG was done, which showed A heart was beating in the normal sinus Rhythm, except for an occasional Dropped beat. An intravenous line was placed. The intern found a bruise behind her ear. She then became quite agitated, and Began to sob without producing tears. We think she’s dry. She’s resting quietly On Haldol, waiting for a bed upstairs.