Embedding narrative medicine into subspecialty training: A novel clinical rotation to foster humanism, empathy, and systems awareness Free

Introduction

Across medical subspecialties—including hematology—there is rising concern about declining empathy, burnout, and a disconnect between humanistic teaching and clinical practice. While most medical schools offer classroom-based instruction in ethics and the humanities, few provide protected opportunities for students to engage meaningfully with patients and families outside of traditional roles. We developed an immersive narrative medicine rotation designed to cultivate empathy, enhance communication skills, and build awareness of systemic barriers within the context of complex subspecialty care.Methods

We implemented a two-week elective rotation for third- and fourth-year medical students on a pediatric hematology/oncology service. Students were relieved of clinical responsibilities and instead spent time observing and interacting with children and families in diverse settings—outpatient clinics, inpatient units, waiting rooms, and procedural areas. They were encouraged to accompany families throughout the day and to engage in informal, unstructured dialogue. At the end of the rotation, students submitted a journal containing their daily narrative reflections. Rather than focusing on the medical aspects of cases, students were encouraged to reflect on their interactions, identify systems-level issues, and reflect on their personal feelings concerning patients and families in crisis. Using qualitative methods, a multidisciplinary research team reviewed the first 120 de-identified narratives collected between 2008 and 2019, identifying key themes by consensus.Results

Student narratives consistently reflected five central themes: (1) a deepening of empathic engagement; (2) enhanced ability to self-direct learning in unpredictable and emotionally charged environments; (3) recognition of meaningful communication during “non-clinical” moments such as waiting or play time; (4) nuanced appreciation for the psychological and logistical challenges facing families experiencing serious illness; and (5) increased awareness of system issues such as consent complexity, procedural delays, and disparities in resource access. Many students reported that the experience influenced their future specialty choice or shaped their approach to patient care. The reflections closely mapped to the seven core competencies of humanism as defined by the Arnold P. Gold Foundation (IECARES).Conclusions

This experiential narrative-based clinical rotation provides a replicable model for embedding humanistic, systems-aware education within subspecialty training. Though developed in a pediatric oncology setting, the structure and outcomes are generalizable across subspecialties, including adult and pediatric hematology. Such innovations may serve as effective countermeasures to empathy erosion, enhance communication competence, and support professional identity formation. Expanding this model to additional specialties offers a novel approach to workforce development by reinforcing meaning-making, reflective practice, and commitment to patient-centered care during formative stages of training.