Humanities Education

A Conceptual Framework for the Use of

Illness Narratives in Medical Education
Arno K. Kumagai, MD

Abstract
The use of narratives, including
physicians and patients stories,
literature, and film, is increasingly
popular in medical education. There is,
however, a need for an overarching
conceptual framework to guide these
efforts, which are often dismissed as
soft and placed at the margins of
medical school curricula. The purpose of
this article is to describe the conceptual
basis for an approach to patient-centered
medical education and narrative
medicine initiated at the University of
Michigan Medical School in the fall

of 2003. This approach, the Family

Centered Experience, involves home visits
and conversations between beginning
medical students and patient volunteers
and their families and is aimed at
fostering humanism in medicine. The
program incorporates developmental and
learning theory, longitudinal interactions
with individuals with chronic illness,
reflective learning, and small-group
discussions to explore the experience of
illness and its care. The author describes
a grounding of this approach in theories
of empathy and moral development and

Editors Note: A Commentary on this

article appears on page 625 of this issue.

The underlying principles of such efforts

emphasize humanism, empathy,
interpersonal connections, patient
autonomy, and dignity.1,2,79 There is
currently a plethora of ways in which
narratives in particular2,10 and humanities
and the arts in generalincluding
literature,7,11 music,3 and visual art12
are being incorporated into medical
education; however, the mere presence of
nontraditional material does not guarantee
that exposure to these subjects will result in
more compassionate doctors. Given that
resources are limited, and curricular
time is a precious commodity, there is a
compelling need for an overarching
conceptual framework to guide the
educational efforts to introduce humanistic
principles into medical education.

t its core, medicine is a type of

applied humanism, that is, the
application of science in recognition of
human values and in the service of
human needs. As defined by Branch and
colleagues,1 humanism in medicine is
the physicians attitudes and actions that
demonstrate interest in, and respect for,
the patient and that address the patients
concerns and values. Within the larger
context of introducing humanistic
approaches to patient care as part of
medical training, many institutions,
including our own, have incorporated
narratives into the curriculum.1 6 The
goal of these efforts is to introduce the
patients perspective into the students
understanding of illness in order to train
physicians to adopt more patientcentered or relationship-centered
approaches to delivery of medical care.

Dr. Kumagai is associate professor, Departments

of Internal Medicine and Medical Education and
Office of Medical Education, and director, Family
Centered Experience Program and Longitudinal Case
Studies, University of Michigan Medical School, Ann
Arbor, Michigan.
Correspondence should be addressed to Dr.
Kumagai, 3901 Learning Resource Center #0726,
University of Michigan Medical School, Ann Arbor,
MI 48109-0726; telephone: (734) 615-4886; fax:
(734) 936-2236; e-mail: (akumagai@umich.edu).

Academic Medicine, Vol. 83, No. 7 / July 2008

In this article, I would like to propose an

approach to the use of narrative in medical
education that is grounded in theories of
moral development and empathy, and to
suggest specific pedagogical techniques that
may effectively incorporate these theories
into educational practice. As an example of
how this approach may be implemented
into actual curricular changes, I will
describe The Family Centered Experience, a
program started at the University of
Michigan Medical School in the fall of
2003, which uses patient narratives to
enhance the development of empathy in
physicians-in-training.

clarifies the educational value that

narratives bring to medical education.
Specific pedagogical considerations,
including use of activities to create
cognitive disequilibrium and the
concept of transformative learning, are
also discussed and may be applied to
narrative medicine, professionalism,
multicultural education, medical ethics,
and other subject areas in medical
education that address individuals and
their health care needs in society.
Acad Med. 2008; 83:653658.

The Development of Empathy

To understand and design educational

approaches to fostering empathy in
physicians-in-training, the nature and
development of empathy should first be
understood. Empathy may be generally
defined as the capacity or action of
understanding, being aware of, or
sensitive to, or vicariously experiencing
the feelings, thoughts or experiences of
another.13 Implicit within this definition
is the idea of individuals as social beings;
and as a positive social attribute, the
concept of empathy validates the
relationships that are at the core of
human interactions and is, therefore,
intimately connected with the concept of
moral development.
Throughout history, all societies and
cultures have generated ethical principles
and codes of conduct in order to
reconcile individual self-interest with that
of the group. More recently, cognitivedevelopmental theoristsmost notably
Jean Piaget,14 Lawrence Kohlberg,15 and
their successors16 have proposed
models in which the development of the
self is intimately linked with discovery of
the other. Development, according to
these theories, occurs in an invariant
sequence of stages that in part involves
the gradual recognition that other
individuals have perspectives and values
which differ from ones own. A
fundamental aspect of these different

653

Humanities Education

stages is a reconciliation of self-interest

with that of others, that is, the gradual
acquisition of skills in exercising
self-interest in the context of a society of
similarly motivated individuals. Both
Piaget and Kohlberg see progression
through each of their respective
developmental stages as occurring in a
cognitive, rather than affective, domain;
that is, although both thinkers stress the
importance of social interaction in moral
development, both see individual moral
development as a cognitive process,
largely divorced from the feelings that
those experiences evoke.14,15,17
So, how can we reconcile cognitive moral
development with the development of
empathy, which, as described above,
involves the affective, vicarious
identification with another individuals
experiences? Developmental psychologist
Martin L. Hoffman17 directly addresses
this question by proposing a model that
incorporates both cognitive and affective
processes in the development of empathy.
Hoffman17(p30) defines empathy as
involving psychological processes that
make an individual have feelings that are
more congruent with anothers situation
than with his or her own. Following
the constructivist tradition of Piaget
and Kohlberg, Hoffman places the
development of empathy into the general
context of development of the self, from
an unclear self/other differentiation to a
growing awareness of the separateness
of self and others physical states, internal
states, and, finally, thoughts, values,
perspectives, and lives. Though he adds an
affective dimension to his theory of
development that is not present in
Piagets14 and Kohlbergs15 approaches,
Hoffman17 shares their constructivist view
of development as a series of chronological
stages, which are grouped into early,
unconsciousness reactions and more
mature, higher-level conscious reactions.
According to Hoffman,17(p4) a key aspect
of empathy is empathic distress, which he
defines as the psychological discomfort
that one feels when encountering
someone who is suffering. The response
to empathic distress may take the form of
one of several reactions, depending on
the individuals developmental stage.
Early reactions in infants are involuntary,
rapid, and do not involve cognitive
awareness. Beginning with older children
and adolescents, responses may include
mediated association, in which an

654

individual may feel empathy towards the

sufferings of another without the others
being physically present; that is, a
response to another individuals distress
may be elicited through language, such as
stories, songs, movies, etc., or pictorial
representation, such as photographs or
paintings. Such mediated association
requires recognition of the other, an
ability to adopt the others perspective,
and consideration of the others
experiences in light of ones own
experiences and values. More advanced
stages involving conscious modes of
empathywhich are more pertinent to
adult learninginclude role-taking,
which may consist of self-directed roletaking, wherein someone elses experience
elicits a response in which the individual
imagines how he or she would feel in a
similar situation, and other-directed
role-taking, wherein another persons
experiences elicit a response in which the
individual imagines how he or she would
feel in a similar situation while taking the
other persons life context into account.
Like Kohlberg, Hoffman envisions a close
association between empathy and justice.
According to Hoffman,17(pp250 275) in its
more mature manifestations, empathy
towards a distressed or disadvantaged
group may take the form of a
commitment to social justice, with an
implicit recognition of the value that each
individual has within the group.
Hoffman17(p87) maintains that
maturation of the empathic response also
involves the gradual transformation of
empathic distress into sympathetic
distress. The initial feelings of distress at
the sight of someone who is suffering
gradually mature into a feeling of
concern for the other person, and the
motive to comfort oneself (i.e., to
relieve ones own empathic distress) is
transformed into a desire to help. This
response is both affective and cognitive in
that the emotional response is coupled
with a cognitive awareness of oneself and
others as separate, independent entities.
Hoffman17(p80 81) also proposes that in
the more mature stages of empathic
development, sympathetic distress
may be enhanced by so-called hot
cognitions, that is, situations in which the
plight of another person triggers the
recollection in the observer of a similar
event or situation in his or her past. This
recall is thus charged with affect, and the
person may respond by either self-directed
or other-directed role-taking.

The Family Centered Experience

With an understanding of the nature and

developmental aspects of empathy, we
may now consider the value that
narrative brings to medical education. I
would like to do so by discussing
these themes within the context of the
Family Centered Experience (FCE), a
comprehensive, required, two-year
program at the University of Michigan
Medical School that uses patient
narratives to foster humanistic, patientcentered approaches to medicine.4 In the
FCE, pairs of first- and second-year
medical students make home visits to
families of individuals with chronic
illness to listen to stories of the
volunteers experiences with chronic
illness and its care. Three visits per year
are scheduled with the same family for
the two years of the program, and the
visits are organized according to different
themes pertaining to the experience of
illness, for instance, the impact of illness
on the self and family; the relationship
between doctors and patients; receiving
bad news; stigma and illness; and
resources and obstacles in accessing and
receiving health care.
After each of the home visits, students
meet in small groups of 10 to 12 students
with a faculty clinician facilitator. To
foster and maintain an environment of
safety for discussions of highly personal
or emotionally charged issues within each
group, the small groups and their
clinician instructor remain the same
throughout the two years of the course,
and the instructors undergo extensive
faculty development in topics as diverse
as interactive teaching, active learning,
facilitation of contentious or difficult
discussions, and feedback and
evaluation.18 Through interactive,
student-led discussions, the students
share impressions and insights generated
from their conversations with their
volunteers and engage in activities, such
as role-playing or perspective-taking
exercises, that are designed to help the
participants bring their own personal
experiences, assumptions, and biases into
the discussions. Exchanges are enhanced
by readings from literature and the social
sciences, preparatory reflective essays,
and free-form interpretive projects.
The latter involve collaborative work by
pairs of first-year students, with the
objective of expressing the students
personal understanding of their
volunteers perspective and experiences

Academic Medicine, Vol. 83, No. 7 / July 2008

Humanities Education

using a wide variety of media. These

efforts have resulted in original works as
varied as multimedia presentations, short
stories, one-act plays, songs, music,
dance, sculpture, paintings, and minidocumentaries.
Twice yearly, students are evaluated
by the depth and quality of their
understanding and insights regarding the
patients experience of illness, as well as
their readiness to engage in self-reflection
as part of the learning process. The basis
for these assessments is the quality of
their reflective essays and contributions
to the discussions. Patients feedback
about the students with whom they share
their stories is also a critical element in
student assessments. The activities of
the FCE serve as a foundation for the
students to explore the patients
perspective; the programs ultimate aim is
to train physicians who are equally skilled
in understanding both the complexities
of clinical medicine and the personal,
cultural, and psychosocial aspects of
illness and its care.4

Empathy and Narrative: The FCEs

Pedagogical Approach

Although we often speak of medical

education in terms of the acquisition of
knowledge and skills, it is clearly much
more than that. As described by Hafferty
and others,19,20 the development of
physicians is shaped by a hidden
curriculum, which, through role
modeling, informal conversations,
expectations, and social norms, exerts a
powerful influence both beneficial and
pernicious on the attitudes, values, and
behavior of physicians-in-training. The
culture of medical training affects the
meaning of medicine that individual
physicians develop, and, in this
environment, learning occurs on
cognitive, affective, and experiential
levels. Shaping the ways in which
students learn the meaning of medicine
is, therefore, a critical part of medical
education. One of the ways in which
meaning is learned is through stories. In
fact, in the context of human history and
culture, stories arguably represent the
most effective vehicle that human beings
use to communicate the meaning of an
existentially important experience to one
another. Stories may therefore foster and
develop empathy in physicians-intraining in a number of critical ways.

Academic Medicine, Vol. 83, No. 7 / July 2008

First, narratives of illness offer a glimpse

into the subjective experience of illness;
they offer an entry into the kingdom
of the sickin Susan Sontags21
wordsand, in doing so, provide a
complementary perspective to the
biomedical knowledge acquired through
the study of disease processes.2,7,8(p206) As
such, narratives may stimulate mediated
empathic associations and responses in
the listener, even in the absence of the
individual who suffers. If, however,
actual people (e.g., individual patients)
participate in the educational experience,
the physical presence of, and interactions
with, another human being whose life is
profoundly affected by chronic illness, as
well as the story he or she tells, may
foster an interpersonal link in affective,
cognitive, and experiential domains. This,
in turn, will enhance perspective taking,
stimulate other-directed role taking, and
serve as the basis for a hot cognition17 for
empathic feelings between the learner
and another individual. Daloz22 refers to
this type of interaction as a constructive
engagement with otherness in which the
listener may form a personal attachment
with someone previously viewed as very
different from himself or herself. This
opportunity to develop perspective taking
is particularly important for those
students who have not had any personal
experience with significant illness or
injury and who may look on patients
from the privileged position of youth or
health. In contrast, the often twodimensional individual patients
portrayed in paper-based cases do not
allow for true interpersonal interactions,
and, because of the medically based
language in which the cases are often
written, they may actually dehumanize
the patient and minimize observers
appreciation of the patients suffering.23,24
In the FCE, we4 have found that a faceto-face conversation with an individual
with chronic illness, as well as with
members of his or her family, add
complexity to the learners understanding
of the experience of illness by offering the
opportunity to meet the patient in what
Kleinman8(p206) has described as the
messy, confusing, always special context
of lived experience. In a recent study,25 a
second-year student who had worked
with a volunteer with diabetes and
advanced complications remarked,
Our patient had diabetic neuropathy: she
has prostheses for her feet, she had a
kidney transplant, and shes had eye

problems from it too. . . . [T]hese were

permanent things I really didnt know
could really occur. Even after we learned
about it in class, it really doesnt strike
you until you see it. Like every day she
still cant stand on her feet, she has to use
prostheses. If you go visit her at her
house, she has to wear these shoes to walk
around or get up to see someone.

From such encounters, students may

acquire an understanding of chronic
illness that is personal and immediate
rather than abstract and statistical:
their knowledge of the illness is
emotionally and empathically charged
from the personal relationship which
develops between student and patient
storyteller. In addition, comparison of
the stories of different individuals with
the same medical condition (e.g., breast
cancer, multiple sclerosis, or type 1
diabetes) may serve to underscore the
diversity of backgrounds, beliefs, and
human responses to chronic illness in
such a way that the particular (e.g., an
individual with chronic illness), as well as
the general (the spectrum of human
experience), may be explored.4
Second, very closely linked with their
ability to foster perspective taking,
narratives derive their power to
communicate meaning in part through
their ability to appeal to fundamental,
universally held emotionsloss, anger,
jealousy, joy, sadness, a sense of injustice,
etc. This appeal gives hot cognitions their
psychological and emotional force and
may arouse a sense of urgency in the
listener to address the causes of an
individuals suffering. In addition, when
coupled with a moral dilemma or
evidence of inequality, this type of hot
cognition may inspire a commitment to
understand and address causes of social
injustice.17(p250 275) Recognition of the
universality of emotions may span the
distance created by time, language,
culture, race, socioeconomic class,
gender, or sexual orientation to evoke a
shock of recognition within the self for
the emotions, struggles, and life of a very
different other.26
Third, narratives have the ability to
foster identification with the other;
however, in presenting ideas, beliefs, life
circumstances, or perspectives that are
not congruent with ones own, certain
narratives also create emotional or
cognitive dissonance within the self. By
posing morally ambiguous or conflicting
situations or situations which challenge

655

Humanities Education

the validity of ones worldview, certain

stories stimulate self-reflection on ones
own perspectives, values, and biases and
are all the more powerful in doing so
because of their link with fundamental
processes in learning and moral
development. Both Piaget27 and
Kohlberg15 believe that progress from one
developmental stage to another is
initiated by a cognitive disequilibrium,
which occurs when an individual
encounters unfamiliar or new ideas,
values, perspectives, or circumstances.
This conflict stimulates self-reflection, as
well as a heightened awareness of oneself
and others in the world, and it results
in new learning on a fundamental
level which incorporates these new
perspectives into ones own worldview.
The importance of this concept is
underscored by its prominence in the
work of other theorists as varied as
Hoffman,17 Mezirow,28 Freire,29 Giroux,30
and Habermas.31 I would propose that
this is also the mechanism underlying the
educational importance of Branch et
als32 critical incident reports, Boltons7
meaningful moral dilemmas, or Wear
and Nixons33 view of literatures ability
to evoke discomfort and vulnerability.
These approaches may be used to
stimulate critical self-reflection and
engaged discussion on questions of
humanism, patient care, professionalism,
ethics, and social justice.
An example of the use of narrative to
provoke cognitive disequilibrium can be
found in Fadimans34 Spirit Catches You
and You Fall Down, a text we use in the
FCE. The conflicts between the family of
Lia Lee, who is Hmong, and their white
American pediatricians, Neil Ernst and
Peggy Phillips, are all the more tragic, not
because one party is absolutely wrong,
but because both parties are partially
right. The best intentions of each,
nonetheless, result in devastating
consequences. This conflict between two
rightsthe Lees and their doctors
create divided loyalties in the thoughtful
reader and provoke reflection on ones
own perspectives and values. They force
the question, What would I do if I were
the Lees or their pediatricians?
In the FCE, we also incorporate this
concept in small-group interactions
through the instructors posing of
questions or introducing examples of
clinical situations which involve ethical
conflicts, ambiguities, or controversies in

656

order to stimulate thoughtful discussion.

In this setting, the instructors are trained
to gently challenge the students
preconceptions and biases regarding
illness, disability, medical care, and
doctoring in order to stimulate an honest
exploration of their own, each others,
and societys assumptions, values, and
beliefs.18 This type of engaged discussion
may be achieved productively within
the small groups because of their
longitudinal nature and fostering of trust
within the groups, the confidentiality
of each groups discussions, close
monitoring by faculty instructors, and
ground rules established early on by
each group.
As mentioned above, in the small groups,
we aim for the creation of reflective
discussion to explore the insights the
students have gained from the stories of
their volunteers. Mezirow35(p11) defines
reflective discourse as a critical
assessment of assumptions [that] leads
towards a clearer understanding by
tapping collective experience to arrive at
a tentative best judgment. Reflective
discourse is not mere discussion of a
particular subject. Rather, it is the
collective engagement of diverse personal
identities, values, life experiences,
and beliefs in developing a deeper
understanding of the meaning of an
experience. I would agree with Branchs36
assertion that small-group discussions
are superior to lecture-type formats in
fostering ethical, humanistic professional
identities among physicians-in-training
in part through their capacity to
stimulate active self-reflection and
engagement with others. In addition to
self-reflection, and critical to this type of
discourse, are an openness to a diversity
of views, participation of traditionally
silenced voices (e.g., women, students
of color, gay/lesbian students), empathic
and active listening, and suspension of
judgment. By giving voice to different
perspectives, the group becomes open
to diverse (and, at times, divergent)
worldviews, which may enhance growing
and learning through cognitive
disequilibrium27 and consensus building
through engaged discourse as the basis
for moral action.31 In this setting, the
instructors role is not to impart
information but to facilitate discussion
and pose questions that stimulate deeper
exploration of the themes.18,29,35,37

Beyond Professionalism:
Transformative Medical
Education

Empathy, which is at the core of patientcentered, humanistic approaches to

medicine, is based on the vicarious
identification with another individuals
suffering. Fostering this quality in
physicians-in-training requires more
than an acquisition of knowledge, skills
in communication, or lists of codes of
behavior: it involves a transformation of
perspective and activities that stimulate
self-reflection and engaged discourse, an
internalization of humanistic values, a
critical exploration of ones own and
societys assumptions, biases, and values,
and a commitment to enact the values
that the profession espouses.33,38,39
The type of learning that the use of
narratives attempts to enhance is,
thus, fundamentally different than
that involved in the teaching of the
biomedical sciences. It is transformative:
it consists of a process that involves
learning on cognitive, affective, and
experiential levels and results in a shift in
nonverbalized, habitual, taken-forgranted frames of reference towards a
perspective that is more open, reflective,
and capable of change.28 This shift in
perspective is not limited to a particular
subject but encompasses a wholly
different way of seeing oneself in
relationship to others and the world. For
example, after listening with openness
and sincerity to a familys story of their
thoughts, feelings, and fears surrounding
the diagnosis of type 1 diabetes mellitus
in their 10-year-old daughter, a medical
student, whose prior understanding of
the disease has been limited to a
knowledge of pathophysiological
mechanisms and insulin therapy, may
begin to understand that diabetes isnt
just about blood sugars but that it
represents an entire way of living in
which each minute of each day involves
choices, risks, and restrictions.25 Through
the story and through the self-reflection
and discussion the story may provoke,
the students awareness of the patient and
the family may change such that there
is a shift from a purely instrumental,
cognitive knowledge of the biomedical
sciences to knowledge that incorporates
an understanding of biological processes
into an orientation associated with
serving human needs.40 This shift
represents not a change in beliefs about
diabetes but a change in the frame of

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Humanities Education

reference with which the student

approaches individuals with diabetes in
particular and, with additional discussion
and insight, individuals with chronic
disease in general.25 With this awareness,
the doctorpatient relationship changes
from subject-to-object communication
to intersubjective communication and
action: the patient is no longer reified as
an object to be worked on but an active
subject to be worked with.
So, how do we know whether efforts
incorporating narratives yield the desired
results? As mentioned above, the
students understanding of the patients
perspective is assessed during the two
years of the FCE through scheduled
evaluations by faculty instructors, as
well as feedback from the volunteers.
However, this does not answer the
question of whether the programmatic
development of narrative approachesas
well as the substantial commitment of
resources this entailsresults in shifts in
students perspectives toward more
humanistic, patient-centered approaches
to medical care. Several quantitative
instruments have been published to
assess changes in students attitudes
toward medicine and patient carefor
instance, the Patient-Practitioner
Orientation Scale41,42and ongoing,
longitudinal survey studies of students
attitudes are currently being conducted at
our institution. Nonetheless, I would
argue that if the intention of these studies
is to document a shift in meaning
perspective (Mezirow)35 in students
attitudes towards patients and medicine,
qualitative approaches may yield a more
in-depth, rich understanding of the
impact of such interventions. Whereas
quantitative methods may measure the
prevalence of certain attitudes and beliefs,
qualitative methods are uniquely capable
of exploring the meanings which
individuals confer on events or life
experiences.43,44 With this in mind, we
recently conducted two qualitative
studies to assess the impact of the FCE on
medical students: the first, a focus-group
study of first-year medical students,
explored the understanding of the
psychosocial dimensions of illness
students gained through conversations
with FCE volunteers,4 and the second, a
study using in-depth, one-on-one
interviews with second- and third-year
students whose FCE volunteers had
diabetes, investigated the ways in which
the conversations shaped the students

Academic Medicine, Vol. 83, No. 7 / July 2008

understanding of diabetes and how this

knowledge differed from that acquired
through traditional lectures and
textbooks.25 Both studies have offered
evidence that the personal interactions
between the students and volunteer
patients of the FCE have fostered an
understanding of chronic illness in
general, and diabetes in particular, that
combines the instrumental biomedical
knowledge gained through traditional
educational approaches with a personal,
affective, and experiential knowledge
acquired through the students
relationships with patients and their
families. As one student respondent
described the process, It opens your
eyes, its enlightening and I think it
makes you see things and realize things
that maybe you hadnt seen before.4
Narratives, either through literature or as
the personal stories of individuals with
illness, help prepare the ground on which
such a transformation may occur by
allowing glimpses into the subjective
world of lived experience, forging
emotional links with the other,
stimulating self-reflection through
cognitive dissonance, and eliciting
resonance of similar, fundamental
emotions in the learner. Also key to this
type of approach is transformation of the
educators frame of reference to one
that incorporates a shift from the expert/
novice paradigm to an explicit validation
of the perspectives, values, and
experiences which students bring to the
learning environment. Although I would
completely agree that the culture in
which medicine is taught and practiced
must be critically assessed to address the
more negative, dehumanizing influences
of the hidden curriculum,38,39,45 a critical
gaze must be also directed on the ways in
which the incorporation of narratives and
humanism is framed. Indeed, because
most medical students enter their
training with idealism and compassion
and subsequently have it trained out of
them,33 it is inappropriateand,
perhaps, presumptuousfor medical
schools to teach students empathy. It is,
instead, our responsibility to engage the
students in learning activities which allow
them to shape the empathy and idealism
that they bring into the educational
environment into powerful tools for
healing. The Brazilian educator Paulo
Freire29(p81) once characterized the act of
teaching as the practice of freedom. This
perspective, I believe, lies at the heart of

humanistic approaches to medicine: to

rehumanize the relationships between
doctors and patients, students, and teachers
such that the value of human beings is
realized, not as a means to an end but as an
end in itself.
Acknowledgments
The author would like to thank Casey White,
Rachel L. Perlman, Monica L. Lypson, Joseph C.
Fantone, and Paula T. Ross for many important
discussions; Dr. Lindy F. Kumagai for his
suggestions, inspiration, and commitment to
medical education; and the volunteers, students,
and faculty of the Family Centered Experience
for their efforts in teaching and learning.

References
1 Branch WT Jr, Kern D, Haidet P, et al. The
patient-physician relationship. Teaching the
human dimensions of care in clinical settings.
JAMA. 2001;286:10671074.
2 Charon R. Narrative medicine: A model for
empathy, reflection, profession, and trust.
JAMA. 2001;286:18971902.
3 Newell GC, Hanes DJ. Listening to music:
The case for its use in teaching medical
humanism. Acad Med. 2003;78:714 719.
4 Kumagai AK, White CB, Schigelone A. The
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