Educational Innovation: Narrative Medicine Course in Kasr Al-Ainy “The House of Life”; Bridging the Past, Navigating the Present and Drawing Vision for the Future.
Mona Said El-Sherbini *
Medical Parasitology Dept., Kasr Al-Ainy School of Medicine, Cairo University.
This paper aims to elucidate the careful connection of medical practice in Ancient Egypt covering the time span with the theoretical and practical constructs of “Narrative medicine” interventions in today’s health care settings; proposing the essence of a training model in Narrative Medicine which is designed to prepare future physicians to practice medicine ethically and compassionately, using reflective manners that helps to clarify personal values and a sense of professional identity.
*Author: Medical Parasitology Dept., Kasr Al-Ainy School of Medicine, Cairo University. Kasr Al-Ainy St., Cairo, Egypt. POB: 11562, Tel.: (+202) 23632733, Fax: (+202) 23644383, Mobile phone: (+2) 01002465704
Received : 9 February, 2020
Accepted: 19 February, 2020
Published : 9 March, 2020
Keywords : Learning approach, objective structured clinical examination (OSCE).
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
The attributes of a medical student as a healthcare provider and promoter who embrace a more ‘holistic’ approach towards patient-centered care, is considered a key competency ,that should be reflect on the community as one of the demands stated by the National Academic Reference standards (NARS), Egypt as well as the World Federation of Medical Education (WFME) from a global perspective. Thus, medical educators are constantly provoked to meet the needed balance between ‘hard science’ of biomedical knowledge and ‘soft skills’ of interpersonal communication .
In today’s healthcare system, constitutive aspect of care and empathy for the patient’s illness represented by diagnostic listening to patient’s needs became a necessity where doctor's attention is often a scarce resource in our busy healthcare settings . This paper claims to trace the origin of medicine and narration whether in spoken or written forms, in a trial to unfold the joint dimension of the doctor/patient relationship in the Egyptian civilization; from antiquity to the present day. From this ensures a second objective: to achieve a far reaching envision of the medical practices which rotates around the themes of communication and representation.
Narrative and Medicine: Lessons learnt from the past.
Health care systems had developed and changed throughout history. In Ancient Egypt; “houses of life” (per ankh), were institutes associated with medical functions like a system of today’s medical schools which were based on an integrated scientific methodology . Description of illnesses stemming from either spiritual, physical, or mind/heart causes were documented in papyrus scroll dating back since 1700 BC. The fundamental logical approach of disease representation (examination, diagnosis, prognosis, and treatment) as indicated in the Edwin Smith and Ebers Papyri basically denoted that these narratives were used for professional teaching purposes in “houses of life” .
The notion of universal harmony, truth, morality and justice has been reflected on Ancient Egyptians who were quite compassionate to bearing witnessing to suffering of people; living the principles of “Ma’at”, which codified into the “moral idol” of ancient Egypt. Thus, physicians at that time followed the Ma’at in their relationship with their patients which means precisely, the spirit of mutual understanding, honesty and respect .
As noted, the physicians of ancient Egypt were considered the best of their time and first in mankind. Imhotep's medical knowledge was significant, and we may well take him as the first great man in medicine. None the less, physicians of antiquity had skillfully converged the science of medicine with many other disciplines, these include medical ethics, law, anthropology and sociology . Never did I do evil towards any person’; an ethical code adopted centuries before the Hippocratic Oath, with one such inscription on the tomb of Nenkh-Sekhmet, chief of the Physicians during the 5th Dynasty .
Ethical code shown on the tomb of Nenkh-Sekhmet, chief of the Physicians discovered in Abu sir, Cairo, Egypt 
Narrative Medicine: Theory and Interventions
With the advancement of “modern” medicine, stressing on the importance of “facts and findings,” as more scientific and objective than considering patient’s subjective narratives is nowadays perceived differently. medical narrative is gaining attention —from the stories about patients and their illnesses, to the interwoven stories between health care professionals and patients, leading to the creation of narrative-based medicine (NBM). The term was generated deliberately to mark its distinction from “fact and findings” or evidence-based medicine (EBM); in fact, NBM was propagated to counteract the shortcomings of EBM [8-10].
In 2001, Charon coined the word “Narrative medicine” which underpinned a number of analytical and interpretative approaches related to psychiatry and medical anthropology. However, the field of Narrative medicine with its own autonomy encompassed within its boundaries the four practical narrative situations in which physicians play a part: physician and patient, physician and self, physician and colleagues, and physician and society .
Thus, “Narrative medicine” is defined as the dynamic interaction between the health provider and the patient with great attention to physical, psychological, social and ontological features .
Thus, putting “Narrative Medicine” into practice will require reinforcement of humanistic virtues into clinical setting with mindfulness to absorb and interpret the stories of illness: helps healthcare professionals to improve their effectiveness of care by cultivating their skills for attention, reflection, representation, and affiliation with patients and colleagues .
Training in Narrative medicine and medical humanities now forms part of the core curriculum at more than half of all North American medical schools; applying different forms of narrative medicine interventions . However, despite the considerable influence of these fields in Europe and America  and Asia , the concepts remain little known in Egypt .
Narrative Medicine: Implementation in Egypt
It was worth a brief look to our past to find our best path forward. Indeed, the practice of medicine in ancient times had inspired the implementation of the first Narrative medicine training course across the current Egyptian Medical schools, such intervention had emanated from the oldest medical institute of Kasr Al-Ainy (founded in 1827) heritage with a promising addition to the current training strategies offered by the Integrated Program of Kasr Al-Ainy (IPKA), Cairo University which aims at preparing undergraduate medical students for effective performance as future resident physicians and practicing clinicians .
The training course in Narrative medicine projected on the required competencies that are singled out by the responsible authority of Quality Assurance and Accreditation of Education’s (NAQAE) in Egypt, and the National Academic Reference Standards (NARS) -Medicine (2017) aligning with international medical updated standards .
The structure of the 20-credit hour, elective course of “Narrative Medicine” was basically anchored in a reflective practice platform. Teaching undergraduate third year medical students the skills of pro-active listening and reflective writing, focusing on honoring patients’ stories with the capacity to develop a holistic approach on the dis-ease; aiming at placing humanities and science together in the healthcare practice. Hence, providing crucial opportunities to cultivate attention to narrative and critical thinking for the well-being of the physician as well as for the patient .
Narrative medicine course adopted the central idea of ‘bringing humanity back to the healthcare practice”, which acted as a tidal notion among the self-selected students enrolled in the elective. The course content highlighted 10 interdisciplinary themes: Introduction to narrative medicine, Personalized narrative medicine competencies, Narrative medicine practice, Stories in medical education, Narrative assessment, evaluation and feedback, Honoring the stories of illness, Cultural aspect in illness narratives, Patient-centered care, Balancing evidence-based medicine with narrative medicine.
“Myths of narrative medicine” was the last theme in the elective course which ran as a “students’ mini-exhibition”. Where, students justified the importance of studying narrative medicine (through short oral presentation, exhibiting their group project as assignment) and expressing the potential barriers to implementation in the healthcare system. Students were acknowledged by receiving a certificate of training achievement and a report on professional (cognitive, non-academic) performance and development throughout the course.
Training in narrative and medicine can thus re-conceptualize and re-construct personal and professional values in interpretation of data either narrated by patients, colleagues, and oneself through analytical and synthetical reasoning with sensitivity and wisdom in response not only in clinical experiences but also with others in the healthcare system; an area that is not taught in the biomedicine courses .
Exploring medical practices in Houses of life “per ankh” represents a thought-provoking insight into the Ancient Egyptian civilization as an inherit in the creation of medical care. The goal of the Narrative Medicine intervention, in this sense, was defined by its aim; to meet medical education challenges and to probe deeper questions regarding the central role of the medical student as a health care provider, promoter and as a professional, practicing medicine ethically and compassionately with holistic perspectives; shadowing on the most-important-community attached healthcare service, represented by the old institute of Kasr Al-Ainy at Cairo University.
The article has not been previously presented or published, and is not part of a PhD or thesis project.
CONFLICT OF INTEREST
There are no financial, personal, or professional conflicts of interest to declare.
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