Masters physiotherapy students’ attitudes to the use of ‘illness narratives’ during a neurological physiotherapy module

Background: Patient narratives are a means through which health care workers may explore the world of people with illness or disability. Narrative competence is also recommended as part of the skills clinicians need to engage with a patient in holistic assessment and negotiation of rehabilitation goals. Purpose: This purpose of this study was to evaluate use of ‘illness narratives’ in learning and teaching on a Masters module in neurological physiotherapy. It aimed to survey the participation of Masters physiotherapy students and to explore their attitudes about the use of such ‘illness narratives’. Methods: This evaluation used a sequential mixed methods approach to answer both aspects of the research question. Masters students were encouraged to borrow from a box of books brought to weekly classes on a neurological physiotherapy module. The books were selected narratives about experiences of neurological illness, ranging widely from J.D. Bauby's Diving Bell and the Butterfly, to third person vignettes of patients by Oliver Sacks. During each class students were given time to discuss in small groups their reflections about the previous week's reading. At the end of the 11 week module students were given an opportunity to rate the books sampled. Participation and general attitudes to the scheme were assessed using anonymised questionnaires. After the module assessment was completed some students were recruited via a general e-mail to all students in the class to take part in semi-structured interviews lasting 20-30 minutes. Interview transcripts were analysed using interpretive thematic analysis for students’ attitudes to this type of literature and their thoughts on how it contributed to their learning.Results: Eleven out of 14 students (79%) completed questionnaires and 3 students were interviewed. Contrasting attitudes were apparent in the group. Generally students found the accounts useful and interesting, and some were very enthusiastic. In contrast two students expressed a lack of interest in this type of literature, and felt that time devoted to feedback and discussion ate into the time for “class teaching”. Some of the students using English as a second language evidently found extra reading onerous when already working at capacity. Most students enjoyed the opportunity to ‘share experiences’ with peers, and to appreciate ‘different perspectives’. In interviews there were comments on how narratives showed how much the effects of neurological insult were felt throughout a patient's family and community, the emotional impact on individuals and how these are often hidden, and perspectives new to them (e.g. with respect to families coping with the effects of dementia or loss of memory in a family member). Conclusion(s): Narratives of illness experience are a tool for widening and deepening clinicianś insight into the patient's perspective. The ways in which such narratives are introduced and used are critical for best impact.