The use of student narratives as research substrates
The Journal of Health Design
Supervising medical students to develop a research project can be challenging. Unless a student has prior experience in research, they may struggle to identify a research question that can be addressed by a novice researcher in a time-limited project. At the same time, when a project spans years of the degree, a student who has been offered an "off-the-shelf" idea may lose interest in the project and the assignment can become burdensome. We describe how a cohort of medical students were
... udents were encouraged to focus their project ideas on a story of someone whose medical problem was of interest to them. Most students opted to conduct a literature review based on their "story". Here we present their stories and describe how they were led to this point in the process. Key Words medical education; research; medical students; medical schools; narrative medicine 2. Detsky ME, Detsky AS. Encouraging medical students to do research and write papers. CMAJ. 2007 Jun 5;176(12):1719-21. 3. Krejany C, Jiwa M. Finding Joe: Patient-directed goal setting on the journey to therapeutic targets in diabetes care. and impaired vision. She has had no time lately to attend her own GP appointments. As a result, her health is also declining. Research Question: While there is significant research on carer burden of those supporting people living with dementia, this is not the case for culturally and linguistically diverse (CALD) carers. What is the impact on the health of older carers of a CALD person living with dementia? Michael Who: Michael is a 23-year-old in his final year of his undergraduate degree at university. He is a healthy and active young man, having grown up playing rugby, basketball, and touch football. He is a very sociable character and loves his lifestyle. What: Michael has no significant past medical history and rarely needed to visit his GP. But over a couple of weeks, Michael started to feel generally unwell, fatigued, and nauseous. He ignored these vague non-specific symptoms attributing them to being run down from university, which in the past had amounted to nothing and abated within a few days. A few months later, he noticed a small painless lump in his left testicle. Michael being the eldest child of three, felt too awkward about talking to younger family members for advice, so instead he left it for a few more weeks in the hope that it would spontaneously resolve. When the lump did not go away, Michael had to accept that something might be wrong and made an active decision to book an appointment with a GP. Aspect of Care: At the first consultation Michael was told that "it was all fine and nothing to worry about". But this did little to clear Michael's mind and he left with a sinking feeling that something was simply "not right". After battling with these feelings for a few weeks he decided to alert his family into what has been happening and he was again booked into see a GP. This time, the GP suspected it was a varicocele and wrote up a non-urgent referral to a urologist. The next available appointment was in three months. The urologist sent him off for a scrotal ultrasound. Again, the next available scan was a few days later. Upon review of the ultrasound, the urologist diagnosed Michael with testicular cancer and urgently referred him onto the oncologist. It was December 23 of that year when he was finally diagnosed. Michael went in for orchiectomy surgery the following day, Christmas Eve. This was eight months after he initially noticed the lump and seven months after he first presented to a health professional. Research Question: What factors lead to delays in diagnosis of testicular cancer in young males? Julie and Daniel Who: Julie, Daniel, and their two children were a typical working-class Australian family. Julie and Daniel were brought together by their passion for photography and outdoor adventures. They eventually married, had a family, bought a house, and enjoyed many family holidays. Like most families, things weren't always perfect, and Julie and Daniel also had their share of arguments and disagreements, financial difficulties, and work stresses. In spite of the difficult times, they loved each other and were quite satisfied with their lives. What: About four years ago, Julie and Daniel's life was forever changed after Daniel was diagnosed with a terminal illness. Daniel was given a 10-year prognosis. The doctors said that there was no available treatment for this rare condition and virtually no chance of remission. Daniel and Julie now live in the hope that a new treatment will become available. In the meantime, Daniel's health is gradually declining, his moods unpredictable or sullen, and Julie finds herself managing the roles of a worker, career, wife, and mother. Aspect of Care: Four years after Daniel's diagnosis, Julie experiences what could be described as an emotional breakdown; she becomes unable to cope with everyday life and requires long-term sick leave and emergency mental health support. Research Question: What is the impact of a terminal illness diagnosis on the physical health of the caregiving spouse? 201 JHD 2019:4(3):194-204 DESIGN INSIGHT James Who: James is a 22-year-old carpenter, with strong ambitions to develop his own building and project development business. He works incredibly hard, six days a week, 50 weeks of the year. He bought his first a house at 21. James is the only son of four children. When he has time off, he helps his father on the family property, building sheds and fixing fences. James plays sport and enjoys being active with his mates. What: Recently, James has been having issues with his lower back at work. As one of the youngest onsite, he is often given physically demanding roles such as shovelling dirt or moving timber, instead of technically difficult and less physical roles. Coming from a rowing background at school, James is used to "putting up with" a sore back. Aspect of Care: James feels the pressure of being the youngest onsite, part of a team that is trying to meet a deadline. If he complains about having a sore back, he is ridiculed for being "soft", and often told to get on with the job. When he gets home from work, he self-treats the issue with heat and topical ibuprofen gel, exhausted and in need of rest for the next day's work. Work-related social pressures have the potential to influence work practice, heightening the risk of physical and mental harm. Research Question: What is the influence of workplace culture on the incidence of low back pain in workplaces with high physical demand? Elizabeth Who: Elizabeth is a 30-year-old female accountant, living in a Sydney apartment. Her workday begins with a 40-minute commute on the train, followed by a 9-hour workday, with approximately 2-3 hours overtime per week. What: Elizabeth often finds herself working through lunch and snacking during the day to keep her energy levels up. When she does have a lunch break, Elizabeth often attends one of the many lunch meetings where food is plentiful and calorie dense. The last 10 years has seen her waistline grow and her weight increase from 60kg to 100kg. This weight gain is mirrored by her husband of five years, Phillip, who has been overweight since his mid-twenties. A nonsmoker and social drinker, Elizabeth tries to eat well during the week but barriers, such as being time poor, prevent her from adequate meal preparation and instead, see her reach for takeaways or frozen foods. Exhausted by work and life in general, Elizabeth perceives the thought of going to the gym as impossible. Aspect of care: Elizabeth attends her local GP to discuss bariatric surgery, to help her lose weight. On the day of her appointment Elizabeth has a BMI of 35, no diagnosed co-morbidities, no medical conditions, no medications, no allergies, and no significant family history. She is tired of trying "everything" without result and sees weight loss surgery as the easy route to a long-term solution. Elizabeth is not interested in hearing about possible complications. She just wants to stop struggling with her weight and regain her confidence. Research Question: What is the prevalence of long-term complications over the lifespan of a person following weight-loss surgery? Andy Who: Andy is a 15-year-old passionate soccer player from the North West suburbs of Sydney. He is balancing training for his school and local club teams during the week and scrambles to fit in two games of soccer on the weekend. He is a well-rounded sportsman and has not suffered any major injuries to date. Previously he has suffered from a few scratches and contusions as well as a minor ankle strain last year that resolved within a couple of days. He believes that he is on track to be selected in the 1st grade opens squads for both of his current teams by next year and has recently increased the intensity of his training. What: During a warm-up drill on Saturday morning, a teammate attempts to tackle the ball in front of Andy, missing the ball and kicking Andy's knee. In doing so, the team mate inflicts a medially directed force on the outside of Andy's knee, damaging his medial collateral ligament. Andy falls to the ground in pain, clutching his right knee. He is helped up by his team mates and hobbles over to the sideline, struggling to weight bear on the right side. His coach retrieves him some ice and tells him to lie on his back and elevate his knee.