Abstracts

Rationale: The way that people interact with, experience and provide epilepsy care is diverse. Analysis for themes involving medical core competencies and social determinants of health can be studied through a narrative approach and begin to extract common themes, stressors, challenges and rewards in epilepsy care. Methods: We distributed a voluntary survey via email to health care workers providing epilepsy care within the Temple University Health System in order to collect reflective, narrative medicine pieces that encompassed participants’ most memorable epilepsy experience in the past academic year.  Anyone who had a significant role in epilepsy care, or a significant patient story, from medical assistant, to medical student to senior faculty was invited to share a de-identified story. A prompt was shared, with a request to take no more than 30 minutes and 100-500 words when completing the task. The responses were then anonymously submitted and collected with their job title. Participants could opt to keep their writings identified if they desired in order to contribute to future group discussions within the Neurology department.  Participants were given a two-week time period to respond.  Essays were analyzed by a group of readers to identify themes within the domains of 5 Social determinants of health (SDH), 6 Accreditation Council for Graduate Medical Education (ACGME) competencies and 12 General Clinical Competencies (GCC) as created by the research group.  We reviewed the responses through thematic analysis. Results: Analysis thus far identified that on average 2.47 of the 3 domains were addressed.  In regards to each domain, 30.7% of possible social determinants of health, 56.7% of ACGME competencies and 25.6% of GCC were addressed per response.  The most common themes were then extracted from the grading criteria created by the team.  The most common themes addressed were, “Patient Care and Procedural Skills” within ACGME, “Social and community context” and “Health and health care” within SDH and “Inability to reach a goal with a patient” within the GCC. Conclusions: Narrative medicine is a cathartic and illuminating practice, which allows healthcare workers to divulge thoughts, otherwise not readily expressed in the regular work setting. There were enormously honest and powerful comments through out the pieces, suggesting that respondents felt comfortable describing these deeply personal moments, deeply held feelings, or personal struggles. The majority of the stories focused on satisfaction and inspiration, an affirmation to the empathy of the staff and dedication to the humanity of patient or family. The more frustrating stories centered on limits of the system and challenges with difficult patients. The themes of Social determinants of health, Accreditation Council for Graduate Medical Education competencies and General Clinical Competencies being present throughout many pieces shows that common issues are experienced throughout the workplace and can be targeted for issues such as burnout and wellness.  The high rate of SDH themes also reflects the unique patient population experience in North Philadelphia at Temple University Hospital and the affect it has on healthcare workers and their views on epilepsy. Further research can examine how the process of narrative medicine and reflection affects the outcomes of burnout and overall wellness longitudinally. Funding: None