A Storied Community: Piloting a Patient/Student Narrative Workshop at a Community Health Center

The students enter the room unsure. They come from various health professions across the University: Pharmacy residents, Doctorate of Nursing Practice students, and medical students. For perhaps the first time they will be sitting with patients in a room that is not an exam room. They will be writing stories, not medical notes. Together, students and patients will be talking and writing about illness as people who have experienced it in their lives, not with their role in institutionalized medicine on their sleeves. The students have been instructed that, if asked, they may be called on to help the patients with the physical act of writing, serving as scribes. The patients are encouraged to ask for such help if needed. Together, over a communal meal, everyone in the room will begin to form a dialogue about illness and the road to health as a community.

The Community–University Health Care Center (CUHCC), housed within the Academic Health Center (AHC) of the University of Minnesota, is located in the Phillips Neighborhood in South Minneapolis. This neighborhood is one of the first places where new immigrants to Minnesota begin their journey in America. The patient mix at CUHCC reflects this as no ethnic group makes up over 20% of the patient community and 20% of the patients are uninsured. CUHCC services include medical, dental, behavioral health (which includes therapy, psychiatry, case management, care coordination, and Adult Rehabilitation Mental Health Services) for both pediatric and adult patients. There is also a midwifery service, dermatology clinics, and pharmacy appointments. As part of the commitment to patient access and overall well–being of the patients, CUHCC also employs domestic abuse and sexual assault advocates and in–house interpreters for our patients who speak Hmong, Lao, Vietnamese, Spanish, and Somali. Legal aid is also available through a partnership with Stinson Leonard Street, who provided about 5,000 hours of pro bono services to patients last year.

As part of a large university, close to 300 students across the professional schools rotate through the site each year. These include students in social work, medical, nursing, pharmacy, psychiatry, legal, communication, and behavioral health programs as well as those interested in public, global, and community health who are undergraduates or in various master’s programs. CUHCC also serves as the main continuity clinic site for Med–Peds, a combined internal medicine and pediatrics residency at the university. For their entire four years in their residency, they come to the clinic around one day a week to learn and build their patient base, allowing a continuity of care. They also spend special months at the clinic focused on projects to improve the quality of care. Residents from Psychiatry and Internal Medicine also hold continuity clinics at CUHCC, with Pharmacy residents spending about 90% of their residency on site. CUHCC serves as the bridge between the school and community, providing healthcare to those most in need. After 50 years providing primarily health care services, CUHCC is entering a new era with a revised mission, “Transforming Care and Education to Advance Health Equity” and a new goal to integrate education into everyday practice. Narrative workshops were born out of this new direction and a push toward person–centered care. If the patient and their community is the center of education and healthcare, then it’s time to integrate them into an educational setting outside the exam room. Health Centers such as CUHCC are not only members of the academic institution that houses them, but also within and born from the geographic communities where they are located. As such, students and patients need to be at the center of education and healthcare together.

The past year, we piloted narrative health sessions. Patients were recruited from the patient advisory group, which is comprised of a group of people who have been patients at CUHCC for a length of time around two years or more and wish to help guide the clinic on patient experience. They help with satisfaction surveys, create informational materials for patients, and help bring patient concerns to the greater CUHCC administration. We...