Start with Them

All good communication begins with a clear consideration of the audience. Who are they? Why do they care? The impact of your story will only be met if you consider the people involved. It makes sense that in a conference forum or in a journal such as the Journal of Clinical and Translational Science, that a researcher may be able to speak in their own discipline-specialized language. But it behooves us to learn to be “multi-lingual,” so that we can explain our research to people with varying levels of expertise. Doing this involves an actively empathetic approach in order to understand how your work might be perceived and internalized by those who would benefit from it. A simple process to help you understand your audience, as introduced through the “Character” analysis in Table 1, provides a first step to successful storytelling.

After you have defined the people involved, it helps to think of the story structure. If you are preparing for a talk, presentation, or paper for the public and want to prepare, we have developed a tool called What’s the story? which can be found in supplementary material. We developed this form to teach the use of story to medical students and faculty as part of the The Center for Compassionate Communication curriculum at UC San Diego’s T. Denny Sanford Institute for Empathy and Compassion.

We offer a simplified version of the story form in Table 2 in order to continue to illustrate the process. Imagine Chelsea began with inquiry to learn more about Richard’s story, and then used elements of this structure to relay information about the clinical trial.

Table 2.

Simplified story form

Beginning with common ground is always a good first step to build curiosity in the listener and connection between the audience and the storyteller. We can always find common ground, even when it does not seem obvious. In the sample above, Chelsea focuses the story on their common ground of hypertension to help connect with Richard. In the real world, the sample would likely be fluid and conversational, but this table can give the reader an idea of how this story might play out in written form or as the beginning of a group presentation.

The beginning of a story sets the stage for what was true before the advent of the research question, engages the emotions of the listener, and builds connection with the storyteller. It’s an important foundation, because the arc of storytelling takes you from what was true, through an inciting incident (your research question), into the characters involved who encounter twists, turns, and surprises that carry the audience into a climax of discovery – and out the other end when the world is different because of that journey. Scientist, playwright, and educator Holly Kerby, from Story Form Science, often asks her students to consider the beginning and the ending first, so they can recognize the scope of change.

One could argue that the methods section of a research article parallels the twists, turns, and surprises that lead the audience to the climax of discovery. One could also argue that in a scientific journal, this area of reporting is the most devoid of emotion as it is meant to indicate how the study could be replicated by others. And yet, it is for this very same reason that a way to clearly communicate and explain these steps is equally crucial; surely, it benefits all of us if others can replicate proof. This is where story and science have the potential to powerfully connect without contradicting each other: by showing how the steps that lead scientists toward a particular discovery are sound and applicable to the people for whom they are conducting this research.

The utility of story can be used in presentations, media interviews, and writing for the lay public in grant applications to disseminate complex science and research findings. Some resources that can provide you more in-depth instruction can be found through online learning modules called The Heart of Communicating Science presented by the American Heart Association and based on The Compassionate Practice® curriculum from TCU. One scientist from these modules, Keisa Mathis PhD, highlighted the vagus nerve as a character in her presentation to a community audience to help them imagine and understand her research on the neuroimmune mechanisms involved in autoimmune-induced hypertension and renal injury. Here is an excerpt of her preparation:

Barriers

Despite the growing interest to utilize story in research, education, and faculty development, there remains a lack of resources and time to support the faculty in the arts and humanities who specialize in the pedagogy surrounding story. We have experienced firsthand the magic of pairing an actor with a physician or researcher to connect the lessons of story with real-world clinical examples that are relatable to the learner. Often, science and medical institutions are unable to support the salaries for arts and humanities faculty, even on a limited basis by way of visiting faculty positions, post-doctoral research for specific projects, and freelance work. In academia, humanists, social scientists, and artists are at somewhat of an impasse regarding their relationship with the sciences. Funding for humanistic programs, which tend to not bring financial gain to universities, has been under assault, and there are frequent – and understandable! – anxieties within humanistic and artistic disciplines about whether or not the only way for them to exist is under the good grace of the sciences. Though incrementally adapting, the promotion and tenure process remains a barrier to inspiring researchers to dedicate some of their time to mastering tools of communication, like the use of story, in their research and publications.

Opportunities to Address Unmet Needs

Despite these challenges, there is progress in efforts to incorporate the humanities in medical and research education. There is now more than a decade of innovative curriculum and experiential learning based on story that can be used to establish best practices. This will allow for scaling up by training trainers and disseminating the curriculum. The Association of American Medical Colleges’ recent white paper on The Fundamental Role of Arts and Humanities in Medical Education sets the stage for addressing many of these barriers calling for interdisciplinary competency and evidence-based teaching and learning of arts and humanities in medicine. They value the research process and promote the use of, “effective integrative pedagogical practices and recognize an expansive view of scholarship in academic promotion and tenure processes.” They are backing up their recommendations with grant support and faculty development opportunities. This provides a model for research disciplines.

A growing number of universities and affiliated centers that have the resources to support humanities programs in medical and research education are witnessing the growing interest and passion their students have for the humanities. From our experience at one of these institutions, lessons surrounding humanism in medicine are even starting to influence which programs prospective students may choose to apply.

What Does All This Mean for the Future?

Using story to translate typical research methods may seem daunting at first, especially within fields that tend to prioritize quantitative research. However, as those in the scientific community navigate the multifaceted uses of story, we may find that there are exciting opportunities to strategically utilize interdisciplinary methodologies. Engaging modes of inquiry that often fall outside of the hard sciences expands potentials for innovation and new forms of discovery. “Narrative Inquiry” [Reference Kim9], a form of interview that lifts from qualitative research as well as oral history methods, is a useful concept when designing research studies. Both sets of information-gathering modalities are typical in the humanities and social sciences and offer beautiful opportunities to strategically integrate representatives from disparate-seeming disciplines into a cohesive project.

With that said, there is also a reality that there are untapped opportunities for artists, humanists, and social scientists within medicine and bench sciences, especially if the scientific community is willing to engage the narrative-based, qualitative research methods that nonscientific researchers engage in their own fields. Qualitative research is, after all, largely steeped in the close reading practices inherent to studies in history, theater, literature, journalism, and many others. Consultations or collaborations with representatives from these disciplines are encouraged if institutions want to prioritize interdisciplinary research between the sciences and other disciplines.

Charon, physician and humanist, has developed research surrounding narrative methodologies, particularly in the evolution of clinical trials to evidence-based medicine [Reference Goyal, Charon and Lekas10,Reference Charon and Wyer11]. Such methodologies are actively steeped in deep, intellectually rigorous analyses of story – something that Charon has long practiced and advocated for in clinical practice [Reference Charon12]. These studies are an excellent example of how such research can map onto Clinical and Translational Research. It is also important to note that the Narrative Medicine program, which attracts students from a wide variety of professional backgrounds, has been instrumental in bringing focus and formalized skill to paying close attention to the story. Part of the program’s master’s degree is a required research methods course so that students are equipped to leverage narrative inquiry into their research repertoires once they leave the program, equipping them with practical tools in order to incorporate story. Neuroscientists have also recently defended story as an important way to “lighten the cognitive load of information” [Reference Willems, Nastase and Milivojevic13] and a way to translate findings to the public [Reference Martinez-Conde, Alexander and Blum14]. Additionally, Kotarba et al have delved into research on the identities of scientists through their qualitative research, which emphasizes story in two ways: using story for data, and also requesting that scientists reflect on the culture of their field by reflecting on themselves [Reference Kotarba, Wooten, Freeman and Brasier15].

Kortaba’s study also leads to a useful formation of community-engaged research. The community’s story ideally should be the driver of the research design, enrollment, and dissemination. But often, it does not become a priority, and participants’ and community’s stories do not inform the research protocols, process, and procedures; they only inform the results, not with their experiences, but only with their physiology. Moreover, they often do not hear the results of the research they have contributed to with their bodies. This continues to contribute to division and distrust between the researchers and community participants as illustrated in our example with Chelsea and Richard. By collecting and integrating the community members’ stories into research, there is a healing opportunity to bridge divides while also contributing to interesting, authentic research practices. In order to do this, one must acknowledge all of the players and ask who are the characters in this research narrative? If it is possible to do this for a community of scientists, then surely it is possible to engage these methods for a wide variety of other communities.

The use of story in the dissemination of research has made great strides in the past decade, and there is room for incorporating story in all aspects of clinical translational research including design and enrollment keeping the human subject central to the research process. If scientific and humanistic fields are willing to combine forces for the purpose of highlighting story from the inception of research projects, there is potential that will benefit both fields. By allowing story to be our North Star, we can imagine the new and innovative ways research can be shaped.