Tsevat Rebecca K, Sinha Anoushka A, Gutierrez Kevin J, DasGupta Sayantani
R.K. Tsevat is a medical student, Columbia University College of Physicians and Surgeons, New York, New York. A.A. Sinha is a recent graduate, Master's Program in Narrative Medicine, Columbia University, New York, New York. K.J. Gutierrez is a recent graduate, Master's Program in Narrative Medicine, Columbia University, New York, New York. S. DasGupta is a faculty member, Master's Program in Narrative Medicine, Columbia University, New York, New York.
Acad Med. 2015 Nov;90(11):1462-5. doi: 10.1097/ACM.0000000000000743.
As health humanities programs grow and thrive across the country, encouraging medical students to read, write, and become more reflective about their professional roles, educators must bring a sense of self-reflexivity to the discipline itself. In the health humanities, novels, patient histories, and pieces of reflective writing are often treated as architectural spaces or "homes" that one can enter and examine. Yet, narrative-based learning in health care settings does not always allow its participants to feel "at home"; when not taught with a critical attention to power and pedagogy, the health humanities can be unsettling and even dangerous. Educators can mitigate these risks by considering not only what they teach but also how they teach it.In this essay, the authors present three pedagogical pillars that educators can use to invite learners to engage more fully, develop critical awareness of medical narratives, and feel "at home" in the health humanities. These pedagogical pillars are narrative humility (an awareness of one's prejudices, expectations, and frames of listening), structural competency (attention to sources of power and privilege), and engaged pedagogy (the protection of students' security and well-being). Incorporating these concepts into pedagogical practices can create safe and productive classroom spaces for all, including those most vulnerable and at risk of being "unhomed" by conventional hierarchies and oppressive social structures. This model then can be translated through a parallel process from classroom to clinic, such that empowered, engaged, and cared-for learners become empowering, engaging, and caring clinicians.
随着健康人文学科项目在全国不断发展壮大,鼓励医学生阅读、写作并对自身职业角色进行更多反思,教育工作者必须将自我反思意识带入该学科本身。在健康人文学科中,小说、患者病史和反思性写作作品常常被视为可供人进入并审视的建筑空间或“家园”。然而,在医疗环境中基于叙事的学习并不总能让参与者感到“自在”;如果在教学时不批判性地关注权力和教学法,健康人文学科可能会令人不安甚至危险。教育工作者可以通过不仅考虑教什么,还考虑如何教来降低这些风险。
在本文中,作者提出了三个教学支柱,教育工作者可以用它们来邀请学习者更充分地参与,培养对医学叙事的批判性意识,并在健康人文学科中感到“自在”。这些教学支柱是叙事谦逊(意识到自己的偏见、期望和倾听框架)、结构能力(关注权力和特权的来源)和参与式教学法(保护学生的安全和福祉)。将这些概念融入教学实践可以为所有人创造安全且富有成效的课堂空间,包括那些最易受伤害以及有被传统等级制度和压迫性社会结构“边缘化”风险的人。然后,这个模式可以通过一个平行的过程从课堂转化到临床,这样有能力、积极参与且得到关爱的学习者就能成为有能力、能吸引患者且关爱他人的临床医生。