Charon Rita, Hermann Nellie, Devlin Michael J
R. Charon is professor, Department of Medicine, and executive director, Program in Narrative Medicine, College of Physicians and Surgeons of Columbia University, New York, New York. N. Hermann is creative director, Program in Narrative Medicine, College of Physicians and Surgeons of Columbia University, and adjunct faculty, Master of Science in Narrative Medicine Program, Columbia University School of Continuing Education, New York, New York. M.J. Devlin is professor, Department of Psychiatry, and codirector, Foundations of Clinical Medicine, College of Physicians and Surgeons of Columbia University, New York, New York.
Acad Med. 2016 Mar;91(3):345-50. doi: 10.1097/ACM.0000000000000827.
Medical educators increasingly have embraced literary and narrative means of pedagogy, such as the use of learning portfolios, reading works of literature, reflective writing, and creative writing, to teach interpersonal and reflective aspects of medicine. Outcomes studies of such pedagogies support the hypotheses that narrative training can deepen the clinician's attention to a patient and can help to establish the clinician's affiliation with patients, colleagues, teachers, and the self. In this article, the authors propose that creative writing in particular is useful in the making of the physician. Of the conceptual frameworks that explain why narrative training is helpful for clinicians, the authors focus on aesthetic theories to articulate the mechanisms through which creative and reflective writing may have dividends in medical training. These theories propose that accurate perception requires representation and that representation requires reception, providing a rationale for teaching clinicians and trainees how to represent what they perceive in their clinical work and how to read one another's writings. The authors then describe the narrative pedagogy used at the College of Physicians and Surgeons of Columbia University. Because faculty must read what their students write, they receive robust training in close reading. From this training emerged the Reading Guide for Reflective Writing, which has been useful to clinicians as they develop their skills as close readers. This institution-wide effort to teach close reading and creative writing aims to equip students and faculty with the prerequisites to provide attentive, empathic clinical care.
医学教育工作者越来越多地采用文学和叙事教学方法，比如使用学习档案袋、阅读文学作品、进行反思性写作和创造性写作，来教授医学中的人际和反思方面。此类教学法的成果研究支持了这样的假设，即叙事训练可以加深临床医生对患者的关注，并有助于建立临床医生与患者、同事、教师以及自我的联系。在本文中，作者提出，尤其创造性写作对培养医生很有用。在解释叙事训练为何对临床医生有帮助的概念框架中，作者聚焦美学理论，以阐明创造性和反思性写作在医学训练中可能产生益处的机制。这些理论提出，准确的感知需要表征，而表征需要接受，这为教导临床医生和学员如何表征他们在临床工作中的感知以及如何阅读彼此的作品提供了理论依据。作者随后描述了哥伦比亚大学内外科学院所采用的叙事教学法。由于教师必须阅读学生的作品，他们接受了精读方面的强化训练。从这种训练中产生了反思性写作阅读指南，该指南在临床医生培养精读技能时很有用。这种在全机构范围内教授精读和创造性写作的努力旨在让学生和教师具备提供专注、共情临床护理的先决条件。
