Department of Pediatrics; Department of Medical Education, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.
BMC Med Educ. 2020 Nov 10;20(1):415. doi: 10.1186/s12909-020-02336-6.
Medicine practiced with narrative competence is called narrative medicine, which has been proposed and used as a model of humane and effective medical practice. Despite the in-depth discussions of narrative medicine, the study of narrative competence in literature is limited; therefore, this study aims to explore the dimensions and connotations of the clinical narrative competence of medical personnel.
This qualitative study used in-depth interviews to collect participants' experience and perspectives regarding narrative competence, followed by thematic analysis of the transcripts. Through purposive sampling, this study successfully recruited 15 participants (nine males and six females in 2018-2019) who were engaged in narrative medicine or medical humanity education from different medical schools and hospitals across Taiwan. The authors performed manual thematic analysis to identify the themes and concepts of narrative competence through a six-step theme generation process.
There were four major themes of narrative competence generalized and conceptualized: narrative horizon, narrative construction (including narrative listening, narrative understanding, narrative thinking, and narrative representation), medical relationship (including empathy, communication, affiliation, and inter-subjectivity), and narrative medical care (including responsive care, balanced act, and medical reflection). These four themes were further integrated into a conceptual framework and presented in a diagram.
Cultivating narrative competence in medical education can complement traditional biomedical orientation. Regardless of their treatment orientation, narrative medicine-informed health practitioners may take advantage of their multi-dimensional narrative competence, as presented in this article, to enhance their awareness and preparation in different areas of competence in medical services. In addition, the results of this study can be used as a framework for the development of the behavioral indicators of narrative competence, which can be taken as the basis for medical education curriculum design.
具有叙事能力的医学实践称为叙事医学，它被提议并用作一种人道且有效的医学实践模式。尽管对叙事医学进行了深入的讨论，但对文学叙事能力的研究有限；因此，本研究旨在探讨医务人员临床叙事能力的维度和内涵。
本定性研究使用深入访谈收集参与者对叙事能力的经验和观点，然后对转录本进行主题分析。通过目的抽样，本研究成功招募了 15 名参与者（2018-2019 年期间，9 名男性和 6 名女性），他们来自台湾不同医学院校和医院从事叙事医学或医学人文教育。作者通过手动主题分析，通过六步主题生成过程，确定叙事能力的主题和概念。
概括和概念化了叙事能力的四个主要主题：叙事视野、叙事构建（包括叙事倾听、叙事理解、叙事思维和叙事表现）、医患关系（包括同理心、沟通、认同和主体间性）和叙事医疗护理（包括回应式护理、平衡行为和医疗反思）。这四个主题进一步整合到一个概念框架中，并以图表形式呈现。
在医学教育中培养叙事能力可以补充传统的生物医学定位。无论他们的治疗方向如何，受叙事医学启发的健康从业者都可以利用他们本文中呈现的多维叙事能力，在医疗服务的不同能力领域提高他们的意识和准备。此外，本研究的结果可作为叙事能力行为指标发展的框架，可作为医学教育课程设计的基础。
