Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
BMC Med Educ. 2023 Aug 11;23(1):568. doi: 10.1186/s12909-023-04492-x.
Narrative medicine purports to improve medical students' communication skills, self-reflection, empathy and professional development. These interpersonal skills and attitudes can facilitate more patient-centered care and positively impact patients' treatment outcomes. However, current studies report mainly on small study populations, leaving the efficacy of narrative medicine in larger study groups unknown. Therefore, this study aimed to evaluate a mandatory narrative medicine lesson in a large sample of medical students. We assessed if this narrative medicine lesson stimulated meaningful self-reflection on patient-centeredness in medical students.
All fourth-year medical students of a Dutch medical school participated in this mandatory narrative medicine lesson. The four-step activity consisted of an introductory lecture, close reading and watching of a book and film, a discussion group and a short reflective writing exercise. Students were divided over three thematic pairings (or book and film combinations): 'The doctor as a patient,' 'The mysterious brain,' and 'Until death do us part.' A mixed-methods design was used. First, we qualitatively analyzed the content of 203 essays from the reflective writing exercise. A quantitative analysis of the reflective quality was conducted using a scoring-system based on the REFLECT rubric.
Students demonstrated reflection on a professional level and connected this to future intentions as medical practitioners, for example to use specific communication strategies or to deliver healthcare in a broader sense. They also reflected on a personal level by questioning their own worldview or beliefs. Furthermore, they stressed the importance of individual patient stories to gain understaning of patients' perspectives. Approximately half of the students showed an in-depth and authentic reflection, according to the REFLECT rubric. Additionally, reflection levels differed between book and film pairings.
This study supports the value of narrative medicine in the medical curriculum by validating its outcomes in a larger study population and in a mandatory course. Students reflected on themes related to the principles of patient-centeredness, namely personal attitudes towards patients and the uniqueness of patient stories. In additon, the majority of students demonstrated higher levels of reflection, which suggests that this exercise contributes to self-awareness and self-reflection, important qualities for delivering patient-centered healthcare.
叙事医学旨在提高医学生的沟通技巧、自我反思、同理心和专业发展。这些人际交往技巧和态度可以促进以患者为中心的护理，并对患者的治疗结果产生积极影响。然而，目前的研究主要报告了小样本研究人群，因此叙事医学在更大的研究群体中的效果尚不清楚。因此，本研究旨在评估在大量医学生中进行强制性叙事医学课程的效果。我们评估了这种叙事医学课程是否激发了医学生对以患者为中心的有意义的自我反思。
荷兰一所医学院的所有四年级医学生都参加了这门强制性的叙事医学课程。该四门课程的活动包括一个介绍性讲座、对一本书和一部电影的精读和观看、一个讨论小组和一个简短的反思性写作练习。学生们分为三个主题配对（或书籍和电影组合）：“医生作为患者”、“神秘的大脑”和“直到死亡将我们分开”。采用混合方法设计。首先，我们对 203 篇反思性写作练习的内容进行了定性分析。使用基于 REFLECT 量表的评分系统对反思质量进行了定量分析。
学生们在专业层面上进行了反思，并将其与未来作为医疗从业者的意图联系起来，例如使用特定的沟通策略或更广泛地提供医疗保健。他们还在个人层面上进行了反思，质疑自己的世界观或信仰。此外，他们强调了解患者观点的个体患者故事的重要性。根据 REFLECT 量表，大约一半的学生表现出深入和真实的反思。此外，反思水平因书籍和电影配对而异。
本研究通过在更大的研究人群中验证其结果，并在必修课程中验证其结果，支持叙事医学在医学课程中的价值。学生们反思了与以患者为中心原则相关的主题，即个人对患者的态度和患者故事的独特性。此外，大多数学生表现出更高水平的反思，这表明这种练习有助于自我意识和自我反思，这是提供以患者为中心的医疗保健的重要素质。
