ABSTRACT
With the rapid development of modern biomedicine, subjective factors such as human emotion and disease experience are diluted. Accurate data, programmed diagnosis and treatment process and other objective factors cut off the effective communication between doctors and patients, aggravating the already tense doctor-patient relationship and intensifying various conflicts in the clinic. In order to improve clinical humanistic care, medical and nursing workers have launched reflections and explorations. Narrative medicine is a new form of medical humanistic practice, while parallel chart, as an important way of its practice, records patients’ subjective experiences and painful feelings. It is of great theoretical significance and clinical value to sinicize narrative medicine and construct and promote parallel chart in Traditional Chinese Medicine (TCM) by studying the research progress of parallel chart in China and its application in TCM.
ABSTRACT
Narrative competence is one of the factors to reflect humanistic literacy of doctors and nurses. According to the advice of many experts, the narrative competence should be improved from the stage of medical students through the two major tools including close reading of text and reflective writing. Based on the background of prevention and control of COVID-19 outbreak, this paper aimed to clarify the focus and methodology of close reading and reflective writing, that was, close reading was supposed to focus on the analysis of disease metaphors in classic literature and narrative function in clinical works and realism works, and writing tended to focus on the the differentiation of writing purpose and the writing guidance in different texts. The proper guidance plus solid training in close reading and writing will definitely lay a strong foundation for medical students in achieving humanistic quality.
ABSTRACT
On the whole, the Yi Xue Cong Zheng Lun written by Jing Xian, a famous doctor in modern Liaoning, outlines the unique vision of the narrative medicine focusing on "benevolence". To be specific, the writing is good at constructing narrative projection, and makes full use of the essence of relevant traditional culture such as the body-country integration idea, the military strategy and tactics and the calligraphy aesthetics concept to create narrative schema. It focus on the concrete example narration of the cultural ideology of Traditional Chinese Medicine(TCM), such as the concept of interlinked viscera, the ideology that the characteristics of the treatment remain the same as the external properties of the disease, the compatibility of opposite and complementary and the idea of making prescriptions and selecting optimal Chinese herbal medicines. In addition, Jing Xian has constructed his professional identity as a doctor of TCM through in-depth narrative reflection. From the perspective of narrative medicine, the study of Yi Xue Cong Zheng Lun has certain instruction and reference significance in the inheritance of TCM culture, and can help to promote the in-depth exploration and multi-dimensiona reflection of "modern Liaoning TCM culture".
ABSTRACT
By reviewing the research context of narrative medicine in China in the past five years and sorting out the development status of narrative medicine in clinical practice in China, this paper pointed out the reasons why narrative medicine is difficult to implement in clinical practice in China at present. It mainly includes three points: the awareness of narrative medicine within the clinical medical community is not high; the humanities community focuses on the development of narrative medicine in medical education, resulting in rather scarce research on narrative medicine based on clinical practice; the research objects of narrative medicine are too narrow, ignoring the importance of the public and the front-line clinical personnel in the clinical practice of narrative medicine. Accordingly, this paper proposed corresponding countermeasures: it is advocated to investigate the awareness of narrative medicine in clinical medicine and the public, and it is suggested to list them as important objects of narrative medicine education. At the same time, it is recommended that the relationship between narrative medicine and doctor-patient communication should be clarified theoretically to guide the construction of a harmonious doctor-patient relationship in clinical practice.
ABSTRACT
In recent years, progress has been made in general practice education research with the integration of narrative medicine and general practice. The narrative medicine is conducive to upgrading the abilities of general practice residents in doctor-patient communication, disease management and clinical decision makings; it also conducive to improvement of their humanistic quality and doctor-patient relationship. This article reviews the application of narrative medicine in the general practice residency training, and discusses relevant problems and countermeasures.
ABSTRACT
Narrative medicine provides a new perspective on medical humanity and clinical ethics. Recently, the research on narrative medicine in China has gradually developed, involving a wider range of applications, especially in patient health education. This article reviews the basic concept and process of narrative medicine,and its application and implication in patient health education, in order to provide reference of the relevant practice and research in this field for medical professionals.
ABSTRACT
Objective:To investigate the effect of narrative medicine teaching on the academic performance and empathy ability of clinical interns in department of thoracic surgery.Methods:A total of 74 interns in the department of thoracic surgery, with the "5+3" integration major of clinical medicine in Chongqing Medical University, were divided into observation group and control group, with 37 interns in each group. The interns in the control group received traditional teaching, and those in the observation group received narrative medicine teaching in addition to traditional teaching. The two groups were compared in terms of department examination score, level of humanistic concern, empathy level, ability to handle doctor-patient relationship, degree of satisfaction with teaching, discipline interest, and job intention after graduation. SPSS 21.0 was used to perform the t-test and chi-square test. Results:Compared with the control group, the observation group had significantly better theoretical score [(85.16±10.04) vs. (79.73±8.27)], operational skill score [(85.32±8.77) vs. (79.70±7.56)], level of humanistic concern [(3.78±0.95) vs. (3.24±1.04)], empathy scale score [(104.89±12.90) vs. (96.57±11.00)], results of the questionnaire on doctor-patient communication skills, confidence in professional practice, and doctor-patient orientation [(52.59±10.15) vs. (72.59±5.86)], degree of satisfaction with teaching (89.2% vs. 64.8% in the control group), discipline interest [(3.86±1.08) vs. (3.05±1.12)], and job intention after graduation (29.7% vs. 8.1%).Conclusion:Narrative medicine introduced into clinical practice teaching can improve the effectiveness of teaching, the empathy ability of students, and the degree of satisfaction with teaching.
ABSTRACT
The application of the image theory of psychology to the modern doctor-patient relationship offers a new perspective and method for alleviating tensions between doctors and patients. In the construction of a doctor-patient community, doctors and patients must empathize and build a consensus based on empathy. From the perspective of constructivism, it is recommended that patients actively complete the process of "meaning construction" of disease cognition through "collaboration" and "dialogue" with doctors, so as to achieve the goal of shared decision-making between doctors and patients. Constructing a harmonious doctor-patient relationship requires putting patients in the center to create patient persona, taking narrative medicine as a bridge to listen to doctor-patient stories, and using multimedia as a platform to medical knowledge.
ABSTRACT
In the context of a healthy China, strengthening humanistic literacy education for general medical students reflects the demands of the times, promotes the transformation of medical models, and has important practical significance in reducing the work burnout of general practitioners in practice. Integrating narrative medicine into general practice student education is conducive to implement the patient-centered concept of general practice, provide continuous and systematic medical services, and further improve the humanistic literacy of general practitioners. Based on these, this paper proposed the relevant paths of integrating narrative medicine into student education in general medicine, including changing educational concepts and integrating educational resources, boldly carrying out curriculum reforms and innovating educational methods, fully utilizing parallel medical records and reflective writing, as well as cultivating the habit of lifelong learning.
ABSTRACT
【Objective:】 To understand the development of narrative medicine in medical schools and the cognitive level of narrative medicine among medical students. 【Methods:】 Taking 2,353 medical students nationwide as the research subjects, Knowledge, Attitude/Belief, Practice (KAP) questionnaire was distributed online to conduct a survey. The survey results were analyzed from the perspectives of general knowledge, ways to understand narrative medicine, and cognitive level of parallel medical records. 【Results:】 44.50% of the survey respondents had never learned about narrative medicine, and 50.79% of them had never heard of parallel medical records. 26.80% of the survey respondents had participated in the training of narrative medicine courses, while most medical students learned about narrative medicine through other ways. 【Conclusion:】 This paper showed that the majority of the survey respondents are not familiar with the key concepts of narrative medicine. By introducing the concept of big culture in anthropology into medical college education or exploring the perspective of doctor-patient interaction, integrating communication models to improve doctor-patient relationships. The current popularization level of parallel medical records and narrative types among medical students is not good, and the cultivation of cultural sensitivity and reflective ability may help promote the teaching and application of parallel medical records. Multiple learning pathways lay the foundation for further teaching, and build a diversified teaching system to enrich the course content, which should be the focus of promoting narrative medicine education in the future.
ABSTRACT
【Objective:】 The co-word analysis method was used to analyze narrative medical literature studied in China in the past 10 years to explore the research status in this field and lay a foundation for further research. 【Methods:】 Using "narrative medicine" as the theme term, with the limited time interval of 2013—2022 to retrieve for relevant literature in CNKI, Wanfang, and VIP databases, and include literature that meets the research standards. Bicomb2 was used to perform keyword statistics and analysis on the downloaded literature. Ucinet6.0 and Netdraw were used to draw co-occurrence analysis graphs to visualize the co-occurrence relationship between high-frequency keywords. 【Results:】 A total of 565 papers were included and 31 high-frequency keywords were extracted. The co-occurrence relationship diagrams showed that the current research hotspots of narrative medicine in China include traditional Chinese medicine, nursing, general practice, evidence-based medicine, medical ethics, hospice care, chronic diseases, cancer and other popular disciplines and diseases. Most of them were about enhancing the empathy and humanistic caring ability of medical personnel and improving doctor-patient communication to improve the doctor-patient relationship, as well as doing well in medical humanities education and cultivating narrative ability through parallel medical records and reflective writing. The research on gerontology, improving the professional identity of medical staff, integrating literature and medicine, and the impact on patients were relatively few. 【Conclusion:】 At present, narrative medicine in China has achieved many achievements in fields such as nursing, traditional Chinese medicine, general practice medicine, chronic diseases, cancer, medical humanities education, and improving doctor-patient relationships. In the future, in-depth exploration can be conducted from the use of narrative medicine in multi-disciplinary and disease fields, trying different training methods, and synchronous cultivation of teachers and students, so as to build a more comprehensive narrative medicine system.
ABSTRACT
【Objective:】 To explore the practice experience of narrative medicine among postgraduates majoring in Traditional Chinese Medicine (TCM) and its impact on their professional identity. 【Methods:】 A total of 56 first-year master’s and doctoral degree students majoring in TCM at a university were selected through purposive sampling for a 16-hour narrative medicine course training and 4 weeks of clinical practice in narrative medicine. They were asked to complete an open-ended writing assignment on their practical experience after this clinical practice. Subsequently, the topic analysis method in qualitative research was used to analyze their writing contents. 【Results:】 After learning narrative medicine, the students’ practical experience in clinical practice included 3 major themes and 9 sub-themes: wide application range (all diagnosis and treatment stages, multiple departments, and disease types), integration of multiple communication skills and diagnosis and treatment methods (communication skills, psychological techniques, reflection, and TCM humanistic diagnosis and treatment methods), and increasing professional identity (achieving mutual healing, building the harmonious doctor-patient relationship, and enhancing confidence in TCM). The themes were further integrated to form the relationship between the narrative medical practice cycle and professional identity, and presented in the form of charts. 【Conclusion:】 By exploring the narrative medical practice experience among TCM postgraduates, it was found that through the use of multiple methods and techniques in the entire diagnosis and treatment stage and multi-disciplinary diseases, it is possible to harmonize the doctor-patient relationship, achieve mutual healing, and enhance confidence in TCM. These internalized recognition and sense of achievement contributes to improving professional identity, which may provide new ideas for the development of professional identity for medical students in China and the exploration of the localization of narrative medical practice.
ABSTRACT
Narrative medicine emphasizes paying attention to patients, and aims to improve doctors’ empathy for patients and their ability to reflect on their own medical behaviors by cultivating their narrative abilities of understanding, explanation, and feedback. Traditional Chinese medicine has always focused on people-oriented, syndrome differentiation and treatment, and focused on the physical and mental dual health of individuals. The medical humanistic spirit embodied by the two naturally coincides. From the perspective of narrative medicine, the ancient famous doctors in China have demonstrated their superb narrative ability of listening, communication, and reflection, which are valuable resources for narrative medicine and have important value and significance for enriching and developing narrative medicine.
ABSTRACT
Starting from the inheritance and development of Chinese philosophy of life and Traditional Chinese Medicine (TCM) wisdom through the Chinese narrative medicine practice, this paper discussed the inheritance and correspondence relationship between the text reading ability in Chinese narrative medicine practice and the "four diagnostic" in TCM wisdom, narrative regulation and the "mind-body philosophy" in TCM, as well as the narrative wisdom and the "Tao produces one" in the Chinese philosophy of life. By analyzing the stories of contemporary doctors’ practice of narrative wisdom, this paper clarified that the Chinese narrative medicine system is a new model of medical education and clinical practice constructed by absorbing the essence elements of Chinese traditional life wisdom and TCM culture, and integrating the concept of western narrative medicine. It advocated for Chinese scholars to actively build the discipline of "narrative traditional Chinese medicine", constantly translate and introduce the achievements to foreign countries, and create a good narrative ecology of TCM.
ABSTRACT
Modern medical model advocates holistic medical treatment and holistic care, which transforms the concern about diseases in traditional medicine into the concern about people in modern medicine. Narrative medicine, as a tool for practicing holistic medical treatment and holistic care, runs through the whole process of patients’ entering medical procedures. It not only meets the needs of patients’ disease-related narratives, but also provides a new and more comprehensive way of communication for both doctors and patients, which is helpful to promote the comprehensive recovery of patients and the healthy development of doctor-patient relationship. At present, narrative medicine is facing some difficulties in the process of local practice in China. Social work, as one of the main bodies of multi-disciplinary and inter-professional cooperation in the medical field, can give full play to its professional advantages to help the new exploration of narrative medicine practice in China.
ABSTRACT
After more than ten years of preliminary exploration, the localization development of narrative medicine has made some achievements in theoretical research, medical education and clinical practice, but its development direction and pathway still need to be further confirmed. From the five perspectives of policy system, management mechanism, cultural background, medical education and social development trends, this paper discussed systematically and macroscopically the localization development of narrative medicine, and advocated that improving the top-level design and local policies, constructing management systems at all levels, taking root in Chinese culture, carrying out systematic narrative education and closely integrating with the development trend, so as to inspire the theoretical construction of the development path of narrative medicine in China.
ABSTRACT
Este ensaio almejou refletir sobre a relação entre medicina narrativa, redes sociais e humanização a partir da utilização, por um dos autores, das redes sociais para compartilhamentos de histórias vivenciadas no contexto da Atenção Primária à Saúde. Questões acerca dos modelos de atenção em saúde vigentes, da escuta e da narrativa como dispositivos de humanização do cuidado e da emergência das redes sociais como potencializadoras da prática de saúde humanizada surgiram como importantes pontos a serem analisados à luz da literatura vigente. Ao fim, foram compartilhados apontamentos para utilização da medicina narrativa como ferramenta para uma prática humanizadora.(AU)
Abstract This essay reflects on the relationship between narrative medicine, social media, and humanization based on the use of social media by one of the authors to share experiences in the context of primary health care. Questions about prevailing health care models, listening, and narrative as dispositives of the humanization of care and the emergence of social media as drivers of humanized health practices arose as important points that need to be analyzed in the light of current literature. In the conclusion we present some considerations relating to the use of narrative medicine as a tool for promoting humanizing practices.(AU)
Resumen El objetivo de este ensayo fue reflexionar sobre la relación entre la medicina narrativa, las redes sociales y la humanización, a partir de la utilización, por parte de uno de los autores, de las redes sociales para compartición de historias vividas en el contexto de la Atención Primaria de la Salud. Surgieron preguntas sobre los modelos de atención de salud vigentes, de la escucha y de la narrativa como dispositivos de humanización del cuidado y de la emergencia de las redes sociales como potenciadoras de la práctica de salud humanizada como puntos importantes a analizar a la luz de la literatura vigente. Al final, se compartieron observaciones para la utilización de la medicina narrativa como herramienta para una práctica humanizadora.(AU)
ABSTRACT
Resumo A comunicação, a despeito de ser considerada um aspecto primordial no exercício da prática médica, não ganhou tanta proeminência na literatura e formação médica quanto os aspectos tecnológicos e biomédicos. Em resposta a esse contexto, surgiram campos de conhecimento que se propõem a refletir e fortalecer aspectos da comunicação entre o médico e o paciente. No presente artigo, realizamos uma análise narrativa da literatura de três abordagens de comunicação em Saúde: Grupos Balint, Método Clínico Centrado na Pessoa e Medicina Baseada em Narrativa. Foram destacados aproximações e distanciamentos entre tais abordagens, com o reconhecimento da potência própria de cada uma delas nos diversos contextos da prática médica.
Resumen La comunicación, a pesar de considerarse un aspecto primordial en el ejercicio de la práctica médica, no obtuvo tanto destaque en la literatura y en la formación médica como el que tuvieron los aspectos tecnológicos y biomédicos. Como respuesta a ese contexto, surgieron campos de conocimiento cuya propuesta es reflejar y fortalecer aspectos de la comunicación entre el médico y el paciente. En este artículo, realizamos un análisis narrativo de la literatura de tres abordajes de comunicación en salud: Grupos Balint, Método Clínico Centrado en la Persona y Medicina Basada en la Narrativa. Se destacaron aproximaciones y distanciamientos entre tales abordajes, con el reconocimiento de la potencia propia de cada una de ellas en los diversos contextos de la práctica médica.
Abstract Communication, despite being considered a key aspect in medical practice, has not received the corresponding attention both on literature and medical training as has the technological and biomedical aspects. As a reaction to this context emerged fields of knowledge proposing to reflect and strengthen aspects of communication between the physician and the patient. In this article, we perform a narrative analysis of the literature of three of such approaches to communication in health: the Balint Groups, the Patient Centered Care and Narrative-Based Medicine. The study highlights the approximations and distances between these approaches, along with the recognition of the potency of each of them in the different contexts of medical practice.
ABSTRACT
This work is a bibliographical review of the challenges of professionalism in medical training. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. By virtue of the changes in the practice of medicine during the last years, professionalism values emerge as qualities that should reshape medicine. Several medical associations are redefining professionalism and insist that this issue should be included in the training curriculum. Thus, several medical education institutions are pursuing strategies to teach and assess professionalism. Modeling is still relevant as a learning strategy, but it must be tutored and directed. Also, timely and formative feedback appears as the most frequently suggested evaluative action. Both processes incorporate a personal reflective practice. Several recent studies suggest that a reflective experience is relevant for the formation of a professional identity. Narrative Medicine methodology emerges as an innovative strategy to address this issue, as it seeks to deliver valuable learning experiences to the students through reflection and the search for a new paradigm for medical practice.
Subject(s)
Humans , Students, Medical , Education, Medical , Education, Medical, Undergraduate/methods , Narrative Medicine , Professional Competence , Curriculum , ProfessionalismABSTRACT
The pursuit of an integrated health education has led higher education institutions to question themselves on the ideal training for medical students which would foster a real connection with their surroundings: "educate to learn to live in the world and with others, knowing that the other person is both the same and different from me, oriented towards the same end: the shaping of the human being and the social good."1 Treating complex topics such as the processes underlying immunity, genetic transcription and metabolic diseases, among others, presents significant academic challenges for teachers and students in the learning process. However, there is an equally relevant hidden curriculum which may warrant the use of unconventional epistemological tools such as music, and which may be a good complement for acquiring clinical and humanistic skills, notably the capacity to develop semiological abilities and the capacity to develop empathy in critical health situations. From this point of view, the rehumanization of medicine has become a primary requirement today. Below, we will discuss three complex health situations described in salsa songs which analyze the underlying human emotions, as an invitation to explore the hidden curriculum behind the objectively viewed disease. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2243).
La búsqueda de una formación en salud integral ha llevado a que las instituciones de educación superior se cuestionen sobre la formación ideal que se debe brindar a los estudiantes de medicina en la que se fomente una conexión real con el entorno: "educar para aprender a vivir en el mundo y con el otro, a sabiendas de que el otro es una persona a la vez igual y diferente que yo, orientados a la misma finalidad: la conformación del ser humano y el bien social" 1. El abordaje de temas complejos como los procesos subyacentes a la inmunidad, la transcripción genética, las patologías metabólicas, entre otros, representan retos académicos importantes para los docentes y los estudiantes en el proceso del aprendizaje. Sin embargo, hay un currículo oculto que es igualmente relevante, y que puede ameritar el uso de herramientas epistemológicas no con vencionales, como la música, y que puede ser un buen complemento para adquirir las habilidades clínicas y humanísticas, entre las que destaca la capacidad de desarrollar habilidades semiológicas y la capacidad de desarrollar empatía frente a una situación crítica de salud. Desde este punto de vista, la rehumanización de la medicina se ha convertido en la actualidad en un requisito primordial. A continuación, se expondrán tres situaciones de salud complejas descritas en canciones de salsa, en las que se analiza las emociones humanas subyacentes, como una invitación a explorar el currículo oculto detrás de la enfermedad vista objetivamente. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2243).