A qualitative study of clinical narrative competence of medical personnel

Shao-Yin Chu,Chi-Wei Lin,Chin-Chen Wen

doi:10.1186/s12909-020-02336-6

Shao-Yin Chu, Chi-Wei Lin + Show 1 more

Open Access

https://doi.org/10.1186/s12909-020-02336-6

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Abstract

BackgroundMedicine 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.MethodsThis 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.ResultsThere 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.ConclusionsCultivating 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.

Highlights

Medicine practiced with narrative competence is defined as narrative medicine, which has been proposed and applied as a model for humane and effective medical practice [1]
In accordance with Balint’s work, Charon pointed out that narrative medicine provides the means to understand the personal connections between patient and physician, while simultaneously offering physicians the means to improve their effectiveness to work with patients, themselves, and others
What is your understanding and opinion about the concept of narrative competence (NC) of medical personnel? 4-1.What is your understanding and opinion about Rita Charon’s definition of narrative medicine (NM) and NC? (We provided the definition of NM and NC by Rita Charon before the interviews.) 4-2.What are your understandings and opinions on the definition of NM and NC by other scholars?

Summary

Introduction

Medicine practiced with narrative competence is called narrative medicine, which has been proposed and used as a model of humane and effective medical practice. Medicine practiced with narrative competence is defined as narrative medicine, which has been proposed and applied as a model for humane and effective medical practice [1]. Due to the influence of different schools of thought, including medical humanities, cultural studies, literary theory, social sciences, feminism, psychoanalysis, the work of Michael Balint, primary and patient-centered care, biopsychosocial medicine, holistic care, and postmodern ideas [2,3,4,5,6,7], the concept of narrative medicine emerged late in the twenty century in response to the inadequacies of, but not to dispense with, the biomedical model [6,7,8]. Narrative medicine or narrative-based medicine enables patients to unburden themselves, and attentive listening is intrinsically therapeutic [6], while “the narrative provides meaning, context, and perspective for the patient’s predicament” [11]

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