Abstract
BackgroundUnderstanding patients’ narratives has been associated with methods of improving care that go beyond what may be regarded as a “narrow” view of scientific medicine. Medical interview training in which medical students develop understanding of the importance of patients’ narratives is receiving increased attention. However, students generally receive education on patients’ narratives that does not distinguish inpatients and outpatients. No studies exploring the characteristics of outpatients’ narratives have been reported. We developed an educational program combining ambulatory clerkship and peer role-play using actual narratives from outpatients that students had encountered during their clerkship. These narratives were used as peer role-play scenarios in which the students acted as outpatients. This study explored what and how medical students learned about the characteristics of outpatients’ narratives through this original educational program.MethodsParticipants were 70 fifth-year medical students from Nagoya University, Japan. We conducted 13 focus groups, based on a convenience sample of 11 groups in 2012, one group in 2013, and one group in 2017 (from 17 clinical groups in each year). Focus group transcripts were analyzed using the “Steps for Coding and Theorization” qualitative data analysis method. We assessed medical anthropological findings regarding narratives in a conceptual framework.ResultsPatients’ narratives as perceived by medical students were divided into four quadrants by two axes: medical versus lived content, and objective versus subjective structure. Students recognized that outpatients’ narratives mainly used a subjective structure, but were mixed and crossed each quadrant. This was described as “irreproducibility.” Students also recognized that narratives of simulated patients and inpatients were mainly limited to a medical-lived content with an objective structure. These differences in narrative characteristics were recognized through students’ previous interactions with simulated patients and inpatients.ConclusionsDespite some limitations, medical students learn about patients’ narratives in our original educational program in a way that would be difficult to achieve through training using simulated patients or inpatients.
Highlights
Understanding patients’ narratives has been associated with methods of improving care that go beyond what may be regarded as a “narrow” view of scientific medicine
Actual narratives from outpatients that students had encountered during their ambulatory clerkship were used as peer role-play scenarios in which the students acted as outpatients
We investigated how students’ recognized characteristics of outpatients’ narratives through the original educational program
Summary
Understanding patients’ narratives has been associated with methods of improving care that go beyond what may be regarded as a “narrow” view of scientific medicine. We developed an educational program combining ambulatory clerkship and peer role-play using actual narratives from outpatients that students had encountered during their clerkship. These narratives were used as peer role-play scenarios in which the students acted as outpatients. In 2001, we developed an educational program that combined outpatient encounters and medical interview training using peer role-play [10, 11]. In this program, actual narratives from outpatients that students had encountered during their ambulatory clerkship were used as peer role-play scenarios in which the students acted as outpatients. In our role-play exercises, we used to use scenarios written by medical students based on their own experience as a patient or a patient’s family member [10]
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