Narrative Competence Research Articles

Storytelling: A learning tool to enhance medical students' empathy, attentive listening, clinical curiosity and reflection.

Listening to stories of sickness lies at the heart of the patient-doctor relationship. Storytelling serves as a powerful learning tool fostering empathy, attentive listening, clinical curiosity and reflection, key elements of narrative competence. The patient's story, their history, forms the fundamental core of diagnosis, and their emotions are central to crafting appropriate treatment plans that address their true concerns. This study reviews the benefits of storytelling as a learning tool, particularly in enhancing empathy, attentive listening, clinical curiosity and reflection within medical education. It also describes a practical workshop that demonstrates how storytelling can be utilised to inspire students to develop narrative competence in a supportive learning environment. Since the stories draw on participants' clinical experience, in both primary and secondary care, the article aims to engage clinicians involved in medical education and the teaching of communication skills.

Narrative competence disparities between Children's hospital and General hospital in China: A comparative survey.

Narrative medicine was introduced in China in 2011 and has been applied as a tool for humane medical practice. The prominent problem in the narrative medicine is the lack of adequate attention and devotion. This study aimed to investigate Chinese medical staffs' narrative competence and the influencing factors, confirming whether the level of narrative competence is different in different hospital settings. A cross-sectional survey was conducted among 1003 medical staffs, including 201 from Children's hospital and 802 from the General hospital. The participants were scored based on the Chinese narrative competence scale, a brief Chinese version of the resilience scale, and a Chinese version of the self-efficacy scale. Data were analyzed using IBM SPSS version 25.0. A total of 1003 medical staff from Children's hospital and General hospital participated in the survey, with a response rate of 94.36%. Our results showed that the score of narrative competence of General hospital and Children's hospital was 149.45±26.22 and 147.10±18.87, respectively, both of which were in intermediate level. Resilience, familiarity with narrative medicine were influencing factors of narrative competence in 2 kinds of hospitals, and whether having written parallel charts before were the influencing factors of narrative competence in General hospital. Besides, our study found that the level of narrative competence (χ2 = 13.672, p≤0.001), resilience score (personal ability dimension, t = 3.439, p≤0.001) and self-efficacy (t = 1.976, p<0.005) are different between General and Children's hospital. Narrative competence is different between General hospital and Children's hospital. Medical staff in General hospital are more familiar with narrative medicine. The competence of medical staff in China needs to be improved.

Classical Medical Cases of Doubt Narrative Foreclosure in Traditional Chinese Medicine and Their Corresponding Narrative Mediation

Abstract: Narrative foreclosure is a phenomenon highlighted within the Chinese narrative medicine system, characterized by a state in which individuals become overly suspicious due to certain events in their development, leading to profound concerns about their health and safety. This article employs the logical discourse framework of Chinese narrative medicine to illustrate the experiences of various patients exhibiting typical instances of narrative foreclosure in traditional Chinese medicine (TCM) cases, such as Bei Gong She Ying (杯弓蛇影 snake shadow in the cup), Wu Qiu Zhi Chong (吴球治虫Wu Qiu treats worms), and Fa Jing Qu She (法靖驱蛇 Fajing drives away snakes). It explores how TCM practitioners leverage narrative wisdom to facilitate patients in dispelling their internal doubts through the concept of Bu Yao Wei Yao (不药为药 healing diseases without medicine). Through these medical cases, the article advocates for the significance of narrative competencies among medical practitioners in diagnosing and treating patients, alongside the use of pharmaceuticals and surgical interventions. Additionally, it outlines the prospects for the future development of narrative approaches in TCM.

Digital Stories and Inclusive Cultures at School: A Research Study in an Italian Primary Multicultural Classroom

This study explores the effectiveness of digital storytelling in enhancing communicative competence—encompassing both linguistic and narrative skills—and fostering inclusivity in a multicultural primary classroom in Genoa, Italy. The quasi-experimental intervention spanned four months and involved eight lessons designed to engage students from diverse cultural backgrounds, particularly those with migratory backgrounds. Pre- and post-intervention assessments were conducted to evaluate linguistic proficiency, narrative competence, and educational inclusion. The results from the Italian language proficiency test demonstrated that second-generation students typically performed at the B1 level, while students with more recent migratory backgrounds scored lower. However, narrative competence showed notable improvements among A2+ level students, who outperformed their peers in certain dimensions despite linguistic challenges. Observational rubrics used throughout the intervention revealed increased classroom inclusivity, active participation, and cultural exchange. Despite limitations related to the sample size and intervention duration, the findings suggest that digital storytelling can significantly enhance communicative competence and promote a more inclusive classroom environment. Future research should investigate the long-term effects of digital storytelling on multilingual classrooms and its broader applicability.

A Digital Health Humanities Approach to the Three-Body Problem in Healthcare Education: Balancing the Science, Art and Tech with M.A.G.I.C.

In the provision of patient-centered care, healthcare professionals face a challenging triad that is analogous to the classical "Three-Body Problem" in physics, whereby any shifts in the dynamics of medical knowledge, narrative competence and digital technologies can tip the balance of healthcare education and practice. Drugs/Medications are often caught in the dichotomy of being both "heroes" and "villains", which underscores the necessity of a balanced, informed, and empathetic approach to patient care. Drawing inspiration from the popular novel and Netflix series, the dynamic interplay between the science of medical knowledge, the art of empathy and narrative competence, and the advancement of healthcare technologies to harmonise the diverse, yet interconnected domains, of medication management, medical humanities and digital health is demonstrated - in the emerging field of Digital Health Humanities. The novel project called M.A.G.I.C. is revealed, that blends the rigour of medical science with the nuanced understanding of patient narratives, and the cutting-edge potential of digital innovations like Generative Artificial Intelligence and the Metaverse, to create a holistic, learner-centered approach for the education of the healthcare professions.

The splendors and miseries of narrativity the virtue of the fragment and the formation of clinicians in XXI century

I review the virtues and limitations of the narrative paradigm in contemporary clinical practice. I contrast ‘episodic’ and ‘diachronic’ forms of life, the former characterised by no particular predisposition to see one’s life in narrative terms and the tendency to experience oneself fragmentarily. After highlighting a progressive decline of storytelling in the current socio-cultural scenario, I show how a number of conditions (borderline-type personality and identity development in adolescence) are marked by reduced ability to organise narratively one’s own experiences. I emphasize a mismatch between the episodic and fragmentary phenomena characterizing these conditions and the prevailing opinion among clinicians belonging to academic culture that values instead the narrative paradigm. In the training of the clinicians, in addition to the necessary skills related to the diagnostic framing of the patient’s symptoms, and in addition to narrative competence, the capacity to embrace all that is fragmentary (that is, what at face value escapes diagnosis and narration) is necessary. I corroborate the approach with a theory taken from contemporary art criticism called ‘aesthetics of post-production’ and its capacity to re-signify the meaning of fragments by recontextualizing them. The personal ‘knots’ in the patient’s experience can be preserved and enhanced only through fragment-oriented listening.

When Play Reveals the Ache: Introducing Co-constructive Patient Simulation for Narrative Practitioners in Medical Education.

Despite the ubiquity of healthcare simulation and the humanities in medical education, the two domains of learning remain unintegrated. The stories suffused within healthcare simulation have thus remained unshaped by the developments of narrative medicine and the health humanities. Healthcare simulation, in turn, has yet to utilize concepts like co-construction and narrative competence to enrich learners' understanding of patient experience alongside their clinical competencies. To create a conceptual bridge between these two fields (including narrative-based inquiry more broadly), we redescribe narrative competence via Ronald Heifetz's distinction of "technical" and "adaptive" challenges outlined in his adaptive leadership model. Heifetz, we argue, enriches learners' self-understanding of the unique demands of cultivating narrative competence, which can be both elucidated on the page and tested within the charged yet supportive simulation environment. We introduce Co-constructive Patient Simulation (CCPS) to demonstrate how working with simulated patients can support narrative work by drawing on the clinical vicissitudes of learners in the formulation and enactment of case studies. The three movements of CCPS-resensing, retelling, and retooling-told through learner experiences, describe the affinities and divergences between narrative medicine's sequence of attention, representation, and affiliation; Montello's three forms of narrative competence (departure, performance, change), and Heifetz's three steps (observe, interpret, and intervene) of adaptive leadership.

Narrative Competence among Chinese Medical Students: A Necessary Step in Developing a Narrative Medicine Module

Narrative Competence among Chinese Medical Students: A Necessary Step in Developing a Narrative Medicine Module

Language Learners’ Transferable Skills and Narrative Competence in U.S. Career Advising Appointments: Multilingual Development Beyond Higher Education

ABSTRACT In a career climate that casts “foreign” language proficiency as a measurable and technical skill, this study examines how the notion of transferable skills alternatively mediates how collegiate language learners (LLs) co-construct multilingual-professional trajectories in career advising appointments. In particular, it focuses on how LLs are positioned as perpetually responsible for acquiring and articulating transferable skills of sorts and the affordances of this ideology for sustained engagement with the target language (TL) beyond higher education. Data include five audio-recorded, transcribed career advising appointments with collegiate LLs of five non-English TLs. Excerpts from advising appointments illustrate how transferable skills may or may not be constructed as emanating from language learning but are assumed to provide access to new settings wherein LLs develop professional identities through TL use. The findings highlight socialization processes as LLs develop narrative competence to essentialize skill sets for continuity between previous and prospective positions to construct themselves as employable.

Medical narrative ability and humanistic care ability of Chinese clinical nurses: The mediating role of empathy ability.

To investigate the relationship between medical narrative ability and humanistic care ability among Chinese clinical nurses, examining the potential mediating role of empathy. In the context of the bio-psychosocial medical model and humanistic nursing care, understanding the core competencies of medical narrative ability, empathyand humanistic care in nursing is crucial. This study explored the mediating role of empathy between medical narrative ability and humanistic care ability. A cross-sectional study. The study employed a descriptive, cross-sectional survey design, involving 741 nurses from Wuxi People's Hospital. It assessed nurses' demographic characteristics, medical narrative ability, empathy, and humanistic care ability using an online questionnaire from December 2022 to February 2023. Pearson correlation analysis evaluated variable correlations, and PROCESS v3.3 model 4 was utilised for mediation analysis. The STROBE statement was chosen as the EQUATOR checklist. A positive correlation was found between nurses' medical narrative ability, humanistic care abilityand empathy. Empathy partially mediated the relationship between medical narrative ability and humanistic care ability. Nurses' medical narrative ability directly and indirectly (via empathy) influences their humanistic care ability. Enhancing nurses' narrative and empathic skills can improve humanistic care, nursing qualityand nurse-patient relationships. Managers should prioritise programmes to improve nurses' storytelling and empathy skills to enhance humanistic care, improving nursing quality and patient relationships. This study involves clinical nurses as participants and does not involve patients. This study collected data from clinical nurses using an online questionnaire platform in China. The questionnaire consisted of four sections, including demographic information and scales such as Narrative Competence Scale, Caring Ability Inventoryand the Jefferson Scale of Empathy-Health Professional. Clear instructions were given to participants on how to complete each scale, and measures were taken to prevent missing or duplicate responses.

AN INTEGRATION OF LABOV'S NARRATIVE ANALYSIS MODEL TO CONTINUATION WRITING INSTRUCTIONAL DESIGN

The modern Chinese educational framework increasingly prioritizes critical thinking, creativity, and practical communication skills, recognizing writing as fundamental beyond test performance. Continuation writing, which involves extending a given story, requires students to deeply understand the original text and develop coherent, stylistically consistent continuations. Traditional product-oriented writing instruction separates reading from writing, focusing on the final product and using scores to assess rather than instructing on revisions. This approach tends to lead to student disinterest and passive attitudes towards writing, with compositions revised only for grammatical errors instead of cohesive and coherent content organization. This study highlighted the development of a continuation writing instruction based on Labov's Narrative Analysis Model, guided by sociocultural theory. We implemented the model with 30 senior high school students in Heilongjiang province, China, and collected data to assess the students' needs in terms of complexity, accuracy, and fluency (CAF). The results indicated students' needs in four areas: understanding the article's theme and structure, extracting critical information, organizing and planning, and enhancing style and creativity. Pedagogically, the study offers valuable insights for teachers and students. Teachers gain guidance on integrating Labov's model to nurture students' narrative competence and writing proficiency. Students benefit from a better understanding of their continued writing needs.

Prosody in narratives: An exploratory study with children with sex chromosomes trisomies

Although language delays are common in children with sex chromosome trisomies [SCT], no studies have analysed their prosodic abilities. Considering the importance of prosody in communication, this exploratory study aims to analyse the prosodic features of the narratives of 4-year-old children with SCT.Participants included 22 children with SCT and 22 typically developing [TD] children. The Narrative Competence Task was administered to elicit the child's narrative. Each utterance was prosodically analysed considering pitch and timing variables.Considering pitch, the only difference was the number of movements since the utterances of children with SCT were characterised by a lower speech modulation. However, considering the timing variables, children with SCT produced a faster speech rate and a shorter final syllable duration than TD children.Since both speech modulation and duration measures have important syntactic and pragmatic functions, further investigations should deeply analyse the prosodic skills of children with SCT in interaction with syntax and pragmatics.

Latent profiles of narrative competence and professional identity among nursing students: A cross-sectional analytic study based on the Ring theory of personhood

AimTo identify latent profiles of narrative competence in nursing students and examine the association between the potential competence profiles and professional identity from a person-centred perspective. BackgroundAccording to the Ring theory of personhood, nursing students can develop their professional identities from individual, relational and social aspects through interaction with patients, as well as listening to, understanding and responding to patients' disease narratives. However, few studies have examined the relationship between narrative competence and professional identity through the quantitative method. DesignA cross-sectional analytic study. MethodsA total of 472 nursing students responded to the survey between March and May 2023. The Professional Identity Questionnaire for Nurse Students and the Narrative Competence Scale were given to participants. Latent profile analysis was conducted to identify narrative competence profiles. The Bolck-Croon-Hagenaars method was used to analyse whether these latent profiles for narrative competence affected nursing students’ general, individual, interpersonal and social professional identities. ResultsLatent profiles were identified as “low narrative competence” (12.1 %), “relatively low narrative competence” (39.9 %), “moderate narrative competence” (40.1 %) and “high narrative competence” (7.9 %). The profiles only show level differences rather than combinations of competence areas. These profiles had varying effects on the nursing students’ general professional identities, as well as their individual, relational and social professional identities. ConclusionThis study highlights the significance of providing tailored guidance and support to nursing students, taking into account their unique narrative competency profile, to promote the formation of professional identity from individual, relational and social aspects. Nursing educators should effectively distinguish nursing students with inadequate narrative competence and value patients’ disease narratives to promote narrative competence and professional identity.

In Search of the Development of Narrative Competence in Schooling: Focusing on Bruner’s Theory

In Search of the Development of Narrative Competence in Schooling: Focusing on Bruner’s Theory

A medical school curriculum to foster the physician-patient relationship through narrative medicine.

e21015 Background: Narrative Competence is the ability to acquire, interpret and act on the stories of others.[1] Developing this skill can also improve health care practitioner’s sense of empathy and satisfaction with their work.[2] This study’s purpose is to evaluate the impact of a narrative medicine curriculum on medical students’ sense of connection to their patients and humanism in medicine. Methods: During the 2023 academic year, a narrative medicine assignment was introduced to the internal medicine oncology clerkship curriculum at the Yale School of Medicine. Third year medical students attended a training session on narrative medicine skills, interviewed a patient and wrote the patient’s story, and attended a session to read their written narrative. A survey was distributed to students asking for their reflections on the doctor patient relationship and the role of humanism in improving well-being and reducing burn out. Responses were de-identified and thematic analysis of responses was conducted. Results: 58 students participated in the training sessions and 11 (19%) completed a post-workshop free text survey with 5 questions reflecting on the doctor-patient relationship, the role of humanism in medicine, and the curriculum itself. Common themes that emerged include 1) how strong doctor-patient relationships makes medicine more meaningful, uplifting and enjoyable, 2) how seeking out a patient’s story is essential to the doctor-patient relationship and to optimal quality care, and 3) importance of doctor’s exhibiting care and sensitivity and placing diseases in context of their patients’ stories. Reflecting on the role of humanism in medicine, students reported that 1) taking the time to know your patients makes medicine rewarding, meaningful and worthwhile, 2) allows you to empathize and connect with patients more through recognizing their humanity and vulnerability and putting their frustrations in context, and 3) could be healing to both patient and provider. Further directions: Students suggested making the program mandatory, expanding to include pre-clerkship students and students on other clerkships, and providing more time and structure to facilitate interviewing patients and writing up their stories. Conclusions: A curriculum incorporating narrative medicine was effectively integrated and well-received by students and fostered an awareness of the rewards of listening to patient stories.

Nursing and Playwriting Students Collaborative: Elevating Reflective Practice.

Reflection is essential in the formation and ethical comportment of nurses. The COVID-19 pandemic brought extraordinary challenges to nursing practice and education of nurses. A pilot collaboration between a college of nursing and a department of dramatic writing at a research-intensive urban university aimed to promote the esthetic pattern of knowing through the dramatic presentation of the experiences of nursing students and frontline nurses during the height of the COVID-19 pandemic. The playwrights wrote two short plays based on interviews with two nursing students and three experienced nurses. The project sought to enhance narrative competence and empathy development of nurses and playwrights, and to promote reflection-on-action.

THE ROLE OF NARRATIVE COMPETENCE IN THE DEVELOPMENT OF LEADERSHIP QUALITIES

The article is devoted to a theoretical review of the relationship between narrative competence and leadership qualities. In the context of improving national education, the problem of professional training of competent, competitive specialists remains particularly significant. The analysis of scientific research has made it possible to identify the key elements of the narrative competence of a future leader. The content of the features of narrative competence in the process of training future leaders of various specialties in the context of educational transformations is revealed. The narrative practices that can be used to improve the quality of leadership are presented. Recommendations for improving the level of narrative competence for prospective leaders are highlighted and the reasons why it is necessary to continue research in certain areas of narrative and leadership are substantiated.

Separate the Wheat from the Chaff: Model Deficiency Unlearning via Parameter-Efficient Module Operation

Large language models (LLMs) have been widely used in various applications but are known to suffer from issues related to untruthfulness and toxicity. While parameter-efficient modules (PEMs) have demonstrated their effectiveness in equipping models with new skills, leveraging PEMs for deficiency unlearning remains underexplored. In this work, we propose a PEMs operation approach, namely Extraction-before-Subtraction (Ext-Sub), to enhance the truthfulness and detoxification of LLMs through the integration of ``expert'' PEM and ``anti-expert'' PEM. Remarkably, even anti-expert PEM possess valuable capabilities due to their proficiency in generating fabricated content, which necessitates language modeling and logical narrative competence. Rather than merely negating the parameters, our approach involves extracting and eliminating solely the deficiency capability within anti-expert PEM while preserving the general capabilities. To evaluate the effectiveness of our approach in terms of truthfulness and detoxification, we conduct extensive experiments on LLMs, encompassing additional abilities such as language modelling and mathematical reasoning. Our empirical results demonstrate that our approach effectively improves truthfulness and detoxification, while largely preserving the fundamental abilities of LLMs.

Identifying kindergarteners at-risk of writing difficulties based on foundational literacy skills

AbstractThe main aim of this study was to evaluate the Early Grade Writing Assessment for Kindergarten (EGWA-K), which is grounded in foundational literacy skills, for its validity and diagnostic accuracy in identifying children at risk of developing early learning disabilities in writing (LDW). To the best of our knowledge, no such tool exists for Spanish-speaking children. A sample of 363 Spanish kindergarten children aged 4.7 to 6.6 years was selected for this purpose. The EGWA-K protocol, comprising four tasks (i.e., phonological awareness, writing words from pictures, free writing of words, and oral narrative), was administered to the sample. Additionally, two criterion tasks based on free letter writing and teacher ratings were included for validation purposes. First, an exploratory factor analysis (EFA) was conducted using parallel analysis to determine the dimensionality of the EGWA-K, which was confirmed by a confirmatory factor analysis (CFA) yielding two factors (one related to transcription ability and the other to narrative competence). Additionally, measurement invariance was confirmed at the configural, metric, scalar, and residual levels by gender. The EGWA-K had an acceptable area under the ROC curve (AUC in the 0.87 range), particularly when free letter writing was utilized as the criterion measure, with adequate sensitivity (0.90) and specificity (0.71) indices. Therefore, a reliable and construct-valid screening tool such as the EGWA-K is now available for the early identification of LDW in Spanish kindergarten children.

Clinical narrative competence and humanistic care ability of nurses in assisted reproductive technology: a cross-sectional study

BackgroundGrowing focus on patient-centred care emphasizes humanistic skills and clinical narrative competence in nursing, particularly in assisted reproductive nursing. However, there is limited evidence to suggest the levels of nurse’ clinical narrative competence and humanistic care ability. This study aimed to investigate the clinical narrative competence and humanistic care ability of nurse specialists in assisted reproductive technology (ART) in China.MethodsThis cross-sectional study included nurses who obtained the ART specialist nurse certificate after nurse training in Zhejiang province assisted reproductive technology specialist nurse training base between 2017 and 2022. A demographic questionnaire, the Caring Ability Inventory (CAI) and Narrative Competence Scale (NCS) were used for data collection. Multivariate linear regression analysis was used to explore risk factors.ResultsA total of 122 participants (120 females, with a mean age of 33.35 ± 5.00 years) were included (response rate = 82.43%). NCS score and CAI score was 143.39 ± 19.24 (range: 27–189) and 198.42 ± 19.51 (range: 37–259) among nurse specialists in assisted reproductive technology, respectively. Multivariate linear regression analysis indicated that professional title (β = 20.003, 95%CI: 3.271–36.735, P = 0.020), and the CAI (β = 0.342, 95%CI: 0.180–0.540, P < 0.001) was independently associated with NCS. Head Nurse/ Team Leader/ Clinical Faculty had significantly higher CAI score than nurse (P = 0.006).ConclusionsThe clinical narrative competence and caring ability of nurse specialists in assisted reproductive technology was considered sufficient. Professional titles and work position were associated with clinical narrative competence. Enhancing clinical narrative competence can be considered as an effective strategy for promoting humanistic care ability.Trial registrationNot applicable.