Narrative Analysis of Medical Students' Reflective Writing: Implications for Medical Education

Meei-Ju Lin ； Chin-Chen Wen ； Chi-Wei Lin ； Theodore Mazarakis ； Shao-Yin Chu

《Journal of Medical Education》 18卷2期 (2014/06) Pp. 49-56

https://doi.org/10.6145/jme201407

並列摘要

Purpose: This study examined reflective presentations from medical students' narrative writings and their implications for medical education. Method: 60 5th year medical students completed a reflective writing assignment from a required course, Writing the Patient's and Family's Psychosocial Issues, by observing and interacting with patients and family members while in the process of primary care and history taking interviews. Narrative analysis was applied by coders to read through all the written documents, marked the themes of narrative reflection, and discussed the storylines until reaching a consensus on the coding by an iterative process. Results: Six major storylines were identified from narrative analysis, including: (1) descriptive storyline, enmeshed with ethnic, economic, and parenting issues of patients and families; (2) emotional tone, dominated by pessimistic voices; (3) evaluative storyline, focused on evaluation of limits of students themselves and logical/scientific thinking of medical training; (4) analytic storyline, discussed around themes of social justice and patient privacy; (5) conclusion, torn between inability to effect substantial change and emotional inclination to do so; and (6) action plan, characterized by themes of professional and systemic resources, empathy, and health education. Conclusions: Narrative writing is able to present reflective themes under varied storylines, and point to potential benefits from introducing humanities into medical education. The implications are to understand what students conceive as priorities in patients' illness history, provide the training balance between logic-scientific and narrative modes, foster students' empathy and narrative competencies, and strengthen communication skills in the future.

並列關鍵字

narrative medicine ； reflective writing ； medical education ； narrative analysis ； psychosocial issues

參考文獻

Berkowitz, L.(ed.)(1988).Advances in Experimental Social Psychology.New York:Academic Press.

Charon, R(2001).Narrative medicine: a model for empathy, reflection, profession, and trust.JAMA.286,1897-902.

Charon, R(2004).Narrative and medicine.N Engl J Med.350,862-4.

Charon, R(1986).To render the lives of patients.Lit Med.5,58-74.

Clandinin, J,Cave, MT,Cave, A(2011).Narrative reflective practice in medical education for residents: composing shifting identities.Adv Med Educ Pract.2,1-7.