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醫療人文融入通識教育之教學實踐：以「圖像醫療與生命敘事」通識課程為例
Integration of Medical Humanities into Curriculum of General Education: The Featured Course "Graphic Medicine and Life Narratives" as an Example
摘要
「圖像醫療與生命敘事」課程試圖透過視覺圖像、敘事醫學與文學性表述等跨媒介、跨領域之特性，將醫療人文融入通識課程之教學，以協助學生重新理解、詮釋生命與疾病所帶來的意義。本研究採用質性研究法，解決教學現場遭遇之難題並達成設定之教學成效。研究場域為醫藥大學通識教育課程教學現場，學生背景皆為醫療健康照護相關領域，課程屬性為通識教育架構下之學院特色課程，教學方式包括部分講授、主動學習、議題設定之深度討論、體驗式學習與實作圖文創作之成果展現等。研究資料包括學生每週主題討論及議題回饋的學習單、書面報告、學習歷程心得反思及圖文創作工作坊作品等資料。透過質性分析，研究結果顯示學生相關成長包括：（1）圖像醫療敘事的文化發展理論與歷史脈絡的知識習得；（2）理解自我與他者關係，強化共感同理心；（3）自我生命覺察能力敏銳度的提升。透過圖像醫療敘事作品，詮釋生命教育多元化樣貌，強化思辨論述能力、批判性思考及同理心培養。教學過程引導學生了解醫療人文與社會關懷之相關議題。醫學專業大學透過醫療人文理念融入通識課程，可幫助學生體現課程核心價值，並將所習得之知識、技能及情意，在未來醫護職涯付諸實現。
並列摘要
In recent years, the development of medical care that integrates with humanities has moved from "medical humanities" to the deeper and broader "health humanities." This advancement has led to the emergence of cross-disciplinary training in narrative medicine, which presents the illness narratives from a literary perspective. In the field of health humanities, the rapidly developing genre of graphic medicine has greatly attracted the attention of researchers. Contrast to textual texts that convey concepts through abstract words, works of graphic medicine deal with issues of illness and humanities via more direct/explicit visual avenues that resonate with readers. In a contemporary context that emphasizes cross-disciplinary values, integrating graphic medicine with literary narratives, visual expressions, and even audio-visual elements, has helped create a space of discussion where readers explore health-related issues from different perspectives and interpret text more critically. The course Graphic Medicine and Life Narratives attempts to incorporate concept of medical humanities into the curriculum of generation education through integrating instruction of graphic medicine, narrative medicine, and literary expressions, encouraging students to re-understand and re-interpret the meaning of life and illness. The ultimate teaching objective of this course is to motivate medical undergraduates' learning and encourage deeper learning in medical humanities and liberal arts education. According to the instructor's observation towards the teaching site, students' resonance with visual works such as comics and animations is generally higher than that of pure texts alone. Graphic medicine, presented as visual works, serves to be more intuitive and more responsive to contemporary learners' reading experience. Through the deployment of teaching strategies, the works of graphic medicine achieve the same goals as textual narratives do, such as the cultivation of empathy for patients, the training of critical thinking ability, and the fostering of self-awareness when confronting dilemmas. This study investigated the following research questions: (1) What is the development of graphic medical narratives and their influence on medical-related issues? (2) How exactly is empathy cultivated through reading graphic medicine? (3) How do students develop their ability to self-awareness as well as meta reflective thinking on their lives? In this study, the researcher adopted qualitative research method with reference to the implementation process of action research method, revising the dynamic instructing process, solving the problems encountered in the teaching field and achieving the objectives of this course. By examining the teaching context, understanding and defining problems, and proposing concrete solutions to problems encountered in teaching practice, this action research supports the researcher to effectively respond to challenges and refine the teaching quality through meta reflection. After clarifying the curriculum objectives and establishing problem awareness, the researcher re-analyzed the teaching context again, uncovered the newly emerging problems to be solved, redefined the problems, and then revised the teaching objectives. In this way, the researcher exercised the flexibility and adaptability of action research, adjusted the teaching process without interruption, and gave effective feedbacks to future implementation of similar curricula. This research was conducted at a medical university, and students were all in medical and health care related fields. A total of 50 students took this course in two semesters. The backgrounds of students were all related to medical and health care professions. The teaching approaches included traditional lectures, active learning, in-depth discussions on thematic issues, and the adoption of the Socratic methods, which are proven methods to inspire students to deeply analyze the assigned readings as well as the social and cultural meanings embedded within those works. Students were encouraged to explore questions and clarify the problems arising from their thinking process and peer discussions. The experience of offering the Graphic Medicine and Life Narratives course with literary attributes has allowed the researcher to appreciate the transformation and accessibility of graphic medicine works to contribute to non-directive interpretation and encourage students to access the core concepts of life education. With guidance, students read the assigned materials as a combination of graphic works and cultural theoretical literature, interactively examining the readings and engaging in critical analyses. Several selected medical narratives are written from the patient's point of view, explaining the impact of illness on life, while others are from the perspective of medical practitioners, reflecting what they see and feel in the medical field. Through the combination of text and visual art, the works of graphic medicine lead readers to understand the medical professions from alternative perspectives. In the process of close reading, students develop empathy, rethink the roles and relationships between doctors and patients, and put the emotional experience of abstract ideals into practice. The teaching axis includes the following topics: Introduction to Graphic Storytelling, Stories of Illness-The Patient's Experience, Exploring Normalcy, Disability, Stigmatization, and Bias through Graphic Medicine, Caring for Others-The Perspective of Family Members, Health Care Through the Eyes of the Clinician, and Graphic Medicine in Taiwan. The teaching design emphasizes issue-oriented learning as the main training for analytical thinking. The process of discovering issues/problems, proposing ideas, discussing and seeking evidence, giving feedback on the process of thinking, and correcting and supplementing opinions helps students to take the initiative to think and learn on their own, to ask knowledge-bearing questions, to learn to organize their ideas and responses logically, and to improve their ability of rational discourse. At the end of the semester, the students used the graphic vocabulary, aesthetics and logic they learned in class to rethink important experiences in their own lives and to redefine and reconstruct the meaning of those events through creation of their own life narratives. With the support of the Teaching Practice Program of the Ministry of Education, the researcher introduced substantial resources into this course, holding the Draw What You Feel Like to Say - a visual art creation workshop - for students to create their own life narratives. This workshop serves as a platform for learners to perform their learning outcome in terms of the knowledge level and the emotional level. This event also provided the researcher an opportunity to assess learning outcomes. The research data include students' discussion feedbacks, written reports, meta reflections on their learning process, and the creation of their own life narratives in visual form. In addition to the acquisition of graphic medicine knowledge at the cognitive level, this course equips students with the ability of critical thinking and analytical skills, the enhancement of empathy, and the facilitation of insightful self-awareness at an affective level. Through qualitative analyses, the research results show that students' learning outcomes include: (1) knowledge acquisition of graphic medical narratives; (2) enhancement of the perception towards empathy; (3) generation of self-awareness towards lived experience. To sum up, the Graphic Medicine and Life Narratives course aims to integrate medical humanities into the curriculum of General Education through the cross-disciplinary characteristics of visual images and texts, namely narrative medicine and literary expressions. The core value of this course lies in its capacity to cultivate students from medical and health care backgrounds with innovative perspectives and diversified interpretations towards life experiences through graphic medical narratives. In the process, this course strengthens students' abilities of discursive skills, critical thinking, empathetic medical care, and self-awareness towards their life. This research reveals that, graphic medicine as a form of life narratives fosters the combination of liberal arts and medical humanities and equip medical students with the ability of critical thinking and empathy which are vital to their practice of medical profession in the future.