Current medical education faces an imbalance between technical rationality and humanistic spirit,with medical students' empathy declining as their training progresses.Narrative medicine offers a new path for reform.This paper systematically elaborates on the talent cultivation pathway of "five-dimension education integration and innovation" constructed by Sun Yat-sen University since 2017 under the guiding principle of five-dimension education (moral,intellectual,physical,aesthetic,and labor education) based on narrative medicine.This study innovatively proposes a teaching framework of "one body and two wings" and extends GUO Liping's "little red flower" model to construct a "five-dimension education-little red flower" interdisciplinary collaborative teaching model,which takes the narrative medicine course cluster as the "body" and clinical practice and humanistic experience as the two "wings," achieving deep integration of the five dimensions of education.At the practical level,a three-stage progressive closed loop of "sprouting-deepening-transformation" has been established,with a four-step teaching method of "demonstration analysis-collaborative writing-independent writing-reflection internalization" formed at the transformation stage,along with a "1∶1 interdisciplinary collaboration" general education course for all first-year students.Teaching evaluations show that the curriculum effectively enhances medical students' empathy and communication initiative,with non-medical students benefiting particularly significantly.This practical model validates and extends the application boundaries of localized narrative medicine theory,realizing a conceptual leap from cultivating "technical executors" to nurturing future caregivers" and providing a practical model and operational experience for reference in the reform of medical humanities education in the context of emerging medical education in China.
It has been 15 years since the introduction of narrative medicine into China.The growing of medical humanistic demand,the gradual improvement of industry recognition,and the continuous support of relevant national policies have provided good opportunities for the development of narrative medicine.The current development of narrative medicine faces both opportunities and challenges.The continuous accumulation of favorable conditions provides strong support for the standardized promotion of narrative medicine,while there are still obvious shortcomings,mainly manifested in the weak foundation of the discipline and the unclear path of practice and research.Although the exploration of localization has begun to bear fruit,the overall development still needs to be deepened.China has an improving environment and outstanding potential for the development of narrative medicine.At the same time,it faces many problems such as discipline construction,practical research,and localization deepening,presenting a pattern characterized by coexistence of opportunities and challenges.
Assessment is a critical link in the transition of narrative medicine education from concept to institutionalized curriculum,yet its methods have long faced challenges such as insufficient standardization,poor cross-institutional comparability,and a lack of long-term outcome tracking,while few studies have traced how this situation arose.Focusing on assessment in the educational measurement sense-the measurement of learners' outcomes,as distinct from the evaluation of programs as a whole-and adopting an abductive approach that infers epistemological foundations from actual assessment practices,this article divides the evolution of assessment methods in narrative medicine education since 2001 into three stages according to their epistemological foundations and methodological features.The first stage (2001-2008),grounded in phenomenology and constructivism,was dominated by qualitative text analysis such as reflective writing,emphasizing lived experience and reflection but lacking standardized,generalizable instruments.The second stage (2009-2016),responding to the evidence-based medicine paradigm and seeking disciplinary legitimacy,widely borrowed generic instruments such as the Jefferson Scale of Physician Empathy and the Maslach Burnout Inventory and made initial attempts at mixed methods,thereby exposing an epistemological conflict between positivism and interpretivism.The third stage (2017-present) has shifted toward developing specialized instruments for assessing narrative competence,reflecting a pragmatist integration of quantitative and qualitative approaches,though its maturation remains constrained by weak measurement standardization and the absence of long-term behavioral and clinical outcome assessment.This study suggests that the evolution of assessment methods in narrative medicine education is essentially an ongoing dialogue between humanistic and positivist epistemological traditions,through which the field continually clarifies its assessment aims and defines its disciplinary identity.
Through literature review and analysis of clinical practice cases,this paper proposes that narrative dialogue refers to the conscious expression and communication between physicians and patients,with a clear narrative orientation within specific clinical contexts.Its core lies in externalizing patients' implicit,unspoken suffering and establishing empathic connections.Narrative dialogue comprises four constituent elements-context,subject,orientation,and connection-and manifests distinct objectives and characteristics at three levels:value,narrative essence,and practice.This article synthesizes the general core principles and practical steps of narrative dialogue and argues that narrative dialogue constitutes a recognizable,analyzable,and teachable core component in the clinical practice of narrative medicine.It bridges narrative medicine theory with clinical practice and provides a new breakthrough point for the systematic construction of narrative medicine education and clinical paths.
Lumbar puncture is an important clinical technique.In patients with spinal deformities or those who undergo lumbar surgery，using surface anatomical landmarks for localization is often challenging，and real-time ultrasound guidance can be employed to complete the procedure.This article reports two representative difficult cases of lumbar puncture and provides a detailed review and summary of the application and clinical experience of ultrasound-guided lumbar puncture in these types of patients.
