Abstract Objectives Empathy in medical education reflects both stable dispositional tendencies and context-dependent emotional responses. While prior research has documented the Identifiable Victim Effect in prosocial decision-making, little is known about whether patient identifiability modulates empathy responses within medical professional training contexts. Methods A total of 281 medical students were randomly assigned to read either an identifiable or non-identifiable patient version of a brief disease narrative. Participants then completed the Empathy Response Scale and Interpersonal Reactivity Index. Independent samples t -tests and analysis of covariance (ANCOVA) were conducted to examine the effect of patient identifiability while controlling for dispositional empathy. Differences between undergraduate and graduate students were further explored. Results Narratives featuring identifiable patients elicited significantly higher empathy responses than non-identifiable narratives ( t =−2.0100, p=0.0450). This effect remained significant after controlling for dispositional empathy, indicating that identifiability exerts an independent contextual influence beyond stable empathic traits. Moreover, the identifiable patient effect was observed among graduate students but not undergraduates, suggesting that training stage may moderate responsiveness to narrative cues. Conclusions The findings support a dynamic model of empathy in which situational narrative features interact with dispositional capacity to shape empathic engagement. Patient identifiability functions as a contextual empathy activator in medical education settings, highlighting the importance of narrative design in professional training.

The burgeoning field of Narrative Medicine (NM) in China has drawn the attention of scholars and medical practitioners nationwide, yet discrepancies in understanding its principles and methods remain.The absence of overarching guidance and detailed practice strategies has impeded the development of NM's potential.To address this gap and to foster a unified approach to the history, practice, and research of NM, the Narrative Medicine Association of the Chinese Preventive Medicine Association and the Narrative Medicine Association of the Beijing Integrative Medicine Association convened a panel of experts to draft the Expert Consensus on Narrative Medicine in China (ECNMC 2023) [1].Medicine is fundamentally concerned with preventing and treating diseases as well as preserving or reinstating the physical, psychological, and social well-being of individuals.Humane care should be at the core of medicine.Nonetheless, the emphasis on medical technologism and the paucity

Abstract Objective: This article aimed to offer insights into patients’ expectations regarding the traits of physicians, with the goal of helping physicians gain a better understanding of patient needs and provide better care. Method: This study used a Python crawler script to collect patients’ comments from haodf.com, a major online consultation platform in China, to examine the expected character traits of physicians by patients. A total of 83,315 comments were obtained. We selected positive comments from patients, performed text segmentation using Jieba, and utilized the TextRank algorithm to identify high-ranking words based on the Index of Relative Importance (IRI) within these comments. To make the findings comprehensible and practical for physicians and medical educators, we utilized a word cloud to visualize the results. We classified the high-ranking words into 4 dimensions—professional competence, communication attitude, communication ability, and character traits—based on the categorization of positive physician qualities found in the relevant literature. Results: Key findings from the study included: (1) The top 23 high-ranking words for traits of good physicians (in descending order) were patient, meticulous, proficient, precise, kind, moderate, successful, gentle, rigorous, explicit, clear, effective, humorous, sincere, skilled, kindhearted, modest, awesome, practical (and not flashy), unhurried, experienced, clean, and excellent; (2) patients placed the highest value on the professional competence of physicians, followed by their communication attitude, communication ability, and character traits; (3) despite the highest IRI score for professional competence, it was exceeded by the combined scores of communication attitude and communication ability. This underscored the significance of effective communication in medical encounters. Conclusions: Drawing from these findings, recommendations are proposed for physicians and medical educators to enhance the quality of medical encounters. These suggestions include implementing narrative medicine training to improve communication awareness and skills as well as encouraging lifelong continuing medical education to maintain professional competence among practitioners. This study contributes to the establishment of positive physician-patient relationships in both telemedicine and face-to-face medical interactions.

Aplastic anemia (AA) is a life-threatening disease characterized by bone marrow (BM) failure and pancytopenia. As an important component of the BM microenvironment, endothelial cells (ECs) play a crucial role in supporting hematopoiesis and regulating immunity. However, whether impaired BM ECs are involved in the occurrence of AA and whether repairing BM ECs could improve hematopoiesis and immune status in AA remain unknown. In this study, a classical AA mouse model and VE-cadherin blocking antibody that could antagonize the function of ECs were used to validate the role of BM ECs in the occurrence of AA. N-acetyl-L-cysteine (NAC, a reactive oxygen species scavenger) or exogenous EC infusion was administered to AA mice. Furthermore, the frequency and functions of BM ECs from AA patients and healthy donors were evaluated. BM ECs from AA patients were treated with NAC in vitro, and then the functions of BM ECs were evaluated. We found that BM ECs were significantly decreased and damaged in AA mice. Hematopoietic failure and immune imbalance became more severe when the function of BM ECs was antagonized, whereas NAC or EC infusion improved hematopoietic and immunological status by repairing BM ECs in AA mice. Consistently, BM ECs in AA patients were decreased and dysfunctional. Furthermore, dysfunctional BM ECs in AA patients led to their impaired ability to support hematopoiesis and dysregulate T cell differentiation toward proinflammatory phenotypes, which could be repaired by NAC in vitro. The reactive oxygen species pathway was activated, and hematopoiesis- and immune-related signaling pathways were enriched in BM ECs of AA patients. In conclusion, our data indicate that dysfunctional BM ECs with impaired hematopoiesis-supporting and immunomodulatory abilities are involved in the occurrence of AA, suggesting that repairing dysfunctional BM ECs may be a potential therapeutic approach for AA patients.

This paper sketches the history and the author’s involvement in the development of narrative medicine in China. It also describes “narrative medicine with Chinese characteristics,” explaining why narrative medicine is regarded as a tool to materialize the medical humanities in clinical practice, and detailing the features of narrative medicine in China. The features include the wide acceptance of the “22334 model” of narrative medicine, and borrowing theories and practice from Traditional Chinese Medicine. Finally, the author argues that the medical humanities should be given a “Class-A discipline” status, and narrative medicine should be a class-B discipline under the medical humanities.

Traditional Chinese culture,especially traditional Chinese medical culture,contains rich narrative elements,which can provide theoretical and practical inspiration for the localization of narrative medicine in China.The narrative elements in traditional Chinese culture naturally embody the three dimensions of curriculum ideology and politics:self-improvement,professionalism and patriotism.Therefore,integrating traditional Chinese culture into narrative medicine curriculum not only meets the requirement of curriculum ideology and politics,but also fits the nature of narrative medicine.With a five-part design of sixteen credit hours which comprise of introduction to narrative medicine and traditional Chinese culture,illness narrative,medicine narrative,traditional Chinese medicine narrative and regimen narrative,this course explores the narrative elements in classical texts such as Dream of Red Mansions,The Essays of Dongpo and Life of Li Shizhen,specifically shows the pedagogic objectives,ideological and political elements,pedagogic methods and cases of narrative medicine and traditional Chinese culture,and uses ideological and political cases to promote the cultural and moral education in narrative medicine courses.

This article presents a design of illness narrative course,teaching theoretical frameworks such as explanatory mode and narrative structure to help students understand illness narrative;using specific illness narratives such as psychiatric illness narrative,neurological illness narrative to help students imagine illness experience;guiding students in interviewing patients and writing illness narratives.Ideological and political elements are incorporated from the three dimensions of theory,examples and practice to inculcate “respect for and identification with the patients” into the students.

教育不仅有功利性目的,如教给受教育者谋生的手段,更有非功利性的目的;教育不仅要传授知识、培养智慧,更要使受教育者建立正确的世界观、人生观和价值观,提升个人修养,培养理想信念和健全人格,塑造担当和使命感,使受教育者本人能过一种"美好、道德的生活",使整个社会和谐稳定健康地发展,国家因受教育者的贡献而强大,达到教育的个人价值和社会价值的统一.因此,医学教育虽然是一种职业教育,但不能只停留在教授技术的"技校思维"层面,医学生将要成长为肩负维护社会健康职责的医务工作者,他们的成长不仅体现着个人的需求,更体现着社会对医学的期盼.因此,相比一般性教育,在医学教育中关于道德和责任感的教育就显得尤为重要,这也是教育部2020年颁布的《高等学校课程思政建设指导纲要》中对医学教育的要求.

Moral education integrated into course instruction is a new approach to explore and innovate moral cultivation.The approach aims at instilling virtues and work ethics in all courses,by all teachers and through all channels.Narrative medicine is a tool for cultivating medical students’ “patient-caring and life-respecting spirit” and a way for practicing medical humanities.The integration of moral education into Narrative Medicine course will provide an effective way for cultivating medical students’ personal virtues,professional ethics and social conscience.This paper introduces the course design of such integrated narrative medicine courses,and indicates the necessity and consistency of such integration.

Introduction to narrative medicine introduces the framework and theory of narrative medicine.The course incorporates specific clinical cases to enlighten the learners,which helps moral cultivation take root in the medical curriculum.This paper showcases the course design and teaching arrangements of introduction to narrative medicine,with an emphasis on both the lecturing of theory and discussions of practical implications,highlighting the significance of medical ethics in clinical practice.

叙事医学可以作为大学教学医院进行医学人文教育的重要手段.医学院可以进行细读训练,进入临床后,通过阅读和书写平行病历培养医学生的叙事能力.临床带教教师在医学人文教育中具有关键的示范作用,通过叙事性问诊、用叙事的方法与患者和家属建立关联,用叙事方法协助患者和家属做出临床决策,以及提供案例、点评升华其中的价值元素等叙事性带教方法,实现医学人文教育的言传身教,这也是医学人文教育的重要组成部分.

“Moral cultivation and talent nurturing”is an essential part of education.The medicine and literature course can play an important role in the moral education of medical students.As a foundational course of narrative medicine,medicine and literature not only helps improve students’ comprehensive quality and humanistic quality,but also offers two signature tools to cultivate their narrative competence.This paper explores the different ways to teach moral principles and beliefs in the modules of medicine and literature course.

卡夫卡的中篇小说《变形记》是医学人文教育中的名篇,入选叙事医学细读文本.故事主人公格雷戈尔·萨姆沙变形的经历,类似人们突然罹患疾病,尤其是慢性疾病,身体发生变形、行动不便、不能自理、需要人照顾,而且他的发声也受到影响,处于无法言说的失语状态,从这层意义上来说,也可将其视为一则疾病故事来阅读.它隐喻了患者的存在困境,如疾病羞耻、照护问题、去人化境遇、存在的孤独以及失语问题等.通过对这些困境的分析,建议重新思考慢病时代医学的目标,关注患者生活世界,并强调理解患者存在困境的双向意义.

叙事医学是对生物医学某种程度上的纠偏,探究二者不同的哲学基础有助于更好地理解叙事医学的纠偏功能.生物医学的哲学基础为笛卡尔哲学的身心二元论,笛卡尔把古希腊柏拉图对理性的尊崇发扬到极致,认为知识及科学与身体的感受完全无关,人的身体就是一个需要医生用知识修补的机器,把疾病和患者的人分离了.叙事医学则建立在后现代的哲学基础之上,从身体现象学、叙事诠释学、关于后现代科学知识的认识论、工具理性和价值理性等的论述中汲取养分,强调身体的感受,认为医生的诊断行为也是一种诠释过程,需要听到患者对自己疾病的诠释;同时认为,医生应认识到现在的医学知识不是永恒的真理,要尊重患者故事这种叙事知识,在临床决策时,不仅要关注医学知识的工具理性,更要关注患者的价值理性.

医学与文学虽然同根同源,但也存在着巨大的差异.从翻译的角度来看,医学与文学分别代表着对身体、疾病和健康的不同解读.本文首先介绍直译与意译两种译法,论证不同的翻译方式具有传递同样意义的潜力.其次,以西西的作品《哀悼乳房》为例展示了医学语言和文学语言的差异,发掘翻译理念对于医学的参考意义.最后,本文落脚于翻译理念的开放性、多样性和对话性,认为这是医学与文学融合的基础.

叙事医学的精髓在于愿意去倾听患者的叙事,并为之采取各样的行动,产生对医患都有益的结果.鉴于此,叙事医学近几年来在我国得以迅速发展,以叙事医学为方法的实践、为内容的教学和研究都有一定的发展,但其数量、质量和深度都有待进一步提高.当务之急是要研究各种情境中实践叙事医学的临床路径;探讨在现象学、叙事诠释学和社会建构论指导下医患互动中的关联性,在医学教育中加强细读训练,探索利用叙事进行临床教学的方法,多管齐下,以实现叙事医学在我国的扎根落地.