Background: Narrative competence in medicine enabled physicians to listen to patients’ illness experiences, construct their narratives, and enhance reflective practice, empathy, humanistic literacy, and person-centered care. However, systematic research and clear definitions for measurable indicators of narrative competence assessment were lacking. This study aimed to develop and validate a narrative competence scale for medical students. Methods: A 57-item draft scale was developed, and categorized into four dimensions and eleven sub-dimensions after interdisciplinary literature review. Three rounds of the Delphi method were conducted with eleven experts specializing in narrative medicine. Pilot testing involved 200 fifth- and sixth-year medical students in Taiwan (136 males, 64 females). Confirmatory factor analysis CFA) and Cronbach’s α were used to evaluate the NCS-MS’s reliability and validity. Results: The NCS-MS was refined through three rounds of the Delphi method, focusing on item revisions and sub-dimension definitions. The results of CFA indicated a good fit for the four-factor model (RMSEA = 0.055, SRMR = 0.045, GFI = 0.911, NFI = 0.926, IFI = 0.971, CFI = 0.970). The Cronbach’s α coefficients for the four dimensions ranged from 0.797 to 0.942, with an overall α of 0.972, demonstrating excellent internal consistency reliability. Conclusions: The NCS-MS effectively evaluated the narrative competence of medical students. From the perspective of narrative medicine, the NCS-MS served as a research or teaching assessment tool for assessing medical students’ narrative competence in narrative medicine research, instructional design, and implementation.

Background Taiwan officially became the first country in Asia to legalize same-sex marriage on May 24, 2019. Despite this progressive step, many older adults in Taiwan continue to exhibit more resistance to same-sex marriage and families than do other age groups. The present study delineated the educational strategies employed in lesbian, gay, bisexual, and transgender (LGBT) education targeting older adults. In addition, the study analyzed the reactions and attitudinal shifts of older adults upon being exposed to the narratives of lesbian and gay individuals and the effects of these narratives on the older adults' attitudes toward same-sex families. This study used action research (1) to gauge the responses of older adults to same-sex marriage and families through a specialized course and (2) to explore the pedagogical approaches that are effective in teaching older adults about same-sex marriage and families. Literature Review The Gender Equality Division of the Executive Yuan in Taiwan reported that as of 2022, 66.7% of Taiwanese older adults aged above 60 years were opposed to same-sex marriage being legal. In addition, 45.1% reported that they believed that "homosexuality is a disease that can be cured with treatment," 59.6% believed that "marriage between same-sex couples destroys the family system and ethics," and 46.7% believed that same-sex couples could not raise children as well as heterosexual couples could. These statistics reveal prevailing prejudices, stigmas, and misconceptions about the LGBT community among older Taiwanese adults. Contact theory, first introduced by Allport in 1954, posits that prejudices and stereotypes can be mitigated through meaningful contact between individuals. In his seminal work The Nature of Prejudice, Allport (1954) argued that direct and appropriate interactions can foster mutual understanding between mainstream (majority) and nonmainstream (minority) groups. The application of contact theory in educational settings can effectively reduce stereotypes, prejudices, and discrimination (Pettigrew, 2021; Pettigrew & Tropp, 2006). Such pedagogical approaches also promote empathy in individuals (Allport, 1954). Empirical studies have indicated that individuals who have had contact with the LGBT community demonstrate more positive attitudes and higher levels of empathy toward this community compared with those without such contact (Brown & Hewstone, 2005; Chang & You, 2012; Han et al., 2010; Norton & Herek, 2013). Specifically, individuals experience increased empathy levels after interacting with LGBT individuals who share information regarding their life experiences and personal narratives. Studies on this topic have primarily focused on younger populations, such as college students (Chang & Huang, 2018; Chang & You, 2012), revealing a substantial research gap in the literature on LGBT education for older adults. Methods The present study was conducted at Sunshine University (pseudonym) in Hualien, Taiwan. The criteria for study participation were (1) being 55 years of age or older and (2) self-identifying as heterosexual. The study spanned two sessions, each lasting 3 hours, with the sessions conducted in March and April 2021. The curriculum was designed around the principles of contact theory and empathy (Allport, 1954). In addition, we invited an older adult named Ah Hung (pseudonym), who identified as gay, to share personal stories related to life as a gay person and the problems same-sex families face. The pedagogical approach was primarily focused on storytelling and classroom dialogue (Lee & Lin, 2021). This approach is often employed to expose participants to different forms of family structures, such as those involving different social groups, new immigrants, single or single-parent households, heterosexual couples, gay and lesbian couples, and families with intergenerational caregiving. Data were collected through classroom observations, interviews, and reflective notes provided by the instructors. We used Miles and Huberman's (1994) process for qualitative data analysis, which includes (1) streamlining data, (2) presenting data, (3) interpreting data, and (4) drawing conclusions. Results This study involved 17 individuals. After the course and subsequent data analysis were completed, three central themes emerged: (1) the participants developed a new understanding of the LGBT community, albeit incompletely; (2) the participants' attitudes toward same-sex marriage and families remained unchanged; and (3) the participants were more willing to adjust their explicit discriminatory attitudes (e.g., I understand why we are different) than their implicit discriminatory attitudes (e.g., I still cannot accept same-sex marriage). We elaborate upon these findings in the following. The participants gained a new understanding of gay and lesbian people and empathized with the feelings and perceptions of these people through their interaction with Ah Hung. The participants reported a heightened understanding of the challenges gay and lesbian people face in Taiwanese society when marrying and forming families. Taken together, our findings indicate that the course led the participants to empathize with the emotional and cognitive experiences of gay and lesbian people. Despite the overall increase in empathy, of the 17 participants, only 2 female students experienced a change from disapproving to approving of same-sex families. Some comments from the participants included: "My empathy for homosexuals is not the same as approval of same-sex marriage;" "I respect [the LGBT population], but I still do not accept homosexuals coming out publicly because it can embarrass their parents;" "I understand [the LGBT population's] difficulties in Taiwanese society, but they must also understand that homosexuals raising children will negatively affect the children." These reflections indicate that the participants generally offered "politically correct" responses, such as expressions of understanding and respect; their responses often masked implicit discriminatory attitudes, such as the unfounded belief that children raised in gay families might also "become" gay. Moreover, the participants generally did not perceive themselves to be harboring discriminatory or prejudicial attitudes toward the LGBT community. Taken together, our findings indicate that the course did not lead to immediate changes in the attitudes of most participants toward same-sex marriage and families. However, it did soften the perspectives of the participants on gay and lesbian people, broaden their understanding of gender diversity, and increase their awareness of the needs and challenges related to the formation of gay and lesbian families. Discussion and Suggestions Although the education program led to minimal change in the attitudes of the participating older adults toward same-sex marriage and family concerns, it did provide insights into their true perspectives regarding the LGBT community. These insights distinguish the present study from other studies, which have primarily focused on university students or high school students. This study offers the following suggestions for future efforts toward and studies of LGBT education aimed at older adults: (1) initiating contact with a person who identifies as LGBT can be used as a starting point for fostering acceptance among older adults; (2) empathy and contact theory should be incorporated into curricula to broaden the heteronormative perspectives prevalent among older adults; and (3) strategies for combatting implicit discriminatory attitudes in older adults, such as those related to gay rights or relationships, should be incorporated into curricula. The education of this study established a channel of communication by exposing older adults to the narrative of a gay person, which led them to feel empathy. Through such pedagogical approaches, older adults may develop a better understanding of the experiences of gay and lesbian people and recognize these people's right to make life choices. Our findings indicate that studies and educational practices should be more focused on the development of LGBT educational programs designed for an older population.

To develop the creativity needed to confront the multi-faceted challenges of 21st Century sus-tainable development goals (SDGs), university students urgently need a curriculum framed around their solving real-world problems, such as what a Project-Oriented, Problem-Based Learning (POPBL) curriculum offers. Moreover, to build a functionally sustainable future, stu-dents should develop creativity through an interdisciplinary lens. This study used a quasi -experimental design to explore the impact of an interdisciplinary POPBL course with a partici-patory design pedagogy on university students' engineering creativity. Four professors from future studies, architecture, engineering, and education disciplines designed and implemented the experimental curriculum. The curriculum incorporated three key concepts around creative design thinking: participatory design, future thinking, and visual communication. The experimental group consisted of 19 undergraduate students in the Engineering Design for Society course. The control group of 23 Civil Engineering undergraduates participated in the Civil Engineering Design course. The findings are: (1) The experimental group received significantly higher creativity scores on fluency, flexibility, originality, and usefulness. (2) The control group's scores regressed on the post-test. (3) The experimental group's higher scores indicated that interdisciplinary POPBL instruction combined with participatory design pedagogy can promote interdisciplinary creativity. The researchers propose the term empathetic-future thinking to describe the participa-tory design pedagogy centred on community-based feedback and interdisciplinary communica-tion and teamwork. By developing a sense of empathy for cross-domain cognition and the end -users of the design, students enhanced the originality and usefulness of their design. Educators should incorporate empathetic-future thinking to develop students' engineering creativity for achieving 21st Century SDGs.

The present study, using a moderated mediational model, explored levels of distal/proximal stressors, rumination, resilience, and health in a group of Italian and Taiwanese LGB+ people. The study also examined the role of internalized sexual stigma (ISS) and rumination as mediators between discrimination and health, and resilience as a moderator of the relationship between discrimination and ISS, rumination, and health, respectively. An online survey was administered to 508 LGB+ participants (270 Italian and 238 Taiwanese) whose age ranged from 18 to 70 years ( M = 37.93, SD = 13.53). The moderated mediation model was tested through a series of path analyses stratified by group nationality. Italian participants reported higher discrimination and resilience, but lower ISS, rumination, and health problems compared to their Taiwanese counterparts. The only common path between groups was the direct effect of discrimination on health problems. The mediating role of ISS and rumination in the relationship between discrimination and health, as well as the moderating role of resilience, were partly significant only for the Italian group. Conclusions: The findings suggest that mediators and moderators used to evaluate the effects of minority stress on health may differ between groups; further culturally sensitive research in the field of LGB+ health is needed.

BACKGROUND:Tzu Chi University in Taiwan offers a unique mentoring program. This program differs from others as it comprises triple mentorship, namely, faculty mentors, Tzu Cheng/Yi De (TC/YD; senior volunteers), and school counselors. This study aimed to survey the role functions of the mentors from the perspective of medical students.METHODS:The Role Functions of the Mentoring Program Scale (RFMPS) was developed on the basis of literature reviews and focus groups and it underwent exploratory factor analysis for internal consistency and reliability. RFMPS comprises four role functions, namely, mental, educational, career, and humanistic/moral guidance counseling. The survey was distributed to 171 medical students via an online network with two-month intervals and was analyzed using multivariate analysis of variance.RESULTS:The overall response rate was 64% (116/171). The mean scores of the four role functions in descending order belonged to faculty mentors, TC/YD, and school counselors. For humanistic/moral guidance, students had an equal preference for the faculty mentors and TC/YD over school counselors. As for educational, career, and mental guidance counseling, students preferred faculty mentors over TC/YD and school counselors. Faculty mentors provided students with the required guidance counseling for all the four role functions, especially educational guidance; TC/YD in particular offered prominent humanistic/moral guidance and career counseling; school counselors were less preferred but guided students in need.CONCLUSIONS:Medical students value different role functions provided by faculty mentors, TC/YD, and school counselors. A diversified focus could be provided by the faculty mentors, particularly in educational, career, mental, and humanistic/moral counseling; TC/YD specialized in humanistic/moral guidance; and the school counselors carried out their role function only when needed. Humanistic/moral guidance is equally preferred to other types of guidance, which can be equally valuable in future mentoring programs.