Narrative Reflection Education and Philosophy of General Medicine

doi:10.12114/j.issn.1007-9572.2019.00.602

Abstract

Abstract: Narrative reflection education is an important part of postgraduate medical education training and clinical resident training.Through narrative reflection，residents and graduate students can develop self-regulating learning skills，improve learning ability，humanistic spirit and professional identity，and its application in general medical education is particularly important.This paper intended to make a preliminary discussion of the narrative reflection practice and the philosophy of general medicine，and theoretically analyze the role of narrative reflection practice in medical education，so as to provide some thinking for further research.

Key words: General practice；Family practice；Education, medical；Narrative medicine；Narrative reflection；Philosophy, medical；Physician-patient relations

摘要： 叙事反思教学是研究生医学教育培训和临床住院医师培训的重要组成部分。通过运用叙事反思的学习方法，住院医师和研究生可以发展自我调节的学习技能，可以提高学习能力，改善人文精神和职业身份认知，其在全科医学教育方面的应用尤为重要。本文拟从叙事反思方法与全科医学的哲学理念做一初步探讨，从理论上分析叙事反思方法可能对医学教育的作用，为进一步研究提供参考。

关键词: 全科医学, 家庭医学, 教育, 医学, 叙事医学, 叙事反思, 哲学, 医学, 医生病人关系

LUO Yingquan,HUANG Heying,ZHANG Hui4. Narrative Reflection Education and Philosophy of General Medicine　[J]. Chinese General Practice, 2020, 23(1): 100-104. DOI: 10.12114/j.issn.1007-9572.2019.00.602.
罗荧荃,黄鹤英,张慧. 叙事反思教育与全科医学哲学[J]. 中国全科医学, 2020, 23(1): 100-104. DOI: 10.12114/j.issn.1007-9572.2019.00.602.

References

［1］STRONG C.Medicine and philosophy：the coming together of an odd couple［M］//The development of bioethics in the United States.Dordrecht：Springer Netherlands，2012：117-136.
［2］HUDSON J D.A model of professional knowledge for social work practice［J］．Aust Soc Work，1997，50（3）：35-44．DOI：10.1080/03124079708414096．
［3］CLANDININ D J，CAVE M T.Creating pedagogical spaces for developing doctor professional identity［J］．Med Educ，2008，42（8）：765-770．DOI：10.1111/j.1365-2923.2008.03098.x.
［4］ROLFE V.Can Turnitin be used to provide instant formative feedback［J］．Br J Educ Technol，2011，42（4）：701-710．DOI：10.1111/j.1467-8535.2010.01091.x.
［5］FOOK J，GARDNER F.Practising critical reflection：a resource handbook［M］．Milton Keynes：Open University Press，2007.
［6］HICKSON H.Becoming a critical narrativist：using critical reflection and narrative inquiry as research methodology［J］．Qualitative Social Work，2016，15（3）：380-391．DOI：10.1177/1473325015617344.
［7］CLANDININ D J，CAVE M T，CAVE A，et al．Learning narratively：resident physicians' experiences of a parallel chart process［J］．Internet J Med Educ，2010，1（1）：1-10．DOI：10.5580/2690.
［8］U.S. National Library of Medicine．Changing the face of medicine［EB/OL］．（2010-09-29）［2019-01-03］．http：//www.nlm.nih.gov/changingthefaceofmedicine/video/58_1_trans.html.
［9］MANN K，GORDON J，MACLEOD A.Reflection and reflective practice in health professions education：a systematic review［J］．Adv Health Sci Educ Theory Pract，2009，14（4）：595-621．DOI：10.1007/s10459-007-9090-2.
［10］CONNELLY F M，CLANDININ D J.Teachers as curriculum planners.Narratives of experience［M］．New York：Teachers College Press，1988.
［11］CLANDININ D J，CONNELLY F M.Narrative inquiry：experience and story in qualitative research［M］．San Francisco：Jossey-Bass，2000.
［12］MATTINGLY C F.Acted narratives：from storytelling to emergent dramas［M］．Thousand Oaks：Sage Publications，Inc，2007.
［13］SCHAFER R.Retelling a life：narrative and dialogue in psychoanalysis［M］．New York：Basic Books，1992.
［14］CLANDININ J，CAVE M T，CAVE A.Narrative reflective practice in medical education for residents：composing shifting identities［J］．Adv Med Educ Pract，2011，2：1-7．DOI：10.2147/AMEP.S13241.
［15］TAYLOR S.Reflective practice：writing and professional development［J］．Med Educ，2001，35（8）：813．DOI：10.1046/j.1365-2923.2001.0952c.x.
［16］BRADY D W，CORBIE-SMITH G，BRANCH W T."What's important to you?" The use of narratives to promote self-reflection and to understand the experiences of medical residents［J］．Ann Intern Med，2002，137（3）：220-223．DOI：10.7326/0003-4819-137-3-200208060-00025.
［17］KERN D E.Personal growth in medical faculty：a qualitative study［J］．West J Med，2001，175（2）：92-98．DOI：10.1136/ewjm.175.2.92.
［18］RABOW M W，MCPHEE S J.Doctoring to heal：fostering well-being among physicians through personal reflection［J］．West J Med，2001，174（1）：66-69．DOI：10.1136/ewjm.174.1.66.
［19］CHARON R.The patient-physician relationship.Narrative medicine：a model for empathy，reflection，profession，and trust［J］．JAMA，2001，286（15）：1897-1902．DOI：10.1001/jama.286.15.1897.
［20］CHARON R.Narrative medicine：form，function，and ethics［J］．Ann Intern Med，2001，134（1）：83-87．DOI：10.7326/0003-4819-134-1-200101020-00024.
［21］DASGUPTA S，CHARON R.Personal illness narratives：using reflective writing to teach empathy［J］．Acad Med，2004，79（4）：351-356．DOI：10.1097/00001888-200404000-00013.
［22］GAVER A，BORKAN J M，WEINGARTEN M A.Illness in context and families as teachers：a year-long project for medical students［J］．Acad Med，2005，80（5）：448-451．DOI：10.1097/00001888-200505000-00007.
［23］LEVINE R B，KERN D E，WRIGHT S M.The impact of prompted narrative writing during internship on reflective practice：a qualitative study［J］．Adv Health Sci Educ Theory Pract，2008，13（5）：723-733．DOI：10.1007/s10459-007-9079-x.
［24］KUNG J W，EISENBERG R L，SLANETZ P J.Reflective practice as a tool to teach digital professionalism［J］．Acad Radiol，2012，19（11）：1408-1414．DOI：10.1016/j.acra.2012.08.008.
［25］JUVE M.Reflective practice and readiness for self-directed learning in anesthesiology residents training in the United States［R］．Portland：Portland State University Library，2000．
［26］EPNER D E，BAILE W F.Difficult conversations：teaching medical oncology trainees communication skills one hour at a time［J］．Academic Medicine Journal of the Association of American Medical Colleges，2014，89（4）：578.
［27］ADAMS K E，O'REILLY M，ROMM J，et al．Effect of Balint training on resident professionalism［J］．Am J Obstet Gynecol，2006，195（5）：1431-1437．DOI：10.1016/j.ajog.2006.07.042.
［28］GEORGE P，REIS S，DOBSON M，et al．Using a learning coach to develop family medicine residents' goal-setting and reflection skills［J］．J Grad Med Educ，2013，5（2）：289-293．DOI：10.4300/JGME-D-12-00276.1.
［29］KHANUM Z.Effectiveness of reflective exercises for obstetrics and gynaecological residents［J］．J Coll Physicians Surg Pak，2013，23（7）：468-471．DOI：07.2013/JCPSP.468471.
［30］BERNARD A W，KMAN N E，BERNARD R H，et al．Use of a secure social media platform to facilitate reflection in a residency program［J］．J Grad Med Educ，2014，6（2）：326-329．DOI：10.4300/JGME-D-13-00226.1.
［31］BETHUNE C，BROWN J B.Residents' use of case-based reflection exercises［J］．Can Fam Physician，2007，53（3）：471-476，470.
［32］TOY E C，HARMS K P，MORRIS R K，et al．The effect of monthly resident reflection on achieving rotation goals［J］．Teach Learn Med，2009，21（1）：15-19．DOI：10.1080/10401330802384276.
［33］MAURER M S，COSTLEY A W，MILLER P A，et al．The Columbia Cooperative Aging Program：an interdisciplinary and interdepartmental approach to geriatric education for medical interns［J］．J Am Geriatr Soc，2006，54（3）：520-526．DOI：10.1111/j.1532-5415.2005.00616.x.
［34］NOTHNAGLE M，REIS S，GOLDMAN R E，et al．Fostering professional formation in residency：development and evaluation of the "forum" seminar series［J］．Teach Learn Med，2014，26（3）：230-238．DOI：10.1080/10401334.2014.910124.
［35］DASGUPTA S，MEYER D，CALERO-BRECKHEIMER A，et al．Teaching cultural competency through narrative medicine：intersections of classroom and community［J］．Teach Learn Med，2006，18（1）：14-17．DOI：10.1207/s15328015tlm1801_4.
［36］LEARMAN L A，AUTRY A M，O'SULLIVAN P.Reliability and validity of reflection exercises for obstetrics and gynecology residents［J］．Am J Obstet Gynecol，2008，198（4）：461.e1-10．DOI：10.1016/j.ajog.2007.12.021.
［37］BALLON B C，SKINNER W."Attitude is a little thing that makes a big difference"：reflection techniques for addiction psychiatry training［J］．Acad Psychiatry，2008，32（3）：218-224．DOI：10.1176/appi.ap.32.3.218.
［38］WINKEL A F，HERMANN N，GRAHAM M J，et al．No time to think：making room for reflection in obstetrics and gynecology residency［J］．J Grad Med Educ，2010，2（4）：610-615．DOI：10.4300/JGME-D-10-00019.1.
［39］WINKEL A F，YINGLING S，JONES A A，et al．Reflection as a learning tool in graduate medical education：a systematic review［J］．J Grad Med Educ，2017，9（4）：430-439．DOI：10.4300/JGME-D-16-00500.1.
［40］MCWHINNEY I R，FREEFAN T.The text book of family medicine［M］．Oxford：Oxford University Press，2009.
［41］GREENHALGH T，HURWITZ B.Narrative based medicine：why study narrative?［J］．BMJ，1999，318（7175）：48-50．DOI：10.1136/bmj.318.7175.48.
［42］HAVE H T.Bodies of knowledge，philosophical anthropology，and philosophy of medicine［M］//The philosophy of medicine.Dordrecht：Springer Netherlands，2000：19-36．
［43］VON U.Psychosom medicine［M］．Munich：Urban and Schwarzenberg，1997.
［44］KONNITZER M.Narrative Based Medicine.Wiedereinführung des subjekts in die medizin?［J］．Sozialer Sinn，2005，6（1）：111-130.
［45］WOOD J K.Carl Rogers' person-centered approach：toward an understanding of its implications［M］．Ross-on-Wye：PCCS Books，2000.
［46］BALINT M.The doctor，his patient，and the illness［M］．Oxford：Churchill Livingstone，1986.
［47］MATTHIESSEN P F.Physicians's practice and scientific status of medicine［J］．Forschende Komplementrmedizin，2006，13（3）：136-139.
［48］KALITZKUS V，MATTHIESSEN P F.Narrative-based medicine：potential，pitfalls，and practice［J］．Perm J，2009，13（1）：80-86．DOI：10.7812/tpp/08-043.
［49］ENGEL G L.The need for a new medical model：a challenge for biomedicine［J］．Science，1977，196（4286）：129-136．DOI：10.1126/science.847460.
［50］VON B L.Perspectives on general system theory［M］．New York：George Braziller，Inc，1975.
［51］BROWN C，KIEL L D，ELLIOTT E.Chaos theory in the social sciences［J］．Journal of Politics，1997，91（2）：436.
［52］MINUCHIN S，ROSMAN B L，BAKER L.Psychosomatic families［M］．Cambridge：Harvard University Press，1978.
［53］BORRELL-CARRIó F，SUCHMAN A L，EPSTEIN R M.The biopsychosocial model 25 years later：principles，practice，and scientific inquiry［J］．Ann Fam Med，2004，2（6）：576-582．DOI：10.1370/afm.245.
［54］KIRCH W，SHAPIRO F，Fó LSCH U R.Health care quality：misdiagnosis at a university hospital in five medical eras［J］．Journal of Public Health，2004，12（3）：154-161．DOI：10.1007/s10389-004-0038-1.
［55］CLARK P G.What would a theory of interprofessional education look like? Some suggestions for developing a theoretical framework for teamwork training 1［J］．J Interprof Care，2006，20（6）：577-589．DOI：10.1080/13561820600916717.