Different perceptions of narrative medicine between Western and Chinese medicine students

Investigating medication adherence among Taiwanese patient with hypertension, hyperlipidemia, and diabetes: A pilot study using the Chinese version of a Two-Part Medication Nonadherence Scale and the NHI MediCloud system

BACKGROUND

This pilot study aimed to investigate medication nonadherence among Taiwanese patients with diabetes, hypertension, and hyperlipidemia using the Chinese version of the Two-Part Medication Nonadherence Scale (C-TPMNS) and the National Health Insurance (NHI) Medicloud system. The study revealed insights into the factors contributing to nonadherence and the implications for improving patient adherence to medications for chronic conditions. However, the small sample size limits the generalizability of the findings. Additionally, the study identified the need for further research with larger and more diverse samples to validate the preliminary findings.

METHODS

The study conducted surveys individuals in central Taiwan who received three-high medications and those who returned expired medications from chain pharmacies. A structured questionnaire including the C-TPMNS was administered, and additional data on medical history and HbA1c, LDL, and blood pressure levels were collected from the NHI Medicloud system. Data analysis was performed using multiple ordered logistic regression and Wald test methods. Setting interpretation cutoff point to determine medication nonadherence.

RESULTS

The study found that 25.8% of participants were non-adherent to prescribed medications. Non-adherent individuals had significantly higher systolic blood pressure (SBP ≥ 140 mmHg) than adherent participants. Non-adherence was also associated with factors such as lower education, single status, living alone, abnormal glucose postprandial concentration, and triglyceride levels. The C-TPMNS demonstrated good reliability (Cronbach's alpha = 0.816) and validity (area under the ROC curve = 0.72).

CONCLUSION

The study highlighted the complexity of medication nonadherence with diverse determinants and emphasized the importance of tailored interventions. The findings underscored the need for region-specific research to comprehensively address medication nonadherence, especially focusing on adherence to medications for hypertension, hyperlipidemia, and diabetes. The study also identified the need for larger, more diverse studies to validate and expand upon the initial findings and emphasized the importance of pharmacist interventions and patient empowerment in managing chronic conditions and improving overall health outcomes.

Clinical narrative competence and humanistic care ability of nurses in assisted reproductive technology: a cross-sectional study

BACKGROUND

Growing focus on patient-centred care emphasizes humanistic skills and clinical narrative competence in nursing, particularly in assisted reproductive nursing. However, there is limited evidence to suggest the levels of nurse' clinical narrative competence and humanistic care ability. This study aimed to investigate the clinical narrative competence and humanistic care ability of nurse specialists in assisted reproductive technology (ART) in China.

METHODS

This cross-sectional study included nurses who obtained the ART specialist nurse certificate after nurse training in Zhejiang province assisted reproductive technology specialist nurse training base between 2017 and 2022. A demographic questionnaire, the Caring Ability Inventory (CAI) and Narrative Competence Scale (NCS) were used for data collection. Multivariate linear regression analysis was used to explore risk factors.

RESULTS

A total of 122 participants (120 females, with a mean age of 33.35 ± 5.00 years) were included (response rate = 82.43%). NCS score and CAI score was 143.39 ± 19.24 (range: 27-189) and 198.42 ± 19.51 (range: 37-259) among nurse specialists in assisted reproductive technology, respectively. Multivariate linear regression analysis indicated that professional title (β = 20.003, 95%CI: 3.271-36.735, P = 0.020), and the CAI (β = 0.342, 95%CI: 0.180-0.540, P < 0.001) was independently associated with NCS. Head Nurse/ Team Leader/ Clinical Faculty had significantly higher CAI score than nurse (P = 0.006).

CONCLUSIONS

The clinical narrative competence and caring ability of nurse specialists in assisted reproductive technology was considered sufficient. Professional titles and work position were associated with clinical narrative competence. Enhancing clinical narrative competence can be considered as an effective strategy for promoting humanistic care ability.

TRIAL REGISTRATION

Not applicable.

The Integration of Nanomedicine with Traditional Chinese Medicine: Drug Delivery of Natural Products and Other Opportunities

The integration of progressive technologies such as nanomedicine with the use of natural products from traditional medicine (TM) provides a unique opportunity for the longed-for harmonization between traditional and modern medicine. Although several actions have been initiated decades ago, a disparity of reasons including some misunderstandings between each other limits the possibilities of a truly complementation. Herein, we analyze some common challenges between nanomedicine and traditional Chinese medicine (TCM). These challenges, if solved in a consensual way, can give a boost to such harmonization. Nanomedicine is a recently born technology, while TCM has been used by the Chinese people for thousands of years. However, for these disciplines, the regulation and standardization of many of the protocols, especially related to the toxicity and safety, regulatory aspects, and manufacturing procedures, are under discussion. Besides, both TCM and nanomedicine still need to achieve a wider social acceptance. Herein, we first briefly discuss the strengths and weaknesses of TCM. This analysis serves to focus afterward on the aspects where TCM and nanomedicine can mutually help to bridge the existing gaps between TCM and Western modern medicine. As discussed, many of these challenges can be applied to TM in general. Finally, recent successful cases in scientific literature that merge TCM and nanomedicine are reviewed as examples of the benefits of this harmonization.

Knowledge, Attitude, and Practice regarding Narrative Medicine among Chinese Medical Personnel: An Online Cross-Sectional Survey

Background

Narrative medicine has been applied as a model for humane medical practice in many countries. However, it was not introduced in China until 2011 and there has been no standardized assessment of Chinese medical personnel regarding their perception and application of narrative medicine-related theories. This study is aimed at investigating Chinese medical personnel's knowledge, attitude, and practice regarding narrative medicine and the factors that influence it.

Methods

An online questionnaire based on the knowledge, attitude, and practice model was distributed among Chinese medical personnel from December 2021 to March 2022. All in-service medical personnel across China who had access to the Internet were eligible. Two independent samples t-tests, one-way analysis of variance, Pearson's correlation analysis, and multivariate linear regression were conducted for data analyses.

Results

The participants' scoring rates for knowledge, attitude, and practice were 49.62%, 47.18%, and 41.43%, respectively. Significant influencing factors for knowledge were education level, religious belief, professional role, title, working years, and institution categories; those for attitude were education level, religious belief, professional role, and working years; and those for practice were professional title, religious belief, working years, and institution categories.

Conclusions

Chinese medical personnel have generally good knowledge of, attitudes towards, and practice of narrative medicine; however, there remain deficiencies in their understanding of certain important concepts, their attitude towards narrative medicine, and the application of narrative skills in their daily work. Thus, to improve narrative medicine practice in China, the application of strategies based on theoretical, educational, and institutional aspects is warranted.

Medical Humanities Education and Its Influence on Students' Outcomes in Taiwan: A Systematic Review

Background

Medical education has emphasized the importance of integrating medical humanities training into the curriculum to benefit medical and nursing students' future practice, featuring in the list of national funding priorities for healthcare education research in Taiwan for many years. However, the extent to which this drive has resulted in medical humanities training, what rationales underpin its inclusion, and its efficacy is largely unknown. This study aims to address these issues across medical humanities programs within the Taiwanese context.

Methods

We conducted a systematic review. Inclusion criteria included studies in English or Mandarin reporting outcomes of medical humanities courses in healthcare education settings in Taiwan between 2000 and 2019. We searched across five electronic databases (PubMed, Embase, ERIC, PsycInfo, Web of Science), following PRISMA guidelines. The Best Evidence Medical Education (BEME) Global Scale and Kirkpatrick Levels are used for identifying the strength of evidence.

Results

17 articles were extracted from the 134 identified. Intrinsic and instrumental rationales for the inclusion of medical humanities education were common, compared with epistemological-based and critical-based approaches. Several positive impacts were identified in relation to participation including modification of attitudes, knowledge, and skills. However, the highest level (i.e., unequivocal) of evidence characterized by effects on students' behaviors or ongoing interaction with colleagues and patients is lacking.

Conclusion

Findings suggest that although medical humanities education is widely implemented in Taiwan, no clear consensus has been reached regarding the rationale for inclusion or how it is localized from Western to Asian contexts. Future research still needs to explore the long-term impact of medical humanities education for medical and nursing students and its impact on patient care.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42019123967.

Artificial Intelligence and Medical Humanities

The use of artificial intelligence in healthcare has led to debates about the role of human clinicians in the increasingly technological contexts of medicine. Some researchers have argued that AI will augment the capacities of physicians and increase their availability to provide empathy and other uniquely human forms of care to their patients. The human vulnerabilities experienced in the healthcare context raise the stakes of new technologies such as AI, and the human dimensions of AI in healthcare have particular significance for research in the humanities. This article explains four key areas of concern relating to AI and the role that medical/health humanities research can play in addressing them: definition and regulation of "medical" versus "health" data and apps; social determinants of health; narrative medicine; and technological mediation of care. Issues include data privacy and trust, flawed datasets and algorithmic bias, racial discrimination, and the rhetoric of humanism and disability. Through a discussion of potential humanities contributions to these emerging intersections with AI, this article will suggest future scholarly directions for the field.

Exploring perception and usage of narrative medicine by physician specialty: a qualitative analysis

BACKGROUND

Narrative medicine is a well-recognized and respected approach to care. It is now found in medical school curricula and widely implemented in practice. However, there has been no analysis of the perception and usage of narrative medicine across different medical specialties and whether there may be unique recommendations for implementation based upon specialty. The aims of this study were to explore these gaps in research.

METHODS

Fifteen senior physicians who specialize in internal medicine, pediatrics, or surgery (5 physicians from each specialty) were interviewed in a semi-structured format about the utilization, benefits, drawbacks (i.e., negative consequences), and roles pertaining to narrative medicine. Qualitative content analysis of each interview was then performed.

RESULTS

Three themes emerged from our analysis: roles, practice, and outcomes. Through these themes we examined the importance, utilization, barriers, benefits, and drawbacks of narrative medicine. There was consensus that narrative medicine is an important tool in primary care. Primary care physicians (general internists and general pediatricians) also believed that narrative medicine is not as important for non-primary care providers. However, non-primary care providers (surgeons) generally believed narrative medicine is valuable in their practice as well. Within specialties, providers' choice of language varied when trying to obtain patients' narratives, but choice in when to practice narrative medicine did not differ greatly. Among specialties, there was more variability regarding when to practice narrative medicine and what barriers were present. Primary care physicians primarily described barriers to eliciting a patient's narrative to involve trust and emotional readiness, while surgeons primarily described factors involving logistics and patient data as barriers to obtaining patients' narratives. There was broad agreement among specialties regarding the benefits and drawbacks of narrative medicine.

CONCLUSIONS

This study sheds light on the shared and unique beliefs in different specialties about narrative medicine. It prompts important discussion around topics such as the stereotypes physicians may hold about their peers and concerns about time management. These data provide some possible ideas for crafting narrative medicine education specific to specialties as well as future directions of study.

How does narrative medicine impact medical trainees' learning of professionalism? A qualitative study

BACKGROUND

Narrative medicine (NM) is an approach involving narrative skills and is regarded as a model for medical humanism and effective medical practice. This study aims to explore how NM impacts medical trainees' learning of professionalism during a clerkship in a Taiwanese clinical setting.

METHODS

A qualitative interview study adopting a purposive sampling method was undertaken. Thirty medical trainees participated in this study, including five fifth-year medical students (MSs), ten sixth-year MSs, nine seventh-year MSs, and six postgraduate year (PGY) trainees. Thematic framework analysis was applied, and a modified realist evaluation approach was further used to analyse the interview data.

RESULTS

We identified self-exploration, reflection, and awareness of professional identity as mechanisms explaining how NM impacted professionalism learning in our participants. Furthermore, empathy, communication, doctor-patient relationship and understanding patients were identified as the outcomes of the NM intervention for trainees' learning of professionalism.

CONCLUSIONS

NM facilitates medical trainees' self-exploration, reflection, and awareness of professional identity, thereby affecting their learning of professionalism in clinical settings. Adopting NM as an educational intervention in undergraduate medical education could play an important role in professionalism learning, as trainees can thereby be supported to gradually develop self-exploration and reflection capabilities and heightened awareness of professional identity reflectively through a narrative process.

Evidence-based traditional Chinese medicine research: Two decades of development, its impact, and breakthrough

It has been over 20 years since the introduction of evidence-based medicine (EBM) into the research of traditional Chinese medicine (TCM). The development of evidence-based TCM research has profoundly influenced the process of clinical research and decision-making, impelling researchers to pay attention to raise evidence quality, accumulate data, and explore appropriate evaluation methods adaptive to TCM original theories and knowledge. In this paper, the authors aim to summarize and review the existing work and seek promising research interests in this field, expecting to inspire more thoughts leading to breakthroughs in the near future.

A Visiting Professorship in Undergraduate Medical Education at the University of Alberta: Reflections on possibilities for medical humanities in China, and elsewhere

This article was migrated. The article was marked as recommended. Enhancing humanities in medical education is a pressing concern in China. Similar to other countries, medical education in China evolved over the past century to emphasize bioscience and technology in treating illness and disease. Increasing recognition of the limitations of biomedical technology led to emergence of the medical humanities in the West in the latter half of the 20 th century, an interdisciplinary area that has continued to expand and grow. In China and elsewhere, activity in this area developed somewhat later. Ongoing patient-doctor disputes and decline in public trust in the medical profession in China has led many to advocate for enhanced emphasis on humanism and medical humanities. In 2017, the Chinese government introduced new healthcare reforms which included an education and training plan that promotes medical humanities teaching. Global developments have led to a wide variety of models and approaches that may be considered in cultivating medical humanities and humanism in China. With the support of China Medical University in Shenyang, Liaoning Province, PRC, Professor Wei visited the Faculty of Medicine & Dentistry at the University of Alberta through the 2019/20 academic year. This article provides an overview of a wide array of medical humanities teaching and learning opportunities associated with the undergraduate medical education program at the University of Alberta. Professor Wei reflects on possibilities for medical humanities in medical education in China given all she learned and experienced as a visiting professor at the University of Alberta, which may be of interest to others who are also developing new approaches to introducing medical humanities as part of their health professions education program. Additional reflections regarding possibilities for global medical humanities are also offered.

A modified tool for "reflective practice" in medical education: Adaptation of the REFLECT rubric in Persian

CONTEXT

Reflection is a learnable process that enhances long-life learning, clinical decision-making, and can foster empathy and professionalism. One of the methods for teaching reflection is "reflective writing" that is conducted in "reflective practice." Some tools have been developed to assess "reflective capacity," and The Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) is one of them.

AIMS

This study aimed to adapt the REFLECT rubric in Persian.

SETTINGS AND DESIGN

This quantitative study was conducted in a medical school with the participation of medical interns through census sampling, and in three stages, including translation, pilot study, and main study.

SUBJECTS AND METHODS

Persian translation was obtained by the "forward/backward translation" method. We made some changes in the tool and used it in the pilot and main study to confirm validity and reliability.

STATISTICAL ANALYSIS USED

Cronbach's alpha coefficient, Pearson correlation, and Cohen's kappa were applied for statistical analysis. Data analysis was performed using SPSS23.

RESULTS

We inserted a numerical value of 1-4 at the reflection levels, and also removed Axis 2 and an optional writing component. In the pilot study, face and content validity was confirmed involving 10 interns and five medical education specialists. Then, 67 interns participated in the main study, and we measured the reliability of the tool by internal consistency through Cronbach's alpha (0.83) and test-retest through correlation coefficient (0.89). The size of the agreement was measured to determine the inter-rater reliability by Cohen's kappa (0.84).

CONCLUSIONS

The modified REFLECT version is a valid and reliable tool that can help us to assess reflective capacity. The use of this tool is recommended for reflective practice in medicine.

Impact of narrative medicine program on improving reflective capacity and empathy of medical students in Iran

PURPOSE

Narrative medicine is expressing medical experiences and reflecting on narratives to create empathic communication with patients. Moreover, reflection on narratives causes self-awareness and recognition of the narrator's feelings or the main character of the story, and affect the audience. This study conducted to examine the impact of the narrative medicine program on improving the reflective capacity and empathy of medical students.

METHODS

A quasi-experimental study was performed in 2018-2019 at Isfahan University of Medical Sciences, Iran for 135 medical interns with two groups (control (n=66) and experiment (n=69)). We held seven two-hour reflective practice sessions for medical interns in the experiment group, and no educational intervention for the control group. Pre-test and post-test were held for both of the groups using two valid and reliable tools to assess reflective capacity and empathy. A comparison of mean scores of reflection and empathy was done in pre-test and post-test in one group and between groups using t-paired and t-test (p≤ 0.05).

RESULTS

The mean score of reflection and empathy in the experiment group had a significant increase before and after the educational intervention, but in the control group had not. Moreover, the comparison of the mean scores between the two groups in the post-test was significant. (p<0.001).

CONCLUSION

Narrative medicine is an effective teaching method that can improve reflective capacity and empathy, and ultimately promote professionalism as a core competency in medicine. Consideration of learning conditions and interdisciplinary teaching is necessary for implementing the narrative medicine program.

Reading Between the Lines: A Five-Point Narrative Approach to Online Accounts of Illness

The successful delivery of patient-centered care hinges on clinical affiliation for patients' personal needs and experiences. Narrative competence is a mode of thinking and set of actions that widens the clinical gaze beyond logico-scientific cognition. In this article, we investigate a tool that enables clinicians to rehearse their skills in narrative competence. We apply the narrative competence framework developed by the founding practitioners of narrative medicine to personal accounts of illness and patienthood published on the Internet. We describe our use of the five-point framework in the close reading of 214 accounts by people with the life-threatening skin cancer melanoma.

Development of a checklist to validate the framework of a narrative medicine program based on Gagne's instructional design model in Iran through consensus of a multidisciplinary expert panel

PURPOSE

Narrative medicine is a patient-centered approach focusing on the development of narrative skills and self-awareness that incorporates "attending, representing, and affiliating" in clinical encounters. Acquiring narrative competency promotes clinical performance, and narratives can be used for teaching professionalism, empathy, multicultural education, and professional development. This study was conducted to develop a checklist to validate the framework of a narrative medicine program through consensus of a panel.

METHODS

This expert panel study was conducted from 2018 to 2019 at Isfahan University of Medical Sciences, Iran. It included 2 phases: developing a framework in 2 steps and forming an expert panel to validate the framework in 3 rounds. We adapted a 3-stage narrative medicine model with 9 training activities from Gagne's theory, developed a framework, and then produced a checklist to validate the framework in a multidisciplinary expert panel that consisted of 7 experts. The RAND/UCLA appropriateness method was used to assess the experts' agreement. The first-round opinions were received by email. Consensus was achieved in the second and third rounds through face-to-face meetings to facilitate interactions and discussion among the experts.

RESULTS

Sixteen valid indicators were approved and 100% agreement was obtained among experts (with median values in the range of 7-9 out of a maximum of 9, with no disagreement), and the framework was validated by the expert panel.

CONCLUSION

The 16 checklist indicators can be used to evaluate narrative medicine programs as a simple and practical guide to improve teaching effectiveness and promote life-long learning.

The influence of narrative medicine on medical students' readiness for holistic care practice: a realist synthesis protocol

INTRODUCTION

Holistic healthcare considers the whole person-their body, mind, spirit and emotions-and has been associated with narrative medicine practice. Narrative medicine is medicine performed with narrative skill and has been offered as a model for humanism and effective medical practice. Narrative medicine interventions have been associated with physicians' increased empathy and more meaningful interactions with patients about managing their illness and preventative medicine. However, while there is some evidence that certain groups are more open to narrative practices (eg, traditional vs Western medical students), the extent to which narrative medicine interventions during undergraduate medical education impacts on students' readiness for holistic care, as well as the underlying reasons why, is unknown.

METHODS AND ANALYSIS

Realist review is a theory-driven approach to evaluate complex interventions. It focuses on understanding how interventions and programmes work (or not) in their contextual setting. This realist synthesis aimed to formulate a theory around the influence of narrative medicine medical students' readiness for holistic care practice. We will follow Pawson's five steps: locate existing theories, search strategy, study selection, data extraction, data analysis and synthesis. We will use the following electronic databases: Web of Science, Medline, Scopus and Embase. Articles between January 2008 and September 2018 will be included. Results will be written according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standard for reporting realist syntheses.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Chang Gung Memorial Hospital for the wider study. The findings of this review will provide useful information for academics and policymakers, who will be able to apply the findings in their context when deciding whether and how to introduce narrative medicine programmes into medical students' curricula. We will publish our findings in peer-reviewed journals and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42018115447.