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Best Practice

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Document Typology: Article
Target groups: Health Workers,Policy Maker and Administrators
country Where It Took Place: Italy
Name of compiler: tania
name of institution: cipes piemonte
role: project coordinator
language Of The Description: English
title: Stories as data, data as stories: making sense of narrative inquiry in clinical education
description Of The Best Practice:
This paper aims to make sense of narrative inquiry in clinical education through definition of ‘narrative’, articulation of a typology of narrative research approaches, and critical examination in particular of analytical methods, the dominant approach in the literature. The typology is illustrated by research examples, and the role of medical education in developing expertise in narrative inquiry is discussed. An argument is made that the tension between analysis of the structure of stories and empathic use of stories can be seen as productive, stimulating expertise encompassing both approaches.
Results:
Analytical methods tend to lose the concrete story and its emotional impact to abstract categorisations, which may claim explanatory value but often remain descriptive. Stemming from discomfort with more integrative methods derived from the humanities, a science-orientated medical education may privilege analytical methods over approaches of synthesis. Medical education can redress this imbalance through attention to ‘thinking with stories’ to gain empathy for a patient's experience of illness. Such an approach can complement understanding of story as discourse − how narratives may be used rhetorically to manage both social interactions and identity.
Quality indicators:
Use of means of narrative medicine
Comment:
In making sense of narrative inquiry, this article has critically addressed the apparent split between approaches of analysis and synthesis, reframing this as a productive tension and calling for greater parity between the two approaches. A typology of approaches to narrative research is offered, acknowledging that such a framework helps to make sense of a complex field of inquiry. A further tension is addressed − between approaches that emphasise the structure of a story (content) and those emphasising the meaning of a story (discourse). This can be illustrated by two examples. Ginsburg et al.41 describe medical students resolving professional conflicts. As they report professional lapses, students ‘re-story’ the lapse through certain reasoning strategies, one of which is ‘narrative attitude’. Some students characteristically deflect responsibility through re-storying critical incidents, where others reflect. Good describes how, through learning the genre of case presentations, medical students come to transform patients' idiosyncratic stories into medicalised accounts, where phenomenological description is translated into specific pathophysiological analysis. While this process encourages necessary focus upon scientific consideration of diagnosis and treatment, and also serves to protect the doctor from unnecessary intimacy, it results in a practice where ‘persons are formulated as… medical problems’.

Evaluation:
In the first example, the challenge to medical educators is how to promote reflective, rather than deflective, strategies of telling. In the second example, where doctors, in the role of medical educators, traditionally socialise students and juniors into the structure and content of the standard case presentation, to what extent are they aware of such case presentation as discourse and rhetorical practice that, in transforming the patient's story, may compromise empathy? Further, will medical educators tend to privilege convergent and analytical approaches to story over divergent approaches of synthesis that may educate sensitive listening through story as a medium, again leading to empathy? Rather than being seen as an accidental by-product of practice, narratives can offer a potent medium for structured clinical learning. A further challenge for medical education is to evaluate such a claim.

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