现象学视角下的叙事医学教育实证研究——一项基于医学生叙事医学认知及素养的联合调查报告

doi:10.6040/j.issn.1671-7554.0.2025.0070

摘要/Abstract

摘要： 目的了解医学院校大学生叙事医学认知水平及叙事素养现状,并分析其影响因素。方法采用便利抽样法于2024年10~11月在安徽医科大学对在校大学生进行问卷调查。使用自编问卷收集被调查者一般资料、叙事医学认知水平及叙事素养现状信息,采用单因素分析、多元线性回归分析探讨其影响因素。结果共发放问卷600份,回收有效问卷576份。医学生叙事医学认知水平平均得分为(26.56±4.12)分,叙事素养平均得分为(69.30±9.50)分,两者均受到交际能力和同理心水平的影响。此外,医院实习时长、人文社科课程学习经历及所学专业对叙事医学认知水平,志愿服务经历对叙事素养亦有显著影响(P<0.05)。结论医学院校大学生叙事素养整体水平中等偏上,但叙事医学认知水平尚需提升。结合现象学视角,可通过理解患者的意向性需求、融入患者的生活世界、促进医患主体间最大程度的融合,并分析疾病在医患不同视角下的时间与空间特性,来提升医学生的叙事医学认知与叙事素养水平。

关键词: 叙事医学, 叙事素养, 现象学, 交际能力, 同理心

Abstract: Objective To investigate the cognitive level of narrative medicine and the current status of narrative competence among medical college students, and to analyze their influencing factors. Methods A convenience sampling method was used to conduct a questionnaire survey among medical college students at Anhui Medical University from October to November 2024. A self-designed questionnaire was employed to collect general information, as well as data on the cognitive level of narrative medicine and the status of narrative competence. Multiple linear regression analysis was conducted to identify influencing factors. Results A total of 600 questionnaires were distributed, and 576 of these were returned with valid responses. The mean score for the cognitive level of narrative medicine among medical students was(26.56±4.12), and the mean score for narrative competence was(69.30±9.50). The findings of this study indicated that both communication skills and empathy levels exerted a significant influence on the outcomes under investigation. Furthermore, the duration of hospital internships, experience in humanities and social sciences courses, and students majors significantly affected the cognitive level of narrative medicine, while volunteer service experience had a significant impact on narrative competence(P<0.05). Conclusion Medical college students demonstrate a relatively high level of narrative competence; however, their cognitive level of narrative medicine requires further improvement. From a phenomenological perspective, enhancing students understanding of patients intentional needs, engaging with patients life worlds, maximizing the intersubjective integration between doctors and patients, and analyzing the temporal and spatial characteristics of illness from diverse perspectives of doctors and patients have the potential to elevate their narrative medicine cognition and competence.

Key words: Narrative medicine, Narrative competence, Phenomenology, Communication skills, Empathy

中图分类号:

胡成洋,计红丽,刘维静. 现象学视角下的叙事医学教育实证研究——一项基于医学生叙事医学认知及素养的联合调查报告[J]. 山东大学学报 (医学版), 2025, 63(10): 107-116.

HU Chengyang, JI Hongli, LIU Weijing. Empirical research of narrative medicine education from a phenomenological perspective: a combined survey report on medical students cognitive level and competence of narrative medicine[J]. Journal of Shandong University (Health Sciences), 2025, 63(10): 107-116.

参考文献

[1] 国家卫生健康委办公厅,教育部办公厅,国家中医药局综合司,等.《关于印发医学人文关怀提升行动方案(2024—2027年)的通知》[EB/OL].(2024-10-09)[2025-03-12]. https://www.gov.cn/zhengce/zhengceku/ 202410/content_6979036.htm
[2] 郭莉萍, 朱利明, 黄蓉, 等. 中国叙事医学专家共识(2023)[J]. 叙事医学, 2023, 6(6): 381-411. GUO Liping, ZHU Liming, HUANG Rong, et al. Chinese narrative medicine expert consensus(2023)[J]. Narrative Medicine, 2023, 6(6): 381-411.
[3] 王一方. 步入深水区的叙事医学[J]. 医学与哲学, 2021, 42(23): 8-11. WANG Yifang. Narrative medicine stepping into "the deep waters"[J]. Medicine & Philosophy, 2021, 42(23): 8-11.
[4] 郭莉萍.生物医学与叙事医学的哲学基础[J].叙事医学,2021,4(1):27-32. GUO Liping. The philosophical foundation of biomedicine and narrative medicine [J]. Narrative Medicine, 2021, 4(1): 27-32.
[5] 滕星妤. 身体现象学视域中的疼痛问题[J]. 河北学刊, 2023, 43(2): 65-70. TENG Xingyu. Pain in the perspective of the phenomeno-logy of the body[J]. Hebei Academic Journal, 2023, 43(2): 65-70.
[6] 童天朗. 现象学视域下的临床医患关系分析与启示[D]. 上海:同济大学,2022.
[7] 卢巧, 黎学兵, 游文忠, 等. 土家族苗族聚居区医学实习生对叙事医学的认知调查[J]. 卫生职业教育, 2024, 42(19): 111-114. LU Qiao, LI Xuebing, YOU Wenzhong, et al. Cognitive survey on medical interns from Tujia and Miao ethnic minority inhabited areas on narrative medicine[J]. Health Vocational Education, 2024, 42(19): 111-114.
[8] 伊遥,方昉.医学生叙事医学认知调查研究[J].临床研究, 2020, 28(4):197-198. YI Yao, FANG Fang. A survey study on medical students understanding of narrative medicine [J]. Clinical Research, 2020, 28(4): 197-198.
[9] 康敏娟, 童建辉, 刘可越, 等. 医学生叙事医学认知现状及推广对策研究[J]. 卫生职业教育, 2024, 42(5): 130-133. KANG Minjuan, TONG Jianhui, LIU Keyue, et al. Research on the status and promotion strategies of medical students narrative medical cognition[J]. Health Vocational Education, 2024, 42(5): 130-133.
[10] 刘潞, 李明今, 金贞爱. 某大学不同专业医学生叙事素养现状及原因分析[J]. 中国医学伦理学, 2024, 37(11): 1340-1347. LIU Lu, LI Mingjin, JIN Zhenai. Analysis of the current situation and reasons for narrative literacy among medical students in different majors in a university[J]. Chinese Medical Ethics, 2024, 37(11): 1340-1347.
[11] Xiao SS, Yuan J, Lan H, et al. Investigation of clinical medicine undergraduates recognition of narrative medicine[J]. BMC Med Educ, 2024, 24(1): 321. doi: 10.1186/s12909-024-05279-4
[12] Zarei F, Dehghani A, Ratansiri A, et al. ChecKAP: a checklist for reporting a knowledge, attitude, and practice(KAP)study[J]. Asian Pac J Cancer Prev, 2024, 25(7): 2573-2577. doi: 10.31557/APJCP.2024.25.7.2573
[13] 果彤, 孙咏莉, 励国. 基于2 145名医务人员的叙事医学知识、态度、行为调查[J]. 中国医学伦理学, 2022, 35(12): 1385-1393. GUO Tong, SUN Yongli, LI Guo. Survey on know-ledge, attitude, and behavior regarding narrative medicine based on 2,145 medical personnel[J]. Chinese Medical Ethics, 2022, 35(12): 1385-1393.
[14] 郑奥, 孙咏莉, 励国. 人类学视域下的叙事医学教育探索研究: 基于2 353名医学生的KAP调查报告[J]. 中国医学伦理学, 2023, 36(11): 1208-1215. ZHENG Ao, SUN Yongli, LI Guo. Exploration of the narrative medical education from the perspective of anthropology: based on the KAP survey report of 2, 353 medical students[J]. Chinese Medical Ethics, 2023, 36(11): 1208-1215.
[15] 李然, 田瑞, 杜相宜, 等. 中医大学生叙事医学认知现状调查研究[J]. 医学与哲学, 2017, 38(9):80-83. LI Ran, TIAN Rui, DU Xiangyi, et al. Investigation on the cognitive status of narrative medicine in college students majored in Traditional Chinese Medicine[J]. Medicine & Philosophy, 2017, 38(9): 80-83.
[16] Xue M, Sun H, Xue J, et al. Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial[J]. BMC Med Educ, 2023, 23(1): 38. doi: 10.1186/s12909-023-04026-5
[17] 尚韦泷. 胡塞尔的意向性理论及其效应[D]. 哈尔滨:黑龙江大学,2024.
[18] 李晓进. 从“意向性” 到“超越性”: 论萨特对胡塞尔的意向性理论的改造与继承[J]. 广西大学学报(哲学社会科学版), 2020, 42(6): 43-49. LI Xiaojin. From "intentionality" to "transcendence": on Sartres reconstruction and succession of Husserls theory of intentionality[J]. Journal of Guangxi University(Philosophy and Social Sciences), 2020, 42(6): 43-49.
[19] 沈燕. 疾病还是疾痛: 认知症研究的人类学反思[J]. 湖北民族大学学报(哲学社会科学版), 2023, 41(2): 10-22. SHEN Yan. Disease or illness: an anthropological reflection on dementia study[J]. Journal of Hubei Minzu University(Philosophy and Social Sciences), 2023, 41(2): 10-22.
[20] Chen H, Xuan HW, Cai JQ, et al. The impact of empathy on medical students: an integrative review[J]. BMC Med Educ, 2024, 24(1): 455. doi: 10.1186/s12909-024-05448-5
[21] Kampourelli V. Historical empathy and medicine: pathography and empathy in Sophocles Philoctetes[J]. Med Health Care Philos, 2022, 25(3): 561-575. doi: 10.1007/s11019-022-10087-y
[22] 李越桐, 付洋. 临床同理心:医学人文关怀的丰饶之角[J/OL].中国医学伦理学,1-8[2025-07-15]. http://kns.cnki.net/kcms/detail/61.1203.R.20241209.1705.002.html LI Yuetong, FU Yang. Clinical empathy: the cornucopia of medical humanistic care[J/OL]. Chinese Medical Ethics, 1-8[2025-07-15]. http://kns.cnki.net/kcms/detail/61.1203.R.20241209.1705.002.html
[23] 李洋, 王小伟. 描述、阐释与规范: 从技术存在论到技术生活世界: 道德物化的理论旨趣[J]. 河南社会科学, 2025, 33(3): 101-107. LI Yang, WANG Xiaowei. Descriptive, interpretive and normative approach: a review from ontology of technology towards technological lifeworld: the theoretical context of moralizing technology[J]. Henan Social Sciences, 2025, 33(3): 101-107.
[24] 王凤才. 哈贝马斯对生活世界概念的批判性重构[J]. 北京师范大学学报(社会科学版), 2024(6): 40-50. WANG Fengcai. Habermass critical reconstruction of the concept of life-world[J]. Journal of Beijing Normal University(Social Sciences), 2024(6): 40-50.
[25] Weisz E, Cikara M. Strategic regulation of empathy[J]. Trends Cogn Sci, 2021, 25(3): 213-227. doi: 10.1016/j.tics.2020.12.002
[26] Sternlieb JL. Research cum training: assumptions, Balints method, and future directions[J]. Int J Psychiatry Med, 2022, 57(6): 496-503. doi: 10.1177/00912174221123616
[27] 邱龙虎, 辜美惜. 何谓叙事医学的哲学基础: 基于主体间性的审思[J]. 南京医科大学学报(社会科学版), 2024, 24(3): 249-255. QIU Longhu, GU Meixi. What is the philosophical basis of narrative medicine: reflection based on inter-subjectivity[J]. Journal of Nanjing Medical University(Social Sciences), 2024, 24(3): 249-255.
[28] 刘虹. 论医患身体主体间性[J]. 医学与哲学, 2023, 44(4): 1-6. LIU Hong. On physician-patient body intersubjectivity[J]. Medicine & Philosophy, 2023, 44(4): 1-6.
[29] Rita Charon. The principles and practice of narrative medicine[M]. New York: Oxford University Press, 2017: 86-112.
[30] 李伯群, 黄方, 陈娇娥. 叙事医学文本细读之教学实践[J]. 中国医学人文, 2024, 10(6): 12-15. LI Boqun, HUANG Fang, CHEN Jiaoe. Teaching practice of close reading in narrative medicine texts[J]. Chinese Medical Humanities, 2024, 10(6): 12-15.
[31] Ahlzén R. Narrativity and medicine: some critical reflections[J]. Philos Ethics Humanit Med, 2019, 14(1): 9. doi: 10.1186/s13010-019-0078-3
[32] Rita Charon. Narrative and medicine[J]. N Engl J Med, 2004, 350(9): 862-864.
[33] 赵红红,唐源琦.当代“空间叙事”理论研究的演进概述——叙事学下空间的认知转变与实践[J].广西社会科学, 2021(3): 74-81. ZHAO Honghong, TANG Yuanqi. An overview of the evolution of contemporary "spatial narrative" theory research: cognitive shifts and practices of space in narratology[J]. Guangxi Social Sciences, 2021(3): 74-81.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed