Stories as data, data as stories: making sense of narrative inquiry in clinical education.

摘要

BACKGROUND: Narrative inquiry is a form of qualitative research that takes story as either its raw data or its product. Science and narrative can be seen as two kinds of knowing, reflected in the distinction between evidence-based medicine derived from population studies and narrative-based medicine focused upon the single case. A similar tension exists in the field of narrative inquiry between cognitive-orientated analytical methods and affective-orientated methods of synthesis. AIMS: 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. DISCUSSION: Analytical methods tend to lose the concrete story and its emotional impact to abstract categorizations, 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.