叙事医学实践对中医专业研究生职业认同感影响的质性研究  

Qualitative Research on the Influence of Narrative Medicine Practice on the Professional Identity of Postgraduates Majoring in Traditional Chinese Medicine

作　　者：赵晶晶 杨秋莉[2] 王子旭 ZHAO Jingjing;YANG Qiuli;WANG Zixu(Department of Traditional Chinese Medicine,The Sixth Medical Centre of PLA General Hospital,Beijing,100853,China;Institute of Clinical Basic Medicine of Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国人民解放军总医院第六医学中心中医医学部,北京100853 [2]中国中医科学院中医临床基础医学研究所,北京100700

出　　处：《中国医学伦理学》2023年第11期1191-1199,共9页Chinese Medical Ethics

基　　金：国家自然科学基金青年基金项目“基于近红外脑成像双人同步交互测量技术的中医叙事医学增进医患共情关系脑神经机制研究”(82105051);中国中医科学院科技创新工程中医临床基础学科创新团队项目(CI2021B003);中国中医科学院科技创新工程-中医临床基础项目“中医叙事医学临床操作规范的构建与评估”(CI2021A00705-3);中国中医科学院所级第十三批自主选题“中医院校叙事医学课程教学体系的构建”(Z0649);中国中医科学院优秀青年科技人才培养专项(ZZ15-YQ-053)。

摘　　要：目的探讨中医专业研究生的叙事医学实践体验及对其职业认同感的影响。方法采用目的性抽样选取了某高校中医专业硕博士研究生一年级的56位学生,进行为期16学时的叙事医学课程培训和4周叙事医学临床实践,并要求在临床实践结束后完成一份关于实践体验的开放式书写作业。随后采用质性研究中的主题分析法对作业内容进行分析。结果学生们学习了叙事医学之后,在临床中的实践体验包括3大主题和9个副主题:适用范围广(全诊疗阶段、多科室及病种)、融合多方面沟通技巧及诊疗方式(沟通技巧、心理学技术、反思、中医人文诊疗方式)以及增加职业认同感(实现相互疗愈、构建和谐医患关系、提升中医自信)。主题被进一步整合形成叙事医学实践循环与职业认同感的关系,并以图表的形式呈现。结论通过探讨中医专业研究生的叙事医学实践体验,发现通过在全诊疗阶段及多学科病种中,运用多种方法技巧,能够促进医患关系和谐、实现相互疗愈、增强中医自信,这些内化的认可和成就感进而有助于提高职业认同感。可为提高医学生职业认同感、探索叙事医学实践在地化之路提供新思路。Objective:To explore the practice experience of narrative medicine among postgraduates majoring in Traditional Chinese Medicine(TCM)and its impact on their professional identity.Methods:A total of 56 first-year master's and doctoral degree students majoring in TCM at a university were selected through purposive sampling for a 16-hour narrative medicine course training and 4 weeks of clinical practice in narrative medicine.They were asked to complete an open-ended writing assignment on their practical experience after this clinical practice.Subsequently,the topic analysis method in qualitative research was used to analyze their writing contents.Results:After learning narrative medicine,the students'practical experience in clinical practice included 3 major themes and 9 sub-themes:wide application range(all diagnosis and treatment stages,multiple departments,and disease types),integration of multiple communication skills and diagnosis and treatment methods(communication skills,psychological techniques,reflection,and TCM humanistic diagnosis and treatment methods),and increasing professional identity(achieving mutual healing,building the harmonious doctor-patient relationship,and enhancing confidence in TCM).The themes were further integrated to form the relationship between the narrative medical practice cycle and professional identity,and presented in the form of charts.Conclusion:By exploring the narrative medical practice experience among TCM postgraduates,it was found that through the use of multiple methods and techniques in the entire diagnosis and treatment stage and multi-disciplinary diseases,it is possible to harmonize the doctor-patient relationship,achieve mutual healing,and enhance confidence in TCM.These internalized recognition and sense of achievement contributes to improving professional identity,which may provide new ideas for the development of professional identity for medical students in China and the exploration of the localization of narrative medical practice.

关 键 词：叙事医学 实践体验 中医 职业认同感 

分 类 号：R-05[医药卫生]