从“看病”到“见人”：叙事医学在临床见习中的教学重构

From “Treating Illnesses” to “Caring for People”: Reconstructing the Teaching of Narrative Medicine in Clinical Internships

摘要: 临床见习是医学生从理论走向实践的关键阶段，其意义远不止于技能习得，更关乎职业身份的萌芽。然而，当前教育过度聚焦技术理性，常使学生“识病”却难“见人”。我们尝试以叙事医学为突破口，引导学生在书写标准病历之外，同步完成平行病历，记录患者的恐惧、家庭困境与生活期待。一位学生曾写道：“他反复问还能活多久，其实是在问还能陪女儿高考吗？”正是这类书写，推动他们从疾病机制转向疾痛体验。初步观察显示，持续参与的学生在共情表达、反思深度及职业认同上有所增强。若能将叙事能力纳入临床评价体系，或将有力助推医学教育从“以病为中心”向“以人为核心”转型，让未来的医生既精于科学，亦敏于人心。

Abstract: Clinical internship represents a pivotal phase for medical students as they transition from theoretical knowledge to practical application. Its significance extends beyond mere skill acquisition and is closely associated with the budding of professional identity. Nevertheless, the current educational approach overly emphasizes technical rationality, often leaving students capable of diagnosing diseases but struggling to perceive the patients as individuals. We have attempted to use narrative medicine as a breakthrough point, guiding students to complete parallel medical records in addition to standard medical records. These parallel records aim to document patients’ fears, family hardships, and life expectations. One student once wrote, “When he repeatedly asked how much longer he had to live, what he really meant was whether he could accompany his daughter through the college entrance examination.” Such writing encourages students to shift their focus from disease mechanisms to the patients’ pain experiences. Preliminary observations indicate that students who consistently engage in this practice have shown improvements in empathetic expression, depth of reflection, and professional identity. If narrative skills can be incorporated into the clinical evaluation system, it may effectively facilitate the transformation of medical education from a disease-centered approach to a patient-centered one, enabling future doctors to be not only proficient in science but also sensitive to human emotions.