敘事醫學於牙醫教育之挑戰與機遇
敘事醫學於牙醫教育之挑戰與機遇
大家印象中的牙醫師工作很吃「技術」，臨床技能培訓在牙科專業教育歷程中佔有重要角色。在大學求學過程中，大量學習放在琢磨「技術」層面，學生到了見實習場域或職場，施展在校畢生學習的技術時，看到病人要處置的病，忽略了病人之為人的主體。病患口中的好醫師的形容:「我的醫師技術很好之外，很仔細聽我講話，揪感心」。一個病患覺得的好醫師，專業技術之外，聽聽病患的故事，與病患共感疾病之同理與傾聽也是很重要的「能力」。這能力如何在求學歷程中放到課程裡?
「敘說一個故事（事件）」是敘事基底的定義，我們天生帶有敘說故事能力，在病患說或我們聽的同時，我們成為彼此故事的一部分。敘事醫學為從事與醫療/健康照護相關人員能從病人主觀病痛中辨認、吸收並感同身受能闡釋個體病痛，除了看到病患的病，還看到病患的人。為了達成病患全人照護目標，醫術、藝術、技術全人培育。
萃取敘事的定義，將敘事做為達成全人照護的載體，從敘事醫學走到敘事牙醫學，在106年，敘事融入專業之知能計畫支持下完成敘事口腔健康促進課程，也於110年教育部議題導向敘事計劃將敘事置入牙醫學倫理課程。兩套課程執行完畢後，我們提出敘事牙醫學主題地圖 (如圖一)。
敘事牙醫學主題地圖包含引導敘事表現、醫病對話到醫病共策。敘事牙醫學課程施行過程，透過引導學生敘事能力表現 ，引導出的敘事能力，作爲醫病對話應用策略，醫病對話對接溝通良善，走向醫病共策之全人照護。敘事牙醫學課程主題地圖已在高雄醫學大學與中山醫學大學進行敘事醫學課程，此為全亞洲第一組敘事牙醫學主題地圖。通過敘事作為載體，引導學生從觀察理解自身臨床診間樣貌經歷，到轉換醫生身分傾聽病患疾病經歷，培育，產生同理共感能力。當病患感受到醫生的同理關懷，除增加病患對醫師信任感外，良好醫病溝通與相對產出病患高遵囑性延伸到可預測預後，減低醫療過度支出等提升醫療品質下，創就醫師病患醫療體制等三贏局面。
以患者為中心的牙科統合治療照護能力與臨床技能培訓在牙科專業人員教育歷程中具有同等重要位置。敘事醫學為有效建構學生以患者為中心的牙科統合治療照護能力的方法。整體醫療保健和 COVID-19 大流行的影響極大地影響了當前的牙科教育。許多口腔醫學實驗課程疫情停擺，臨床教育現場除了傳統的核心臨床能力外，應考慮將敘事醫學納入當前的牙科教育課程。
圖形摘要
圖一: 敘事牙醫學主題地圖
Copyright ª 2021, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
應用與亮點：
亞洲首創敘事牙醫學主題地圖
【研究團隊】
團隊成員：黃詠愷、林怡孜、張育超
代表單位：高雄醫學大學口腔醫學院口腔衛生學系及中山醫學大學口腔醫學院牙醫系
團隊簡介：
1.黃詠愷博士是高雄醫學大學口腔醫學院口腔衛生學系專任教授。
研究聯繫Email：ykhuang@kmu.edu.tw
2.張育超博士是中山醫學大學口腔醫學院牙醫系專任教授。
研究聯繫Email：cyc@csmu.edu.tw
【論文資訊】
論文出處：
Journal of the Formosan Medical Association, 2021, 120:12, 2191-2194.
全文下載： https://www.sciencedirect.com/science/article/pii/S0929664621002862
Initiating narrative medicine into dental education: Opportunity, change, and challenge
Initiating narrative medicine into dental education: Opportunity, change, and challenge
The current dental education focuses not only clinical skill competency-based training, but also emphasizes on patient-centered medical service with appropriate attitude and good communication skills. Overreliance on the technology will let dentist ignore patients’ feeling. Listening to the patient about aspects that may not normally be expressed during a routine visit. Encouraging students to write about their own experiences may providing greater empathy throughout the patient. It is a silver lining to reorganize current dental education and redefine the role of dentistry to dentist, patient, and society. Narrative medicine has emerged as a variant from medical humanities and takes inspiration from philosophy, literature, poetry, art, ethics, and social sciences. Narrative medicine adds humanistic care with empathy and listening to patients in daily care.
The definition of “narrative medicine” is medicine practiced with narrative competence, to recognize, absorb, interpret, and be moved by the stories of illness in daily medical practice. Narrative medicine is thought to facilitate patient and medical personnel relationship and provide the holistic healthcare. Narrative medicine applied in clinical practice is based on a model of empathy, reflection, professionalism, and trust.
If the dentist with narrative competence will not just fix the teeth and treat the oral diseases, but also addresses holistically healthcare through a better understanding of the patient. In Taiwan, the first author Dr. Huang seems the pioneer of dental professional to conduct narrative medicine into oral healthcare promotion from 2017 by performing the project of Ministry of Education. Narrative medicine into dental education was launched in School of Dentistry, Chung Shan Medical University from 2019 in the class of medical ethics. The proposed thematic map of narrative dentistry is illustrated in Fig. 1.
The process of narrative dentistry implementation may be through the development of narrative competency skills, the application in patient-dentist discourse, and the achievement of holistic medical care. Recently, the patient-centered and comprehensive dental treatment are emphasized as the same important competency as traditional clinical skill training in dental education. Narrative medicine adds humanistic care with empathy and listening to patients in daily care.
The impact of holistic medical care and COVID-19 pandemic affects the current dental education a lot. In addition to traditional core clinical competencies, the recent established Taiwan Association for Dental Education should consider integrating narrative medicine into current dental education curriculum. By empathically understanding patients’ experiences, dentist can better treat the patients but also heal the patients.
Graphical Abstract
Figure 1. The proposed thematic map of narrative dentistry.
Copyright ª 2021, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
Application and Highlights:
The first in Asia to apply narrative concepts into dental education.
Research Team Members:
Yung-Kai Huang, Yi-Tzu Chen, and Yu-Chao Chang
Representative Department:
Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
Introduction of Research Team:
Yung-Kai Huang, PhD
Professor, Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University
Email：ykhuang@kmu.edu.tw
Yu-Chao Chang, DDS, PhD.
Professor, School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
Email：cyc@csmu.edu.tw
Publication: Journal. Year Month; Issue (Volume): Pages.
Journal of the Formosan Medical Association, 2021, 120:12, 2191-2194.
Full-Text Article: (URL)
https://www.sciencedirect.com/science/article/pii/S0929664621002862
