Effective communication is a fundamental skill in clinical medicine; however, traditional approaches often fail to equip learners with an ability to authentically and empathically engage with the complexities of real patients' experiences. Narratology education has been proposed as a pedagogical framework for augmenting empathy and patient-centred communication in medical students.
In April 2025, we undertook a mixed-methods pilot study to evaluate the impact of a one-week narratology education module on second-year undergraduate medical students at the Royal College of Surgeons in Ireland (RCSI), Dublin. The module involved close reading, group viewings, facilitated small-group workshops, and whole-group discussions in response to narrative works by Irish writers and storytellers, followed by written personal reflections. At the outset and conclusion of the module, each student undertook a clinical history with a simulated patient (SP) portraying early-stage dementia. SPs assessed each student's empathy and communication using the CARE Measure.
Included students undertook two encounters with a simulated patient (SP): one immediately before and one immediately after the one-week narratology education module. In each encounter, students carried out a 7-minute history-taking exercise with an SP portraying cognitive decline/early-stage dementia. Immediately following each encounter, each SP completed the CARE Measure (11) - a validated tool to assess empathy and communication skills in healthcare workers. In the CARE Measure, ten items are rated on a five-point scale from 1 (poor) to 5 (excellent), with the total score being the sum of those ten items; in the event of missing or not applicable (N/A) ratings, the mean rating of available items was calculated and then multiplied by ten to estimate the total score. The CARE Measure items cover key aspects of empathy and clinical communication, including "Really listening," "Letting you tell your story," "Showing care and compassion," and "Being interested in you as a whole person." Ten SPs, with experience in medical education, were employed to perform a scripted-narrative of cognitive decline/early-stage dementia that had been iteratively developed by the investigating team and agreed by consensus prior to the start of the module. Each SP received the approved scripted-narrative one-week prior to the start of the module; in addition, they undertook a one-hour group pre-briefing session immediately prior to each simulation to ensure consistency of performance. Both pre-briefing sessions were facilitated by the investigating team including the narratology-expert.
At the end of the module, students submitted a reflective essay, i.e., 500-words using the Gibbs cycle as a framework, articulating how they had interrogated the narrative works of Irish writers and storytellers during the week and how narratology education had affected their appreciation for point-of-view and perspective in personal stories, their evolving narrative competence, and their empathy, communication, and performance in healthcare encounters.
Statistical analyses were undertaken using Stata/SE 17.0 (StataCorp \[2021\] Stata: Release 17. College Station, TX: StataCorp LLC.), GraphPad Prism version 10 (GraphPad Software, Boston, Massachusetts USA), and NVivo 15 (Lumivero \[2023\] NVivo (Version 15). Lumivero.).
Central tendencies for ordinal data are presented as median (interquartile range \[IQR\]). Pre- and post-intervention CARE Measure total scores and their individual item ratings were compared using the Wilcoxon matched-pairs signed-rank test, with a two-tailed P \< 0.05 considered statistically significant.
Reflection essays were uploaded to NVivo 15 for thematic analysis.
