Dialogical narrative approach to enhance critical thinking and student engagement during lecturebased classes
Keywords:physiology, dialogism, didactic lecture, narrative, medical education, critical thinking, dialogical narrative
Introduction: The dialogical narrative (DN) approach is an interactive teaching method designed and applied to the teaching of physiology to medical students. It uses an interactive conversational style within a narrative design. This study sought to answer the question “How do medical students perceive the effectiveness of the DN approach in promoting participation, engaged learning and critical thinking?”
Methods: Physiological subject matter was presented to a class of second-year medical students in a manner that combined storytelling and a question–answer conversational style. Soon after, two focus group sessions, each with seven participants, were conducted to determine the students’ perceptions of the effectiveness of the approach. Recordings from focus group sessions were transcribed and subjected to qualitative thematic analysis, informed by narrative inquiry and dialogism.
Results: Analysis revealed that students felt the DN approach: encouraged critical thinking, was more engaging and conducive to active participation than traditional didactic lectures and provided a narrative flow and logical progression of material. The approach challenged students who were not used to public speaking and encouraged students to be well prepared. The teacher needed to upskill in managing the approach and asking the right questions.
Conclusions: The students were divided between those who feel comfortable with active, open dialogue in the class and those who do not, but most believed the interactions fostered skills that are important. Most students preferred the DN approach over traditional lectures. The great strength of the DN approach is the manner in which it integrates practical teaching measures within a sound theoretical framework.
Alexander, R. J. (2006). Towards dialogic teaching: Rethinking classroom talk. Retrieved from http://archive.teachfind.com/ttv/static.teachers.tv/shared/files/11117.doc
Bakhtin, M. (2014). 1981[1934–1935]. “Discourse in the novel”. In The dialogic imagination. Four essays, 259–422, selected 261–265, 268–275. Austin: University of Texas Press. In J. Angermuller, D. Maingueneau, & R. Wodak (Eds.), The discourse studies reader [pp. 28–35]. Amsterdam, The Netherlands: John Benjamins. doi:10.1075/z.184.15bak
Biggs, J. (1996). Enhancing teaching through constructive alignment. Higher Education, 32(3), 347–364. doi:10.1007/bf00138871
Boudreau, J. D., Cassell, E., & Fuks, A. (2018). Physicianship and the rebirth of medical education. Oxford Scholarship Online. doi:10.1093/oso/9780199370818.001.0001
Brown, S. T., Kirkpatrick, M. K., Mangum, D., & Avery, J. (2008). A review of narrative pedagogy strategies to transform traditional nursing education. Journal of Nursing Education, 47(6), 283–286. doi:10.3928/01484834-20080601-01
Christensen, N., Loftus, S., & Gwin, T. (2019). Peer learning to develop clinical reasoning. In J. Higgs, G. Jensen, S. Loftus, & N. Christensen (Eds), Clinical reasoning in the health professions (4th ed.) [pp. 491–497]. Edinburgh, Scotland: Elsevier.
Coles, C. R. (1990). Evaluating the effects curricula have on student learning: Toward a more competent theory for medical education. In Z. M. Nooman, H. G. Schmidt, E. S. Ezzat (Eds.), Innovation in Medical Education: An evaluation of its present status (pp. 76–87). New York, NY: Springer.
Cousin, G. (2006). An introduction to threshold concepts. Planet, 17, 4–5. doi:10.11120/plan.2006.00170004
Croskerry, P., Cosby, K. S., Graber, M. L., & Singh, H. (2017). Diagnosis: Interpreting the shadows. London, England: CRC Press. doi:10.1201/9781315116334
Davidhizar, R., & Lonser, G. (2003). Storytelling as a teaching technique. Nurse Educator, 28(5), 217–221. doi:10.1097/00006223-200309000-00008
Diekelmann, N. (2001). Narrative pedagogy: Heideggerian hermeneutical analyses of lived experiences of students, teachers, and clinicians. Advances in Nursing Science, 23(3), 53–71.
Fisher, R. (2007). Dialogic teaching: Developing thinking and metacognition through philosophical discussion. Early Child Development and Care, 177(6–7), 615–631.
Flexner, A. (1910). Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching. Retrieved from https://play.google.com/store/books/details?id=lxgTAAAAYAAJ
Frijters, S., ten Dam, G., & Rijlaarsdam, G. (2008). Effects of dialogic learning on value-loaded critical thinking. Learning and Instruction, 18(1), 66–82. doi:10.1016/j.learninstruc.2006.11.001
Hajhosseiny, M. (2012). The effect of dialogic teaching on students’ critical thinking disposition. Procedia-Social and Behavioral Sciences, 69, 1358–1368. doi:10.1016/j.sbspro.2012.12.073
Kamel-ElSayed, S., & Loftus, S. (2018). Using and combining learning theories in medical education. Medical Science Educator, 28(1), 255–258. doi:10.1007/s40670-017-0519-9
Kassebaum, D. G. (1989). Change in medical education. Academic Medicine, 64, 446–447. doi:10.1097/00001888-198908000-00006
Linell, P. (2007). Essentials of dialogism. Retrieved from https://pdfs.semanticscholar.org/d945/ee907ac6c46fbe8eea1a2e1106ce9e60ac5d.pdf
Loftus, S., & Greenhalgh, T. (2010). Towards a narrative mode of practice. In J. Higgs, D. Fish, I. Goulter, S. Loftus, J. Reid, & F. Trede (Eds.), Education for future practice [pp. 85–94]. Rotterdam, The Netherlands: Sense.
Loftus, S., & Higgs, J. (2005). Reconceptualising problem-based learning in a Vygotskyian framework. FOHPE: A Multi-disciplinary Journal, 7(1), 1–14.
Loftus, S., & Huggett, K. (2019). Directions for education research in health professions: Opportunities for physical therapy. In G. Jensen, E. Mostrom, L. M. Hack, T. Nordstrom, & J. Gwyer (Eds.), Educating physical therapists [pp. 201–209]. Thorofare, NJ: Slack.
Long, A., & Lock, B. (2014). Lectures and large groups. In T. Swanwick (Ed.), Understanding medical education: Evidence, theory and practice [pp. 137–148]. Chichester, England: Wiley Blackwell.
Osler, W. (1913). Examinations, examiners, and examinees. The Dublin Journal of Medical Science, 136(5), 313–327. doi:10.1007/bf02964451
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23, 334–340.
Slavin, R. E. (2006). Educational psychology: Theory and practice. Boston, MA: Pearson/Allyn & Bacon.
Sternberg, R. J., Grigorenko, E. L., & Zhang, L. F. (2008). Styles of learning and thinking matter in instruction and assessment. Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 3(6), 486–506. doi:10.1111/j.1745-6924.2008.00095.x
Wertsch, J. V. (2009). How do we build shared collective memories? In P. Boyer & J. V. Wertsch (Eds.), Memory in Mind and Culture (pp. 113–116). St. Louis, MO: Washington University.
How to Cite
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
Any reproduction of material published in FoHPE must have the express permission of the publisher.
Articles published in Focus on Health Professional Education (FoHPE) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0).