Open Access Open Access  Restricted Access Subscription Access

Learning through narrative writing: Medical students talk to patients in a hospice

E McKinlay, S Donnelly


Aim: This study examined how medical students use narrative writing as a pedagogical tool to process the experience of talking with patients at end-of-life and express what they have learnt.

Background: There are a variety of ways that medical students are nd:taught about communicating with patients at end-of-life, including talking directly with patients.

Method: Eighty-nine students opted to have their narrative essays retained for research after the academic year was completed. Thirty essays were chosen as representative for the dataset. Charmaz’s constructivist grounded theory methodology was adopted, with theoretical sensitivity used to test categories and theoretical concepts of emerging theory.

Results: Narrative writing articulates a learning moment co-created by the medical student, teacher and dying patient. A theory of “learning through narrative” is put forward, with the categories of tension, challenge and growth being identifiable in the students’ essays.

Conclusion: In this context, narrative writing, as a pedagogical tool, assists students to understand both the patient and themselves. For most students, this is a challenging experience. They integrate past experience and articulate transformational learning to teachers who in turn are able to monitor the safety of learning. Narrative writing enables students to resolve initial tension, gain insights, describe new skills as well as grow personally and professionally. 


education; narrative; medical students; palliative medicine

Full Text:



Billings, J. A., & Block, S. (1997). Palliative care in undergraduate medical education: Status report and future directions. The Journal of the American Medical Association, 278, 733–738.

Bleakley, A. (2005). Stories as data, data as stories: Making sense of narrative inquiry in clinical education. Medical Education, 39, 534–540.

Bolton, G. (2006). Narrative writing: Reflective enquiry into professional practice. Educational Action Research, 14, 203–218.

Burks, D. J., & Kobus, A. M. (2012). The legacy of altruism in health care: The promotion of empathy, prosociality and humanism. Medical Education, 46, 317–325.

Charmaz, K. (2004). Premises, principles, and practices in qualitative research: Revisiting the foundations. Qualitative Health Research, 14, 976–993.

Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications.

Charon, R. (2000). Reading, writing, and doctoring: Literature and medicine. American Journal of the Medical Science, 319, 285–291.

Charon, R. (2005). Narrative medicine: Attention, representation, affiliation. Narrative, 13, 261–270.

Charon, R., Wyer, P., & Group, N. (2008). Narrative evidence based medicine. Lancet, 37(9609), 296–297.

Chen, H., & Boore, R. (2009). Using a synthesised technique for grounded theory in nursing research. Journal of Clinical Nursing, 18, 2251–2260.

Dew, K. (2007). A health researcher's guide to qualitative methodologies. Australian and New Zealand Journal of Public Health, 31(5), 433–437.

Dirkx, J. M. (2008). The meaning and role of emotions in adult learning. New Directions for Adult and Continuing Education, 2008(120), 7–18.

Druce, M., Johnson, M. H. (1994). Human dissection and attitudes of preclinical students to death and bereavement. Clinical Anatomy, 7, 42–49.

Fins, J. J., Gentilesco, B. J., Carver, A., Lister, P., Acres, C. A., Payne, R., & Storey- Johnson, C. (2003). Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula. Academic Medicine, 78, 307–312.

Firth, J. (1986). Levels and sources of stress in medical students. BMJ, 292, 1177–1180.

Freire, P. (1974). Education for critical counciousness. London: Sheed & Ward.

Friedlander, M. J., Andrews, L., Armstrong, E. G., Aschenbrenner, C., Kass, J. S., Ogden, P., . . . Viggiano, T. R. (2011). What can medical education learn from the neurobiology of learning? Academic Medicine, 86, 415–420.

Graneheim, U., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nursing Education Today, 24, 105–112.

Head, B., Earnshaw, L., Greenberg, R., Morehead, R., Pfeifer, M., & Shaw, M. (2012). I will never forget: What we learned from medical student reflections on a palliative care experience. Journal of Palliative Medicine, 15, 535–541.

Ilic, D. (2009). Assessing competency in evidence based practice: Strengths and limitations of current tools in practice. BMC Medical Education, 9, 1. Retrieved from

Kelly, M. (2010). The role of theory in qualitative health research. Family Practice, 27, 285–290.

Kumagai, A. K. (2008). A conceptual framework for the use of illness narratives in medical education. Academic Medicine, 83, 653–658.

Lim, B. T., Moriarty, H., & Huthwaite, M. (2011). Being-in-role: A teaching innovation to enhance empathic communication skills in medical students. Medical Teacher, 33, 663–669.

MacLeod, R. D., Parkin, C., Pullon, S., & Robertson, G. (2003). Early clinical exposure to people who are dying: Learning to care at the end of life. Medical Education, 37, 51–58.

Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14, 595–621.

McKinlay, E., & McBain, L. (2010, November). Teaching to learn: An innovative education programme that builds medical student confidence and knowledge to talk with dying patients. Paper presented at the 19th Hospice New Zealand Palliative Care Conference, Wellington, New Zealand.

McKinlay, E., McBain, L., Stanley, J., Johnston Taylor, E., & Robertson, G. (2014). Does multimodal palliative care education help medical students talk with patients at end-of-life? Focus on Health Professional Education, 15(3), 64–80.

Mezirow, J. (1990). How critical reflection triggers transformative learning. In J. E. A. Mezirow (Ed.), Fostering critical reflection in adulthood: A guide to transformative and emancipatory learning (pp. 1–21). San Francisco: Jossey-Bass.

Mount, B., & Kearney, M. (2003). Healing and palliative care: Charting our way forward. Palliative Medicine, 17, 657–658.

Novack, D. H., Epstein, R. M., & Paulsen, R. H. (1999). Toward creating physician– healers: Fostering medical students' self-awareness, personal growth, and well-being. Academic Medicine, 74, 516–519.

Royal, C. (2007). The purpose of education: Perspectives arising from Mātauranga Māori. Wellington, NZ: Ministry of Education


Schein, E. H. (1993). How can organizations learn faster? The challenge of entering the green room. Sloan Management Review, 34, 85–92.

Tavakol, S., Dennick, R., & Tavakol, M. (2012). Medical students’ understanding of empathy: A phenomenological study. Medical Education, 46, 306–316.

Taylor, E. W. (2008). Transformative learning theory. New Directions for Adult and Continuing Education, 2008(119), 5–15.

Wear, D. (2002). Face-to-face with it: Medical students' narratives about their end-of-life education. Academic Medicine, 77, 271–277.

Whyte, R., Quince, T., Benson, J., Wood, D., & Barclay, S. (2013). Medical students' experience of personal loss: Incidence and implications. BMC Medical Education 13, 1. Retrieved from



  • There are currently no refbacks.