“This article, ‘Narrative inquiry: a relational research methodology for medical education’ by D Jean Clandinin, Marie T Cave, & Charlotte Berendonk (2016), serves as a crucial resource for understanding a particular theoretical and methodological framework within the broader field of narrative research in medical education.
Key Concepts and Distinctions: The authors begin by contextualizing narrative research within medical education scholarship. They draw on Bruner’s distinction between narrative knowledge (dealing with human intention, action, and temporality) and paradigmatic knowledge (logico-scientific, replicable, and generalizable). While acknowledging the necessity of paradigmatic knowledge in clinical thinking, the article asserts its insufficiency in addressing the inherent uncertainty and ambiguity of clinical practice. This distinction paved the way for the development of narrative research methodologies.
The paper clarifies the often-confused terms “story” and “narrative” within narrative research. It defines narrative inquiry as a way of understanding experience as a story, where individuals shape their daily lives by stories of who they are and interpret their past through these narratives. This methodology builds on Dewey’s understanding of experience, incorporating his criteria of interaction and continuity within situations. Central to narrative inquiry is the three-dimensional narrative inquiry space comprising temporality (past, present, future), place (particular contexts of events), and sociality (inward and outward focus on desires, reactions, and contextual forces). A fundamental shift emphasized is moving from “thinking about stories” (conceiving narrative as an object) to “thinking with stories” (a process allowing narrative to work on us). Unlike some narrative researchers who treat texts as objects separate from time, place, and people, narrative inquirers attend to experience embedded in these dimensions and relationships.
Application in Medical Learners’ Identity Making: The article specifically explores the uses of narrative inquiry in studying medical learners’ professional identity making. While other narrative research approaches in this area often treat stories as data, narrative inquiry shifts to a more relational approach, attending to the living and telling of stories within context and relationship. The authors describe two studies that employed parallel charting (where learners write stories of clinical encounters) and facilitated narrative inquiry groups, utilizing the three-dimensional narrative inquiry space to explore identity development. Through these inquiries, participants, like Sarah and Lesley, were able to compose and understand their shifting professional identities, recognizing how their stories are lived and told across personal and professional landscapes.
Challenges in Engaging in Narrative Inquiry in Medical Education: The authors highlight four significant challenges researchers face when using narrative inquiry in medical education:
- Starting Point of Inquiry: Narrative inquiry begins with an individual’s stories of experience, not with pre-set theoretical understandings of a phenomenon. This contrasts sharply with many medical education studies that often start with theoretical notions, making it challenging for participants and researchers alike to shift their perspective.
- Shifting from Paradigmatic to Narrative Thinking: Medical education often trains physicians to use clinical cases, focusing on objective biomedical data and excluding the physician’s own experience as an actor in the encounter. Narrative inquiry, as a relational methodology, puts the experiences of all participants (physicians, patients, researchers) under study, a difficult shift for those accustomed to objectivity.
- Creating Congruent Methods: It is challenging to develop methods that align with narrative inquiry’s relational nature, especially with physicians and learners who may harbor “fears/uncertainties” due to assessment-driven environments. Creating safe spaces for storytelling and collaborative inquiry is crucial but difficult to establish against ingrained practices.
- Attending to Multi-perspectival Experiences: Physicians are part of healthcare teams, and their identities are shaped in relation to various allied health providers. Narrative inquiry needs to develop ways to include the experiences of different team members and the broader social, institutional, and professional narratives that embed individual experiences, leading to complex, multi-perspectival inquiries.
Future Directions: The article concludes by pointing to promising future research and practice possibilities, including the continued clarification of epistemological and ontological assumptions underlying narrative inquiry, the development of relational ethics, and the extension of narrative inquiry into professional practice through narrative reflective practice and pedagogy.
This article is essential reading for anyone interested in deeply understanding how narrative inquiry can illuminate the complex processes of professional identity formation and experience in medical education, while also navigating its unique methodological challenges.”
APA Reference:
Clandinin, D. J., Cave, M. T., & Berendonk, C. (2016). Narrative inquiry: A relational research methodology for medical education. Medical Education. doi:10.1111/medu.13136