Narrative medicine and humanities for health professions education: an experimental study

Figures & data

Table 1. A list of proposed research hypotheses.

Null Hypothesis	Dependent variables	Dependent subscale variables
1. There is no difference in the awareness of professional identity between the health professions students using narrative medicine to form an empathetic connection and those not using narrative medicine.	Professional identity	Professional commitment and devotion Emotional identification and belongingness Professional goals and values Self-fulfillment and retention tendency
2. There is no difference in reflective thinking between the health professions students using narrative medicine to form an empathetic connection and those not using narrative medicine.	Self-reflection	Reflective skepticism Self-examination Empathetic reflection Critical open-mindedness
3. There is no difference in emotional catharsis between the health professions students using narrative medicine to form an empathetic connection and those not using narrative medicine.	Emotional catharsis	Emotional identification as self-healing Emotional release for compensation Emotional adjustment for intellectual growth
4. There is no difference in reflective writing competency between the health professions students using narrative medicine to form an empathetic connection and those not using narrative medicine.	Reflective writing competency	Focus and context structure Ideas and elaboration Voices and points of view Critical thinking and representation Depth of reflection on personal growth Language and conventions

Table 2. MANCOVA results for the PIS-HSP posttest.

	Covariance
Posttest	Professional commitment and devotion (pretest)	Emotional identification and belongingness (pretest)	Professional goals and values (pretest)	Self-fulfillment and retention tendency (pretest)
	Wilks’ Λ F(4, 58) (p-value)
	0.307 32.703 (<0.000**)	0.768 4.382 (0.004**)	0.123 103.424 (<0.000**)	0.092 143.678 (<0.000**)
	Tests of Between-Subjects Effects F(1,61) (p-value)
Professional commitment and devotion	64.752 (<0.000**)	0.055 (0.816)	0.925 (0.340)	0.636 (0.428)
Emotional identification and belongingness	22.171 (<0.000**)	4.644 (0.035*)	1.764 (0.189)	1.060 (0.317)
Professional goals and values	0.078 (0.781)	0.401 (0.529)	334.467 (<0.000**)	1.172 (0.283)
Self-fulfillment and retention tendency	0.612 (0.437)	0.171 (0.680)	0.328 (0.569)	422.130 (<0.000**)

Note: Experimental group: N=35; Control group: N=32.

Wilks’ Λ: Wilks’ lambda

F(4, 58): F(hypothesis degrees of freedom, error degrees of freedom)

*p< 0.05; **p< 0.01

Table 3. The adjusted posttest means for the PIS-HSP in MANCOVA.

Posttest	Group	Adjusted Mean	(SD)	p-value
Professional commitment and devotion	ExperimentalControl Control	98.30 92.64	(2.28) (2.39)	.099
Emotional identification and belongingness	ExperimentalControl Control	49.61 44.93	(1.29) (1.35)	<.017*
Professional goals and values	ExperimentalControl Control	43.54 38.82	(0.50) (0.52)	<.000**
Self-fulfillment and retention tendency	ExperimentalControl Control	36.99 33.30	(0.49) (0.52)	<.000**

Note: Experimental group: N=35; Control group: N=32.

SD: Standard deviation

*p< 0.05; **p< 0.01

Table 4. MANCOVA results for the RTS-HSP posttest.

	Covariance
Posttest	Reflective skepticism (pretest)	Self-examination (pretest)	Empathetic reflection (pretest)	Critical open- mindedness (pretest)
	Wilks’ Λ F(4, 58) (p-value)
	0.343 27.795 (<0.000**)	0.371 24.561 (<0.000**)	0.557 11.539 (<0.000**)	0.525 13.112 (<0.000**)
	Tests of Between-Subjects Effects F(1,61) (p-value)
Reflective skepticism	32.777 (<0.000**)	0.012 (0.913)	0.001 (0.975)	10.072 (0.002**)
Self-examination	1.231 (0.271)	50.162 (<0.000**)	0.113 (0.738)	1.511 (0.224)
Empathetic reflection	0.176 (0.677)	0.144 (0.705)	21.087 (<0.000**)	3.105 (0.083)
Critical open-mindedness	0.207 (0.650)	0.036 (0.851)	4.502 (0.038*)	53.750 (<0.000**)

Experimental group: N = 35; Control group: N = 32

Wilks’ Λ: Wilks’ lambda

F(4, 58): F(hypothesis degrees of freedom, error degrees of freedom)

*p< 0.01; **p< 0.01

Table 5. The adjusted posttest means for the RTS-HSP in MANCOVA.

Posttest	Group	Adjusted Mean	(SD)	p-value
Reflective skepticism	ExperimentalControl Control	44.58 41.30	(.78) (.82)	.005**
Self-examination	ExperimentalControl Control	48.22 44.79	(.75) (.79)	.003**
Empathetic reflection	ExperimentalControl Control	40.05 37.44	(.71) (.75)	.014*
Critical open-mindedness	ExperimentalControl Control	38.33 34.89	(.82) (.86)	.005**

Note: Experimental group: N=35; Control group: N=32.

SD: Standard deviation

*p< 0.05; **p< 0.01

Table 6. MANCOVA results for the ECS-IN posttest.

	Covariance
Posttest	Emotional identification as self-healing (pretest)	Emotional release for compensation (pretest)	Emotional adjustment for intellectual growth (pretest)
	Wilks’ Λ F(3, 60) (p-value)
	0.326 41.276 (<0.000**)	0.314 43.605 (<0.000**)	0.323 41.869 (<0.000**)
	Tests of Between-Subjects Effects F(1,62) (p-value)
Emotional identification as self-healing	6.699 (0.012*)	0.078 (0.780)	2.682 (0.107)
Emotional release for compensation	60.031 (<0.000**)	0.790 (0.377)	5.079 (0.028*)
Emotional adjustment for intellectual growth	3.994 (0. 050)	81.172 (<0.000**)	10.934 (0.002**)

Note: Experimental group: N=35; Control group: N=32.

Wilks’ Λ: Wilks’ lambda

F(3, 60): F(hypothesis degrees of freedom, error degrees of freedom)

*p< 0.05; **p< 0.01

Table 7. The adjusted posttest means for the ECS-IN in MANCOVA.

Posttest	Group	Adjusted Mean	(SD)	p-value
Emotional identification as self-healing	ExperimentalControl Control	85.70 82.14	(1.49) (1.60)	.107
Emotional release for compensation	ExperimentalControl Control	66.97 63.38	(1.10) (1.15)	.028*
Emotional adjustment for intellectual growth	ExperimentalControl Control	60.85 57.08	(0.78) (0.82)	.002**

Note: Experimental group: N=35; Control group: N=32.

SD: Standard deviation

*p< 0.05; **p< 0.01

Table 8. MANCOVA results for the ANMWSR posttest.

	Covariance
Posttest	Focus and context structure (pretest)	Ideas and elaboration (pretest)	Voices and points of view (pretest)	Critical thinking and representation (pretest)	Depth of reflection on personal growth (pretest)	Language and conventions (pretest)
	Wilks’ Λ F(6, 54) (p-value)
	0.894 1.064 (0.395)	0.930 0.674 (0.671)	0.911 0.877 (0.518)	0.887 1.141 (0.351)	0.855 1.531 (0.186)	0.824 1.922 (0.094)
	Tests of Between-Subjects Effects F(1,59) (p-value)
Focus and context structure	1.553 (0.218)	0.005 (0.946)	0.856 (0.359)	0.980 (0.326)	0.833 (0.365)	0.474 (0.494)
Ideas and elaboration	2.428 (0.125)	0.001 (0.976)	1.783 (0.187)	4.558 (0.037*)	0.383 (0.538)	2.726 (0.104)
Voices and points of view	0.011 (0.916)	2.288 (0.136)	0.567 (0.455)	2.779 (0.101)	3.652 (0.061)	0.019 (0.891)
Critical thinking and representation	0.019 (0.890)	0.425 (0.517)	0.974 (0.328)	0.770 (0.384)	0.121 (0.729)	1.268 (0.265)
Depth of reflection on personal growth	0.094 (0.760)	0.016 (0.901)	0.197 (0.659)	4.537 (0.037*)	0.208 (0.650)	0.159 (0.691)
Language and conventions	0.010 (0.922)	0.684 (0.412)	0.197 (0.658)	0.065 (0.800)	2.136 (0.149)	8.438 (0.005**)

Note: Experimental group: N=35; Control group: N=32.

Wilks’ Λ: Wilks’ lambda

F(6, 54): F(hypothesis degrees of freedom, error degrees of freedom)

*p< 0.05; **p< 0.01

Table 9. The adjusted posttest means for the ANMWSR in MANCOVA.

Posttest	Group	Mean	(SD)	p-value
Focus and context structure	ExperimentalControl Control	4.20 3.63	(0.11) (0.11)	.001**
Ideas and elaboration	ExperimentalControl Control	3.90 3.14	(0.15) (0.16)	.001**
Voices and points of view	ExperimentalControl Control	4.00 3.63	(0.10) (0.10)	.012*
Critical thinking and representation	ExperimentalControl Control	4.16 3.04	(0.15) (0.16)	<.000**
Depth of reflection on personal growth	ExperimentalControl Control	4.09 3.06	(0.17) (0.18)	<.000**
Language and conventions	ExperimentalControl Control	3.77 3.54	(0.11) (0.12)	.181

Note: Experimental group: N=35; Control group: N=32

SD: Standard deviatio

*p< 0.05; **p< 0.0

Table 10. A summary to highlight the differences between the two groups.

Scale & factors	Professional Identity (PIS-HSP)
Group comparison	Professional commitment and devotion			Emotional identification and belongingness			Professional goals and values			Self-fulfillment and retention tendency
Comparison using MANCOVA	_			*			**			**
Scale & factors	Reflective Thinking (RTS-HSP)
Group comparison	Reflective skepticism		Self-examination			Empathetic reflection			Critical open- mindedness
Comparison using MANCOVA	**		**			*			**
Scale & factors	Emotional Catharsis (PIS-HSP)
Group comparison	Emotional identification as self-healing				Emotional release for compensation			Emotional adjustment for intellectual growth
Comparison using MANCOVA	_				*			**
Scale & factors	Reflective Writing Competency (ANMWSR)
Group comparison	Focus and context structure	Ideas and elaboration			Voices and points of view		Critical thinking and representation	Depth of reflection on personal growth			Language and conventions
Comparison using MANCOVA	**	**			*		**	**			_

Note: *p< 0.05; **p< 0.01.