Dentistry is a highly skill oriented profession where tactile skill plays a major role in delivering dental treatment. Clinical competency-based dental curriculum is emphasized in the traditional dental education. However, face to face interactions between patient and dentist act as the daily routine during clinical practice. It is not surprised that holistic oral healthcare is the core guideline of year 112 teaching hospital accreditation (http://ftp.jct.org.tw:8080/fbsharing/6OduGDVI). The definition of holistic oral healthcare refers to provide the patient-centered oral care which should consider physical, psychological, spiritual, and social issues. It is also necessary to respect and respond the need and value of patients during clinical oral care. Humanism as well as humanities have been recognized as the soul of medical health education. The cultivation of medical humanities is crucial for professional identity formation in dental education.1 The incorporation of humanistic education into traditional simulation based courses is important from dentists’ cultivation period to career development.
Medical humanity has been defined as a combination of its relevant disciplines including ethics, philosophy, religious studies, history, literature, and so forth.2 The implementation of medical humanities education could foster students' critical thinking, scientific process, self-confidence, self-discipline, and the guidance for future professional career. 3 Therefore, how to educate medical practitioners including dental students with the arts and humanities contributing to education, research, and health care practice are quite important.
Narrative medicine founded by Dr. Charon was defined as a patient-centered model with empathy, reflection, profession, and trust.4 Narrative medicine has been reported to be a good tool for patient-dentist discourse.5 The implementation of narrative medicine into dental education has been proposed to achieve patient-centered dental care.6 Be a dentist, we face to the whole individual, but not his or her oral cavity and teeth only. Dentist could not simply eliminate oral diseases, but also heal patient holistically. The aforementioned can be the core value for being a dentist.
Medical humanities education has been recognized as the crucial factor to develop a successful medical practitioner; it could influence the clinical performance and increase the empathy for patients.7 From our opinions, narrative medicine is the roadmap to integrate medical humanity and professional skills to achieve holistic oral healthcare. In this article, the authors presented and discussed that narrative medicine could act as a roadmap to implement medical humanities in dental education.
Since 2019, School of Dentistry, Chung Shan Medical University was the first dental school to implement narrative medicine into dental curriculum to practice medical humanities. Humanistic literacy for caring the vulnerable or disadvantaged individuals is one of the goals in current dental curriculum. The stepwise curriculum roadmap for medical humanities were divided into three portions. First, narrative medicine was implemented and incorporated into medical humanities, college's general education, and psychology to prepare empathy as well as trust for the future clinical practices during the first and second grades in the dental school. In addition, encouraging junior dental students participate in extracurricular activities including social responsibility activities, volunteering, medical history, literature, art viewing, and life narrative.
Second, narrative medicine was conducted into professional courses to change the perspective from dentist to patients' view during third and fourth grades. Initially, literature, visual arts, and ethic were applied to facilitate professional development. For example, the medical history and art of microscopic field were integrated into oral embryology and histology course to bridge medical humanity and professional learning. Senior dental students visit the vegetative care home and patients' home in the domiciliary dental care course to foster their empathy and build up the trust from patient's family. Reflective writing was conducted into medical ethic course from the viewpoints of medical indications, patient preferences, quality of life, and contextual features. Taken together, these flipped courses would enhance the students' vision from oral disease diagnosis and treatment up to the level of holistic oral healthcare.
During the periods of clerkship or internship, the development of clinical skills and the use of narrative skills could explore the physical, psychological, spiritual, and social situations of each individual leading to holistic oral healthcare. Unsatisfactory or non-structured patient-dentist discourse may lead to mistrust and even conflict. Currently, empathy, trust, patient-dentist discourse, and even holistic medical care are not taken into consideration in current clinical skill-based dental education. From the recent reports, narrative medicine was found effectively for promoting interpersonal and communication skills, treatment plan, and patient-centered care from the dental students' perceptions.8, 9, 10 Therefore, narrative medicine seems a good pathway to practice medical humanities.
In conclusion, current clinical competency-based dental education needs to reform. The integration of medical humanities into dental curriculum is required for the holistic oral healthcare and even social welfare. Narrative medicine competencies empathy, trust, professionalism, and reflection are the best model to integrate art, ethics, medical humanities, and social sciences in daily dental practice. Narrative medicine could act as a roadmap to implement medical humanities in dental education. Further consensus to establish the standardized program on medical humanities education is required to improve current dental curriculum.
Declaration of competing interest
The authors have no conflicts of interest relevant to this article.
References
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