Effect of storytelling-based learning on child psychiatry psychopharmacology education among medical students: a controlled pretest–posttest study

Abstract

Aim

This study aimed to examine the effects of a story-based example—developed by the author and centered on the commonly used active ingredient “fluoxetine” in child psychiatry clinical practice—on the academic performance of medical students, compared with traditional teaching methods. Additionally, the study sought to evaluate medical students’ views, perceptions, and attitudes toward this educational approach.

Materials and methods

A total of 54 volunteer third-year students from the Faculty of Medicine at Zonguldak Bülent Ecevit University in the 2025–2026 academic year were included in the study. Participants were allocated into two groups using a matched allocation procedure based on age and sex to ensure baseline comparability between groups. One group received training through the text titled "Worlds Colored By The Journey With Fluoxetine", written by the researcher, in which the mechanism of action, side effects, indications, and contraindications of fluoxetine were presented in a narrative format. The other group was taught the same content using a traditional instructional method. The impact on students’ academic performance was assessed through pre-test and post-test evaluations.

Results

There were no statistically significant differences between the theoretical and story-based education groups in terms of age, gender, income, place of residence, presence of comorbid medical conditions, or psychiatric history (p>0.05). In both groups, fluoxetine quiz scores increased significantly from pre-test to post-test (p < 0.001 and p < 0.001). However, the rate of improvement in the story-based group was found to be significantly higher than in the theoretical group (p = 0.004).

Conclusion

Story-based instruction was associated with greater improvement in fluoxetine knowledge scores compared with traditional instruction, and students generally reported positive attitudes toward this educational approach. These findings suggest that storytelling may be a useful complementary method for teaching psychopharmacological concepts in medical education. Further studies are needed to evaluate its broader applicability and long-term educational effects.

Introduction

Medical education is a challenging and demanding process that requires sustained effort over many years, involves continuous renewal, and aims to equip learners with knowledge and skills relevant to the healthcare field. Given the variability inherent in the educational process, the development of appropriate and effective educational models is of great importance to ensure that acquired knowledge can be applied in practice [1, 2]. For this reason, educators in medicine and other health disciplines have increasingly sought innovative methods to make the learning process more active, interactive, and meaningful [3].

In recent years, innovative approaches such as story- and narrative-based methods have gained increasing attention in education, to enhance knowledge retention and student motivation [1, 4–6]. In this context, storytelling (narrative-based pedagogy) has emerged as a prominent method. Stories may facilitate learning by engaging learners both cognitively and emotionally [7]. In addition, emotionally salient information has been shown to be encoded and retained more effectively than neutral information [8].

In medicine, the “narrative medicine” approach contributes to the development of empathy, observation, and reflective skills between students and patients, not only in clinical practice but also in educational settings [9, 10]. This approach has been reported to help students connect patients’ experiences with medical knowledge and to support reflective and patient-centered learning [10]. Similarly, a review focusing on pediatric medical education demonstrated that narrative-based interventions positively contribute to students’ patient care and communication skills [6].

Pharmacology education is one of the more challenging areas of the medical curriculum, as it intersects both basic sciences and clinical practice and involves a substantial amount of abstract information. Fasinu et al. reported that content overload, low interactivity, and ineffective learning strategies pose significant challenges in pharmacology teaching [11]. Therefore, the use of creative pedagogical approaches has been recommended in recent years to promote long-term retention of pharmacological knowledge [12]. Learning drug mechanisms of action, indications, and adverse effects solely through rote memorization may lead to rapid forgetting of information [13]. At this point, it has been suggested that story-based applications in pharmacology education may facilitate learning.

Indeed, some students have reported that the use of stories in pharmacology courses helps them recall drug mechanisms and adverse effects more effectively [14].

Considering the existing literature, storytelling approaches may also be used effectively in child and adolescent psychiatry education. For example, a psychopharmacological drug entails a significant theoretical load, including its mechanism of action, half-life, indications, and contraindications. In the educational material developed for this study, psychopharmacological information was presented through a storytelling approach that incorporated anthropomorphic characteristics, with the medication represented as a narrative character. This approach was intended to provide a contextual framework that might facilitate engagement with complex psychopharmacological concepts and support the learning process.

This study aimed to examine the effects of a story-based example—developed by the author and centered on the commonly used active ingredient “fluoxetine” in child psychiatry clinical practice—on the academic performance of medical students compared with traditional teaching methods. Additionally, the study sought to evaluate medical students’ views, perceptions, and attitudes toward this educational approach.

Materials and methods

Study sample

In the absence of prior studies providing parameters for sample size estimation, a large effect size (Cohen’s d = 0.80) was assumed. An a priori power analysis was conducted using G*Power (version 3.1.9.2) for an independent-samples t-test (two-tailed), with an alpha level of 0.05 and a statistical power of 0.80. The analysis indicated that a total sample size of 52 participants (26 per group) would be required to detect a statistically significant difference between groups. The sample size calculation was based on the primary comparison between the story-based and traditional education groups. No separate power analyses were performed for gender-based subgroup analyses or within-group pretest–posttest comparisons, which were considered exploratory secondary analyses.

To account for potential attrition, we aimed to recruit slightly more participants than the minimum required sample size. Accordingly, a total of 54 third-year medical students were included in the study.

In the Turkish medical education system, the third year typically represents the final phase of pre-clinical training, with clinical rotations beginning in the fourth year. Although students may have encountered general pharmacological principles, they had not yet received formal instruction specifically focused on psychotropic medications within their curriculum at the time of the study.

Participants were screened using a pre-test to assess baseline knowledge of fluoxetine. Rather than indicating complete unfamiliarity, pre-test results demonstrated limited and inconsistent knowledge of the drug’s mechanisms and clinical applications.

Inclusion criteria

Participants were eligible for inclusion if they:

1. Were enrolled as third-year medical students at Zonguldak Bülent Ecevit University during the 2025–2026 academic year.

2. Had not yet received formal curriculum-based instruction specifically focused on psychotropic medications.

3. Completed the baseline (pretest) fluoxetine knowledge assessment.

4. Provided written informed consent for voluntary participation.

Exclusion criteria

Participants were excluded if they:

1. Had previously completed a formal course or clerkship specifically covering psychopharmacology.

2. Had participated in extracurricular training or research specifically related to antidepressants or fluoxetine.

3. Failed to complete either the pretest or posttest assessment.

4. Withdrew consent at any stage of the study.

Study design and procedure

This study was a controlled pretest–posttest educational intervention study with non-random group allocation. Baseline equivalence was supported through matching on age and sex.

Among third-year medical students, volunteers whose baseline knowledge of fluoxetine was assessed using a pre-test, which indicated limited prior exposure to formal psychopharmacology instruction. Participants were allocated into two groups using a matched allocation procedure based on age and sex to achieve balanced group characteristics. In the intervention (story-based) group, theoretical information regarding fluoxetine—a pharmacological agent commonly used in child and adolescent psychiatry clinical practice—was delivered through a story-based educational material developed by the researcher. In the control group, the same content was presented using traditional teaching methods. Both groups received instruction covering identical psychopharmacological content, including mechanism of action, indications, contraindications, adverse effects, and pharmacokinetic properties of fluoxetine. The duration of instruction was equivalent in both groups. The sessions were delivered by the same instructor under comparable classroom conditions. The only difference between groups was the format of content delivery: narrative-based storytelling versus traditional theoretical explanation.

Evaluation

Following the educational sessions, both groups were administered tests assessing their level of knowledge regarding the presented medication. In addition, students’ opinions and feedback regarding the instructional method used were collected through structured forms.

Data collection instruments

Sociodemographic data form

A form designed to collect information on variables such as age, sex, number of siblings, and history of psychiatric illness.

Fluoxetine quiz form

A 19-item fluoxetine quiz developed by the researcher was used to evaluate learning outcomes. Each correct response was scored as one point, yielding a total score ranging from 0 to 19. The quiz consisted of multiple-choice items aligned with standard psychopharmacology learning objectives and covered mechanism of action, indications, contraindications, adverse effects, pharmacokinetics, and clinically relevant drug interactions. Questions were designed to assess conceptual understanding rather than recall of narrative-specific wording. To enhance content validity, the quiz items were reviewed by an independent faculty member with expertise in pharmacology prior to administration.

The same quiz was administered before and after the educational intervention. Because both the storytelling-based and traditional instructional formats contained identical psychopharmacological content regarding fluoxetine, the quiz items were developed directly from the educational material presented to both groups and aligned with the targeted learning objectives. The quiz was designed to assess knowledge acquisition while ensuring that any differences in performance reflected the mode of content delivery (storytelling versus traditional instruction) rather than differences in educational content.

Storytelling attitude questionnaire

The Storytelling Attitude Questionnaire (SAQ) was used to assess students’ views on the use of storytelling in child and adolescent psychiatry education. The questionnaire consisted of 10 yes/no items designed by the researchers to evaluate students’ perceptions of storytelling as an educational method. The items explored the perceived effects of storytelling on understanding of course content, empathy development, knowledge retention, clinical contextualization, classroom interaction, and overall acceptance of the approach.

Story-based educational material

An educational material entitled “Worlds Colored by the Journey with Fluoxetine,” written by Dr. Öznur Adıgüzel Akman, in which the mechanism of action, adverse effects, indications, and contraindications of fluoxetine are presented in a narrative format (the relevant material is provided in the reference appendix). The narrative was written by the author, a child and adolescent psychiatrist with experience in teaching psychopharmacology to medical students. The story was developed by transforming standard theoretical content on fluoxetine—including mechanism of action, indications, contraindications, adverse effects, pharmacokinetics, and drug interactions—into a first-person narrative format.

All educational materials, including the storytelling text, traditional instructional content, and the pretest/posttest questionnaire, were developed and administered in Turkish, the native language of all participants.

The intervention was implemented before students had received formal instruction on psychotropic medications within their pharmacology curriculum. Rather than altering the scientific content, the theoretical material was reorganized into an anthropomorphic storyline to promote engagement and facilitate comprehension. The narrative was designed to support early-stage medical learners in organizing complex psychopharmacological concepts without compromising scientific accuracy.

The duration and learning objectives of the narrative-based session were equivalent to those of the traditional lecture, with the only difference being the format of content delivery.

Statistical analysis

Statistical analyses were performed using the SPSS 29.0 software package. Descriptive statistics for categorical variables were presented as frequencies and percentages, while continuous variables were expressed as mean, standard deviation, median, minimum, and maximum values. The normality of continuous variables was assessed using the Shapiro–Wilk test.

For comparisons between two independent groups, the independent samples t-test was used for normally distributed continuous variables, whereas the Mann–Whitney U test was applied for non-normally distributed continuous variables. Comparisons of categorical variables between groups were conducted using the Yates-corrected chi-square test and Fisher’s exact test. Changes in fluoxetine scores following the educational intervention were analyzed using the Wilcoxon signed-rank test.

In all statistical analyses, a p value of less than 0.05 was considered statistically significant. In addition to significance testing, effect size measures were calculated for the primary outcome comparisons to assess the magnitude of the observed differences. Effect sizes were interpreted according to established conventions.

Results

A total of 54 third-year medical students participated in the study, with 27 students in each group. The mean age of the theoretical education group was 21.0 ± 2.15 years, while the mean age of the story-based education group was 20.9 ± 1.55 years. No statistically significant difference in age was observed between the groups (p = 0.828).

The groups were comparable in terms of sex distribution. In the theoretical group, 70.4% of participants were female, and 29.6% were male, whereas in the story-based group, these rates were 74.1% and 25.9%, respectively (p = 1.000). The proportion of participants with a monthly income below 30,000 TRY was 22.2% in the theoretical group and 18.5% in the story-based group, with no significant difference in income distribution between the groups (p = 1.000).

There was no significant difference between the groups regarding place of residence with family (province vs. district); 63.0% of students in the theoretical group and 70.4% in the story-based group resided in a province (p = 0.773).

The prevalence of a history of medical illness was equal in both groups (7.4% in each), with no significant between-group difference (p = 1.000). Similarly, no statistically significant difference was found in terms of psychiatric illness history; 11.1% of participants in the theoretical group and 7.4% in the story-based group reported a psychiatric disorder (p = 1.000). The sociodemographic characteristics of the participants are presented in Table 1.

Table 1.

Sociodemographic characteristics of the participants

	Theoretical Education Group (n = 27)	Story- based Education Group (n = 27)	p
Age (mean ± SD)	21.0 ± 2.15	20.9 ± 1.55	0.828a
Gender
Female	19 (70.4%)	20 (74.1%)	1.000b
Male	8 (29.6%)	7 (25.9%)
Revenue
<30.000 TL	6 (22.2%)	5 (18.5%)	1.000b
≥30.000 TL	21 (77.8%)	22 (81.5%)
Living place
District	10 (37.0%)	8 (29.6%)	0.773b
Province	17 (63.0%)	19 (70.4%)
Medical illness
Yes	2 (7.4%)	2 (7.4%)	1.000c
No	25 (92.6%)	25 (92.6%)
Psychiatric illness
Yes	3 (11.1%)	2 (7.4%)	1.000c
No	24 (88.9%)	25 (92.6%)

SD Standard Deviation

^aIndependent samples t test

^bYates Chi-Square test

 ^cFisher Chi-Square test

In the pre-education pretest assessment, fluoxetine quiz scores were similar between the theoretical and story-based groups, and no statistically significant difference was observed (p = 0.967). In contrast, post-education fluoxetine quiz scores showed a statistically significant difference between the groups (p < 0.001). The mean difference between groups was 3.78 points (95% CI: 2.48–5.08), corresponding to a large effect size (Cohen’s d = 1.60). This finding suggests that the change in fluoxetine scores following the educational intervention may differ between the theoretical and story-based teaching methods.

To further examine this effect, within-group changes in fluoxetine scores before and after the educational intervention were analyzed. In the theoretical education group, fluoxetine quiz scores increased by 50%, whereas an 80% increase was observed in the story-based education group. The improvement in fluoxetine quiz performance in the story-based group was statistically significantly greater than that observed in the theoretical education group (p = 0.004), with a moderate effect size (r = 0.39). Comparisons of pre- and post-education achievement scores between the groups are presented in Table 2.

Table 2.

Comparison of pre- and post-education achievement scores between the theoretical and story-based education groups

	Theoretical Education Group (n = 27)	Story-based Education Group (n = 27)	p	Effect Size
Pre-Education Fluoxetine Achievement Score	8.59 ± 3.319 (2–15)	8.56 ± 3.319 (3–15)	0.967a	d = 0.01
Post-Education Fluoxetine Achievement Score	13.63 ± 2.98 14 (6–18)	17.41 ± 1.53 18 (13–19)	< 0.001 a	d = 1.60
Within-group pre/post comparison (p)	< 0.001 b	< 0.001 b
Percentage Change After Education	0.50 (0.11–7.00)	0.80 (0.20–5.33)	0.004 c	r = 0.39

Data are presented as mean ± standard deviation and median (minimum–maximum), unless otherwise indicated

Effect sizes are reported as Cohen’s d for between-group comparisons of achievement scores and as r = Z/√N for the comparison of percentage change after education

Bold values indicate statistical significance (p < 0.05)

^aIndependent samples t test

^bWilcoxon test

^cMann Whitney U test

In the theoretical education group, no statistically significant difference was found between female and male participants in pre-education fluoxetine scores (p = 0.938). Post-education fluoxetine scores also did not differ significantly by sex (p = 0.696).

When pre- to post-education changes were examined, fluoxetine scores increased by 45% in females and by 50% in males; however, the magnitude of change did not differ significantly between sexes (p = 0.938). Comparisons of pre- and post-education scores within each sex revealed statistically significant increases in both females and males (females: p < 0.001; males: p = 0.012). Changes in achievement by sex in the theoretical education group are presented in Table 3.

Table 3.

Comparison of pre- and post-education fluoxetine scores by sex in the theoretical education group

	Female (n = 19)	Male (n = 8)	p
Pretest Fluoxetine Achievement Score	9 (2–15)	8.5 (4–15)	0.938a
Posttest Fluoxetine Achievement Score	14 (8–18)	13.5 (6–18)	0.696a
p	< 0.001 b	0.012 b
Percent Change From Pretest to Posttest (%)	0.45 (0.11–7.00)	0.50 (0.20–1.50)	0.938a

Bold values indicate statistical significance (p < 0.05)

^aMann Whitney U test

^bWilcoxon test 

In the story-based education group, no statistically significant difference was found between female and male participants in pre-education fluoxetine scores (p = 0.063). Similarly, post-education fluoxetine scores did not differ significantly between sexes following the story-based intervention (p = 0.725).

When pre- and post-education fluoxetine achievement scores were compared within each sex, statistically significant increases were observed in both females (p < 0.001) and males (p = 0.018).

In terms of percentage change, fluoxetine scores increased by 70% in females and by 138% in males, and the difference in the magnitude of change between sexes was statistically significant (p = 0.041). Comparisons of pre- and post-education fluoxetine quiz scores by sex in the story-based education group are presented in Table 4.

Table 4.

Comparison of pre- and post-education fluoxetine scores by sex in the story-based education group

	Female (n = 19)	Male (n = 8)	p
Pretest Fluoxetine Achievement Score	10 (3–15)	7 (3–10)	0.063a
Posttest Fluoxetine Achievement Score	18 (13–19)	18 (16–19)	0.725a
p	< 0.001 b	0.018 b
Percent Change From Pretest to Posttest (%)	0.70 (0.20–5.33)	1.38 (0.70–5.00)	0.041 a

Bold values indicate statistical significance (p < 0.05)

^aMann Whitney U test

^bWilcoxon test 

Students’ responses to the Storytelling Attitude Questionnaire (SAQ) are presented in Tables 5 and 6.

Table 5.

Distribution of participants’ responses to the Storytelling Attitude Questionnaire (SAQ)

	Questionnaire Items	Yes n (%)	No n (%)
SAQ1	The use of storytelling in education facilitates the understanding of child and adolescent psychiatry topics.	52 (96.3%)	2 (3.7%)
SAQ2	Stories help students develop empathy skills.	49 (90.7%)	5 (9.3%)
SAQ3	The use of storytelling makes class time inefficient.	12 (22.2%)	42 (77.8%)
SAQ4	Story-based education supports long-term retention of knowledge.	54 (100%)	0 (0%)
SAQ5	Stories make preparation for clinical practice more difficult.	11 (20.4%)	43 (79.6%)
SAQ6	Cases presented through storytelling are useful for placing theoretical knowledge into a clinical context.	52 (96.3%)	2 (3.7%)
SAQ7	I believe that the use of storytelling increases classroom interaction.	38 (70.4%)	16 (29.6%)
SAQ8	I am skeptical about using story-based activities in class because they are difficult to assess and grade.	18 (33.3%)	36 (66.7%)
SAQ9	I believe that the use of storytelling in child and adolescent psychiatry education should be increased.	49 (90.7%)	5 (9.3%)
SAQ10	I agree that stories are effective in education, provided that they are brief and goal-oriented.	54 (100%)	0 (0%)

Table 6.

Comparison of responses to the Storytelling Attitude Questionnaire (SAQ) between groups

	Theoretical Education Group (n = 27)	Story-based Education Group (n = 27)	p
SAQ1 (yes)	27 (%100.0)	25 (%92.6)	0.491a
SAQ2	26 (%96.3)	23 (%85.2)	0.351a
SAQ3	8 (%29.6)	4 (%14.8)	0.326b
SAQ4	27 (%100)	27 (%100)	-
SAQ5	5 (%18.5)	6 (%22.2)	1.000b
SAQ6	26 (96.3)	26 (96.3)	1.000a
SAQ7	22 (%81.5)	16 (%59.3)	0.136b
SAQ8	10 (%37.0)	8 (%29.6)	0.773b
SAQ9	27 (%100)	22 (%81.5)	0.051a
SAQ10	27 (%100)	27 (%100)	-

SAQ Storytelling Attitude Questionnaire

^aFisher Chi-Square test

^bYates Corrected Chi-Square test

Discussion

This study examined the effects of presenting drug-related knowledge through narrative-based storytelling on medical students’ learning attitudes and academic performance in child and adolescent psychiatry education. The findings demonstrated that the post-education increase in academic achievement was significantly greater in the story-based education group compared with the theoretical education group.

As a single-site, short-term intervention, the present findings contribute preliminary evidence regarding the potential value of storytelling in psychopharmacology education. Further research across different educational settings would help clarify the broader applicability of this approach.

No statistically significant differences were observed between the groups with respect to the items of the Storytelling Attitude Questionnaire. This finding suggests that storytelling as an instructional method is generally well accepted by students; however, a single-session intervention may not be sufficient to produce measurable changes in learning attitudes.

To the best of our knowledge, no previous study has systematically examined the use of a fully story-based approach to teach pharmacological content to medical students. In this regard, the present study appears to be the first to explore the structured storytelling of pharmacological information within medical education.

In this study, knowledge related to fluoxetine—an antidepressant commonly used in child and adolescent psychiatry clinical practice—was evaluated using a pretest–posttest design. One group received traditional theoretical instruction, while the other group was taught the same content through a narrative text developed by the researcher. Post-education assessments and attitude questionnaires indicated that narrative-based instruction significantly enhanced the learning process. The majority of students reported that stories made the course content more comprehensible, memorable, and engaging, while quantitative findings also revealed a marked increase in achievement scores following the storytelling intervention. Taken together, these results suggest that narrative-based education may positively influence both cognitive learning outcomes and students’ motivation and subjective learning experiences. The narrative format was designed to enhance engagement and reduce abstraction in early-stage medical learners. By integrating pharmacological mechanisms into a structured storyline, the instructional approach aimed to facilitate comprehension of complex concepts within a clinically meaningful context.

Interest in the use of storytelling (narrative-based learning) as an effective instructional tool in medical education has increased markedly in recent years. Studies conducted particularly in the fields of psychiatry, ethics, communication skills, and professional identity development have demonstrated that the use of narratives facilitates students’ understanding of clinical situations, supports emotional engagement, and enhances empathy skills [15, 16]. Narrative-based teaching has also been emphasized as contributing to longer-term knowledge retention, assisting in the conceptualization of complex clinical processes, and playing a significant role in students’ professional identity formation [17–19].

Within the existing literature, several studies highlighting the role of storytelling in medical education and its potential to enhance knowledge retention have reported that narrative texts can be used as effective pedagogical tools not only at the primary education level but also in instructional activities involving university students [2, 20]. Therefore, story-based approaches appear to be applicable beyond foundational educational levels, extending into higher education and professional training contexts. Moreover, the role of storytelling in medical education is well recognized through established pedagogical frameworks such as narrative medicine, problem-based learning, and long-standing practices in psychiatry education [5, 6, 21–23].

In the present study, the majority of students expressed positive views regarding the use of storytelling in education, particularly in relation to facilitating understanding of course content (SAQ1), supporting knowledge retention (SAQ4), and helping place theoretical knowledge into a clinical context (SAQ6). Although item-level responses should be interpreted cautiously given the sample size, the overall pattern of responses suggests that students generally perceived narrative-based instruction as a useful and engaging component of the learning process.

Students’ positive evaluations of story-based education are consistent with previous studies emphasizing the core functions of narratives in learning. Easton’s qualitative study highlighted narratives as powerful educational tools for “providing context, capturing attention, engaging learners, and facilitating the transfer of information into long-term memory” [24]. Similarly, Haigh and Hardy reported that stories facilitate learning at both cognitive and affective levels and support the internalization of professional values by making human experience more accessible [7]. Although no prior studies employing a comparable design in the field of psychopharmacology have been identified, these findings suggest that the use of narratives may support the comprehension of complex topics and, in particular, promote positive changes in learners’ attitudes. In this context, the positive attitudes toward storytelling observed among students in our study are consistent with the existing literature supporting the effectiveness of narrative-based teaching methods.

A systematic review conducted in the education of health professionals demonstrated that digital storytelling approaches—such as short videos and multimedia narratives—promote learning and behavioral change, while engaging participants in creating their own stories or listening to patient narratives enhances empathy and reflective thinking [25]. Another study reported that film- or story-based learning methods positively influenced medical students’ attitudes toward child and adolescent psychiatry and increased empathy skills [26]. Similarly, Kagawa et al. showed that exposure to patient narratives led to increases in empathy scores among medical students in both the short and long term [27].

In the present study, the high level of positive endorsement in both groups regarding the view that story-based education enhances students’ empathy skills (SAQ2) is consistent with the existing literature demonstrating that narratives in medical education contribute to the development of empathy [15, 16]. The concept of “narrative competence,” as defined by Charon [16], emphasizes the critical role of storytelling in health professions education for fostering empathy, reflection, and the development of professional attitudes. This approach highlights the importance of understanding clinical knowledge not only in its technical dimensions but also as integrated with patients’ stories and contextual experiences [16].

One notable finding of our study was the lower perceived positive impact of storytelling on classroom interaction (SAQ7) in the story-based education group, as well as the lower level of endorsement for the view that the use of storytelling in child and adolescent psychiatry education should be increased (SAQ9), compared with the theoretical education group. However, these item-level differences should be interpreted cautiously given the relatively small sample size and the absence of statistically significant differences. Therefore, these findings should not be considered evidence of a true difference between groups but may instead reflect variation within a small sample.

The literature indicates that for narrative-based interventions to effectively enhance student engagement, appropriate structuring, timing, and guided discussion are essential components [28]. In addition, the relatively small sample size of the study groups (n = 27) may have contributed to the observed differences in SAQ7 and SAQ9 not reaching statistical significance, potentially due to limited statistical power. Indeed, studies assessing attitudinal changes in medical education are often conducted with larger samples, and interventions involving multiple sessions have been reported to produce more pronounced effects [29]. Future research employing larger sample sizes and multiple story-based educational sessions may help to more clearly elucidate the effectiveness of this instructional approach.

In this study, the observation of significant increases in fluoxetine knowledge scores among both female and male students following story-based instruction indicates that narrative-based teaching supports cognitive learning outcomes regardless of sex. However, when percentage change was considered, the increase observed in male students (138%) was significantly greater than that observed in female students (70%), representing a noteworthy finding.

Although this finding is noteworthy, sex differences were not a primary objective of the present study and the analysis should therefore be considered exploratory. The greater improvement observed among male students may partly reflect their lower baseline scores, consistent with a possible floor effect [30]. Further studies with larger samples are needed to clarify whether sex-related differences influence responses to storytelling-based educational approaches.

In our study, the low level of endorsement for negatively worded items in the Storytelling Attitude Questionnaire (SAQ)—specifically items suggesting that storytelling makes class time inefficient (SAQ3) or hinders preparation for clinical practice (SAQ5)—suggests that students generally did not perceive storytelling as having negative effects on the educational process. However, these item-level findings should be interpreted cautiously given the sample size and the descriptive nature of the questionnaire data.

The quantitative data of the present study demonstrate a significant increase in students’ test scores following the storytelling intervention. This finding is consistent with international research indicating that narrative-based medical education supports cognitive learning outcomes. The study by Liao and Wang showed that narrative medicine–based education leads to significant improvements in empathy, communication, and critical thinking skills [31]. The strengthening of learning not only at the emotional but also at the cognitive level may be attributed to storytelling’s capacity to facilitate the structuring, integration, and contextualization of knowledge.

Moreover, by engaging learners in an active process of meaning-making, storytelling contributes to more durable learning, as also emphasized by Easton. Accordingly, the observed increase in achievement scores may reflect not merely a short-term effect but rather meaningful learning. Story-based approaches are widely recognized as having potential advantages in medical education, including bridging the gap between theoretical knowledge and clinical practice, enhancing students’ attention, facilitating contextualization of information, and fostering empathy and reflective thinking skills [32, 33].

In a study reviewing the current state of psychopharmacology education among medical students, residents, and psychiatry trainees, it was reported that psychopharmacology instruction is largely delivered by faculty members from disciplines such as psychiatry, primary care medicine, basic medical sciences, and pharmacy [34]. Our findings support the potential effectiveness of storytelling within psychopharmacology education. Integrating narrative-based approaches into educational curricula may enhance student engagement and facilitate the learning of complex psychopharmacological concepts.

This study has several limitations that should be acknowledged. First, although the study was adequately powered for the primary comparison between the story-based and traditional education groups, it may have been underpowered to detect smaller effects in gender-based subgroup analyses and within-group pretest–posttest comparisons. Therefore, these secondary findings should be interpreted with caution. Second, the relatively small sample size may limit the generalizability of the findings. Third, follow-up assessments were not conducted, preventing the evaluation of the long-term sustainability of attitudinal changes. Fourth, as the study was conducted at a single center, it remains unclear whether similar results would be obtained in different educational settings. In addition, because the quizzes were administered over a short period, the long-term retention of knowledge could not be assessed.

Fifth, students’ attitudinal data regarding storytelling were collected using self-report measures, which may be subject to response bias. Furthermore, the lack of qualitative data exploring the mechanisms through which storytelling operates in a cognitively demanding field such as psychopharmacology limits a deeper understanding of the underlying processes. Although the assessment was developed by the same researcher who designed the narrative intervention, the items were based on established pharmacology learning objectives and were independently reviewed by a faculty member with expertise in pharmacology. Nevertheless, future studies employing externally validated assessment tools may further strengthen methodological rigor.

Although storytelling has demonstrated potential educational benefits, its implementation may also present certain challenges. Factors such as content density, time constraints, instructor competence, and the level of student engagement in the narrative have been frequently cited as potential difficulties [33]. In this context, educators’ familiarity with and aptitude for narrative-based teaching approaches appear to be important considerations.

Despite these limitations, the study also has several notable strengths. One of the key strengths is the application of a storytelling approach in psychopharmacology education, an area that has been relatively underexplored in the existing literature. An additional strength is that the storytelling material used in this study was specifically developed by the researcher to teach fluoxetine-related psychopharmacological concepts within the context of child and adolescent psychiatry. Unlike the adaptation of existing narratives, this educational story was purposefully designed as a tailored instructional intervention, representing an original educational resource for psychopharmacology teaching. This novel approach extends beyond traditional teaching methods commonly used in medical education and provides an opportunity to evaluate how narrative-based instruction influences students’ engagement, motivation, and overall learning experience. In addition, the Storytelling Attitude Questionnaire provided structured information regarding students’ perceptions of storytelling-based education and offered supportive evidence concerning the acceptability and perceived educational value of this instructional approach among medical students.

Future research should aim to enhance the generalizability of these findings by including larger and more heterogeneous student samples. Longitudinal study designs are also warranted to assess the durability of changes in knowledge and attitudes over time. Moreover, systematic investigation of the specific components of learning most strongly influenced by storytelling—such as motivation, empathy, clinical reasoning, and related domains—would provide valuable insights into the mechanisms underlying its educational effectiveness. Comparative studies examining different types of narratives in psychopharmacology education (e.g., real patient stories, fictional characters, or story-based presentations of pharmacological information) may yield more refined conclusions regarding the pedagogical value of storytelling. Furthermore, the incorporation of qualitative research approaches could offer deeper insights into students’ experiences, meaning-making processes, and subjective evaluations of narrative-based learning, thereby strengthening both the theoretical and practical foundations of this educational method.

Conclusion

This study makes an original contribution to the literature by evaluating a researcher-developed storytelling intervention in psychopharmacology education within the context of child and adolescent psychiatry through both attitudinal data and achievement measures. Given the limited number of studies examining storytelling in child mental health education, the findings suggest that story-based instruction may positively influence students’ attitudes and may contribute to the learning process by addressing both cognitive and affective dimensions. Consistent with the existing literature, storytelling may represent a potentially useful pedagogical tool, particularly for teaching complex and abstract content. In conclusion, storytelling appears to be a promising complementary educational approach for teaching psychopharmacological concepts in medical education. The findings of the present study suggest that story-based instruction may enhance short-term knowledge acquisition and is generally well accepted by students. However, given the single-center and short-term nature of the study, the findings should be interpreted with caution. Replication in larger and more diverse samples, across different educational settings, and with long-term follow-up assessments is needed to better understand its educational impact and broader applicability.

Authors’ contributions

ÖAA developed the study concept, created the story-based educational materials, and wrote the manuscript. MÇB performed the statistical analyses. All authors reviewed and approved the final manuscript.

Funding

This research received no external funding.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request and subject to ethical considerations.

Declarations

Ethics approval and consent to participate

Approval was received from the Non-Interventional Clinical Research Ethics Committee of Zonguldak Bülent Ecevit University, and the study was conducted in accordance with the Declaration of Helsinki (Approval No: 2025/15; Date:03.09.2025). Informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.