Narrative research approaches provide the opportunity for constructing a detailed understanding of lived experiences relevant to medical education, in areas such as illness narratives, explorations of doctor-patient relationships, and the development of professional identities in students and educators. The benefits of the depth of data gathered in narrative research are, however, counterbalanced by possible weaknesses relating to a focus on individual cases and the risk of identification of participants where subjects are sensitive or unique. To address these concerns, researchers from a variety of social science disciplines, carrying out research employing a range of methodological approaches, have begun to use ‘composite narratives’ in which the commonalities in the experiences of research participants are combined to create joint narrative or narratives which illustrate participants’ shared experiences. Composite narratives have been used both as a component of the methodological approach and as a method of presenting the results of research in a variety of methodologies. This A Qualitative Space paper explores the role, strengths, and weaknesses of narrative research, before outlining the ways in which composite narrative has been defined within existing research. Distinctions between the various approaches to creating composite narratives are discussed, highlighting the differences in the types of data utilised, and the approaches taken to data analysis and presentation. A key distinction is identified between the use of composite narratives as part of an integrated methodology and as an approach to the presentation of data. Finally, issues relating to trustworthiness, reflexivity, and implications for researchers are considered.
Although well-established worldwide as a method of clinical medical education, Longitudinal Integrated Clerkships (LICs) are green shoots in the UK medical education landscape. The first comprehensive LIC in the UK was introduced in Dundee, Scotland in 2016. Substantial work has been carried out to evaluate the experiences of students and primary care tutors involved in the Dundee LIC, but the experiences of the patients LIC students cared for had not been evaluated. The purpose of this study was to explore the experiences of these patients, particularly the impact the involvement of a LIC student might have on their experience of healthcare. The study is a crosssectional qualitative study involving semi-structured interviews with five patients who had experienced several contacts with LIC students. An interpretive phenomenological approach was taken. We describe the presence of the student as a disruptive force leading to the empowerment of patients. Students disrupted the status quo in the consultation by altering both the structure of the interaction and the doctor-patient relationship. The student-patient relationship was a powerful enabler of patient empowerment through the provision of education and information to the patient and through increasing patient centredness in the consultation. The positive social interaction provided by the student-patient relationship led to a reframing of patients' perceptions of the medical profession, challenging their perceptions of occupational hierarchy and power of the medical profession.
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