Learning about social suffering through illness narrative: possibilities and challenges

Area of Science:

• Medical Education
• Qualitative Research
• Social Determinants of Health

Background:

• Holistic healthcare emphasizes understanding social determinants of health.
• Empathy for patient suffering is a core competency for healthcare professionals.
• Narrative medicine education can enhance empathic responses, but its role in teaching "social suffering" is underexplored.

Purpose of the Study:

• To qualitatively analyze how medical students conceptualize patient suffering and engage with social dimensions of illness after a narrative medicine-based class.
• To explore the effectiveness of patient illness narratives in teaching the concept of social suffering.

Main Methods:

• Qualitative analysis of 40 second-year medical students' essays after a narrative medicine class.
• Students analyzed a patient transcript with hypertension, detailing illness experiences.
• Iterative coding (inductive and deductive) identified patterns in conceptualizing suffering and social dimensions.

Main Results:

• Three themes emerged: categorical framings of suffering, recognition of narrative complexity, and limited engagement with structural social suffering.
• Students identified physical and psychological suffering but showed surface-level engagement with social dimensions.
• Challenges were observed in moving beyond individualistic frameworks to recognize social, cultural, and institutional factors shaping illness in Korean society.

Conclusions:

• Narrative medicine fostered recognition of suffering's complexity and empathy.
• Limited student engagement with social suffering indicates a need for curricular enhancements.
• A spiral curriculum is proposed to deepen understanding of social determinants of health, integrate qualitative research, and address sociocultural contexts for better clinical practice.