Evolution of Assessment Methods in Narrative Medicine Education:A Historical Overview (2001-2026)

Assessment is a critical link in the transition of narrative medicine education from concept to institutionalized curriculum,yet its methods have long faced challenges such as insufficient standardization,poor cross-institutional comparability,and a lack of long-term outcome tracking,while few studies have traced how this situation arose.Focusing on assessment in the educational measurement sense-the measurement of learners' outcomes,as distinct from the evaluation of programs as a whole-and adopting an abductive approach that infers epistemological foundations from actual assessment practices,this article divides the evolution of assessment methods in narrative medicine education since 2001 into three stages according to their epistemological foundations and methodological features.The first stage (2001-2008),grounded in phenomenology and constructivism,was dominated by qualitative text analysis such as reflective writing,emphasizing lived experience and reflection but lacking standardized,generalizable instruments.The second stage (2009-2016),responding to the evidence-based medicine paradigm and seeking disciplinary legitimacy,widely borrowed generic instruments such as the Jefferson Scale of Physician Empathy and the Maslach Burnout Inventory and made initial attempts at mixed methods,thereby exposing an epistemological conflict between positivism and interpretivism.The third stage (2017-present) has shifted toward developing specialized instruments for assessing narrative competence,reflecting a pragmatist integration of quantitative and qualitative approaches,though its maturation remains constrained by weak measurement standardization and the absence of long-term behavioral and clinical outcome assessment.This study suggests that the evolution of assessment methods in narrative medicine education is essentially an ongoing dialogue between humanistic and positivist epistemological traditions,through which the field continually clarifies its assessment aims and defines its disciplinary identity.