Cultural competence is one of the core capacities for conducting medical practice in cross-cultural settings.The cross-cultural perspective in narrative medicine serves as an important catalyst for the cultivation of such competence among healthcare professionals.Although cross-cultural narratives in healthcare are common,relevant research remains insufficient.Taking the narratives by Chinese medical teams in Africa as a case,this study examines their characteristics and value as a form of narrative medicine in the cross-cultural sense. Representative narratives by Chinese medical teams in Africa vividly depict their lived experience,reconstruct the professional scenes of practicing medicine in a foreign context,and highlight the long-standing,robust trust between Chinese and African peoples.Narrative humility is central to how narrative medicine enhances cultural competence.Narratives by Chinese medical teams in Africa demonstrate the potential of narrative medicine in fostering cultural competence.

Objective To examine how artificial intelligence (AI) tools affect the Attention-Representation-Affiliation framework of narrative medicine in rare disease care,with particular attention to changes in narrative and interpretive authority among patients,clinicians,patient organizations,and platforms.Methods An exploratory case study was conducted with the patient organization FDS (pseudonym) and its AI tool development practice as the case context.Eight key informants occupying different experiential positions were interviewed.The interviews were considered alongside 12 months of online observation and an analysis of publicly described functions of narrative-oriented AI tools.Thematic analysis was the primary method,supplemented by within-role analysis and cross-role comparison informed by the framework method.Results The materials suggest that AI may support information organization and patient expression,while its contribution is conditional.In Attention,AI may reduce documentation burdens,while clinicians remain responsible for questioning,examination,and verification.In Representation,AI may help patients organize their experiences,while predefined fields,prompts,and filtering rules may reshape what can be expressed.In Affiliation,digital platforms may strengthen informational and emotional connections among patients,whereas the present evidence does not show that they can replace trust grounded in clinical responsibility,empathy,and embodied presence.Conclusions The integration of AI and narrative medicine should be treated as an empirical proposition requiring continued examination.Narrative-oriented AI should remain assistive and should preserve original expression,enable patient review and revision,and specify responsibilities for human verification,interpretation,and clinical decisions,so that efficiency-driven approaches do not displace narrative practice itself.

Narrative medicine advocates a clinical practice model centered on narrative competence. However,how narrative competence translates into observable and trainable behaviors in clinical interactions still lacks detailed micro-level explanation.This paper takes illness metaphors,such as pain metaphors,as the breakthrough point,and proposes “clinical metaphor co-construction competence.” This competence is defined as the clinician’s ability to recognize and understand patients’ metaphorical expressions during clinical interactions. Through taking up,probing,negotiating,and generating metaphors,the clinician and patient jointly organize illness experience and form shared understanding.This understanding is then connected to clinical explanation and action.The paper draws on conceptual metaphor theory and conceptual integration theory to explain how this competence works.It conceptualizes the operation of clinical metaphor co-construction competence as three mutually embedded dimensions:decoding,transcoding,and encoding,thereby clarifying how the construct relates to attention,representation,and affiliation in narrative medicine.In this way,clinical metaphor co-construction competence provides identifiable,verifiable,and revisable interactional evidence for empathic understanding.Furthermore,it establishes an assessable and trainable operational path for the cognitive-linguistic dimension of narrative competence.

The emergence of narrative medicine offers new possibilities for the research of bioethics.This paper proposes the concept of “life narrative ethics” and uses the three life attributes—natural life,spiritual life,and social life—as an analytical framework to reveal the ethical demands of life narratives in the finiteness of the physical body,the rupture of self-identity,and the transformation of social roles.On this basis,this paper distills four core principles:centering on life stories,reciprocal narrative relationships,interpretive humility,and dignity integration.These principles respectively establish the epistemological basis,value goals,attitude requirements,and practical approaches for ethical judgment.The applicability and explanatory power of these principles are analyzed through a case of a patient’s death.This paper argues that life narrative ethics represents a progression from relational ethics to substantive value ethics,providing new theoretical tools and practical guidelines for medical practitioners to understand the patients’ holistic lives and respond to their profound ethical demands.

Digital health has improved the efficiency of information processing while also changing how patients’ illness narratives enter healthcare systems.Patient narrative flattening refers to the excessive compression of patient narratives during digital processing,whereby temporal trajectories,life contexts,value preferences,and other dimensions of illness experience are diminished.It is mainly manifested in the compression of narrative content during expression,the fragmentation of information in clinical documentation,and the fixation of information in subsequent use.Such flattening may constrain clinical understanding,affect clinical decision-making and patient-clinician interaction,and allow governance risks to accumulate when these data are further used in research,evaluation,and algorithmic applications.In the digital era,narrative medicine should attend to the loss of patient narratives in digital transformation and preserve their significance for clinical understanding and healthcare practice.

Ethical dilemmas in real-world medical settings expose the limitations of bioethics,represented by the “four-principle framework” in dynamic and personalized clinical decision-making.The development of narrative medicine provides more space for showcasing the unique context of life,alleviating the predicament of normative ethics.However,current ethical practices in narrative medicine have not responded to the theoretical problem of the lack of ontology,moral subject,and reflective process in principlism,calling for the further exploration of the moral issues inherent in the narrative process and outcomes.This paper,based on the ontology of life narrative,proposes a new understanding of narrative bioethics in healthcare.Through comparative analysis of an ethical case involving living organ transplantation,this paper demonstrates the necessity and challenges of shifting ethical decision-making from reflective equilibrium to narrative co-construction.

Objective To analyze the disease burden and trends of non-alcoholic steatohepatitis-associated hepatocellular carcinoma (NASH-HCC) in China,the globe,and regions with varying socio-demographic indices (SDI) from 1990 to 2021,thus providing theoretical support for the prevention and control of NASH-HCC. Methods Using the Global Burden of Disease Study 2021 database,we assessed the age-standardized incidence rate,prevalence rate,mortality rate,disability-adjusted life years (DALYs),and other disease burden metrics for NASH-HCC,along with their trends.Decomposition analysis and frontier analysis were performed to evaluate influencing factors and regional disparities. Results From 1990 to 2021,the age-standardized incidence rate of NASH-HCC in the globe increased from 0.36 per 100 000 to 0.49 per 100 000,while that in China rose from 0.48 per 100 000 to 0.54 per 100 000.All burden indicators in China showed lower growth rates than the global average.The burden increased most significantly in high-SDI regions and decreased in low-SDI regions.Decomposition analysis revealed that population aging was the primary driver of burden changes in China,while epidemiological shifts were the main factor contributing to global prevalence changes.Frontier analysis indicated that China ranked in the middle globally in terms of the effective gap between its age-standardized mortality rate,age-standardized DALY rate,and the theoretically optimal prevention and control level. Conclusions The global disease burden of NASH-HCC keeps rising,with the most significant increase occurring in high-SDI regions.There are substantial disparities in prevention and control capabilities across regions with different SDI.Comprehensive public health policies,targeted interventions,and effective treatment strategies must be developed to further enhance prevention and control efficacy.

Narrative nursing is an important practical model for the implementation of humanistic nursing.This article reviews the origin and development of narrative nursing as well as its core concepts and theoretical connotations,and then elaborates on the conceptual definition and current development status of narrative nursing in traditional Chinese medicine (TCM).It summarizes the clinical applications of narrative nursing in the fields of disease management,health education,nurse-patient relationships,and nursing education,analyzes the existing problems in current practice,and makes an outlook on the future development trends.The aim is to provide a reference for the standardized and localized practice of TCM-featured narrative nursing and to contribute to the construction of a humanistic system and high-quality development of TCM nursing.

Objective To systematically review the conceptual evolution and research focus of narrative competence among healthcare professionals and to reveal the differences and complementary relationships between Chinese and English articles.Methods CiteSpace-based knowledge mapping was conducted on the articles related to narrative competence published between 2001 and 2025,including 103 articles from four major English databases (PubMed,Web of Science Core Collection,APA PsycINFO,and CINAHL) and 186 articles from three major Chinese databases (CNKI,Wanfang Data,and VIP).Keyword co-occurrence analysis was performed to identify research hotspots,and cluster analysis to reveal differences in research orientations between English and Chinese articles.Keyword bursts were detected to track the temporal trajectory of conceptual evolution.Results The concept of narrative competence shows a trend of evolving from abstract humanistic ideas to concrete clinical competencies.English articles focus more on theoretical construction and humanistic connotations,while Chinese articles emphasize application and operability,translating narrative competence into measurable core abilities. Conclusions The development of narrative competence follows a trajectory of “meta-concept—dimensionalization—operationalization framework”.English and Chinese articles represent two complementary pathways:theoretical deepening and practical transformation.Future efforts should promote the standardization and localized integration of the conceptual framework,assessment tools,and training systems for narrative competence.

Objective To address the insufficient educational-context explanation in postgraduate stress research and the limitation of standardized scales in capturing process-based difficulties in research training,this study constructs “parallel thesis” as a narrative tool for postgraduate education based on the text-generating logic of “parallel chart” in narrative medicine,and examines its value in identifying stressors among medical postgraduates.Methods Seventeen postgraduates from Jiangxi University of Chinese Medicine completed parallel thesis writing after a narrative workshop.Their texts were analyzed through constructivist grounded theory,including open,axial,and selective coding,followed by theoretical saturation testing.Results Twelve initial categories and five main categories were identified and further integrated into three core stressors:institutional,executive,and endogenous pressures.Institutional pressure involved graduation requirements,evaluation mechanisms,and career competition;executive pressure concerned research progress,supervisor interaction,and insufficient support;endogenous pressure involved goal ambiguity,self-doubt,and identity crisis.Conclusions Parallel thesis is not a simple conceptual transplantation from parallel chart,but a reconstructed narrative tool that transforms experience-oriented narrative medicine into data generation,stress identification,and support feedback in postgraduate education.It may supplement scale-based assessment and provide a replicable route for medical education reform and postgraduate support system building.

With the continuous advancement of medical imaging technologies,deep learning-based semantic segmentation has emerged as a key methodology in medical image analysis,achieving substantial progress in recent years.In particular,these techniques have demonstrated remarkable effectiveness in the automated identification and segmentation of lumbar spine-related diseases.This review provides a comprehensive overview of widely used deep learning-based semantic segmentation methods and systematically summarizes their recent applications in intervertebral disc segmentation,detection and classification of lumbar degenerative disorders,and quantitative analysis of lumbar intervertebral discs.Furthermore,the major challenges associated with current approaches in clinical and practical settings are discussed,and potential directions for future research and methodological improvements are highlighted.

Through literature review and analysis of clinical practice cases,this paper proposes that narrative dialogue refers to the conscious expression and communication between physicians and patients,with a clear narrative orientation within specific clinical contexts.Its core lies in externalizing patients’ implicit,unspoken suffering and establishing empathic connections.Narrative dialogue comprises four constituent elements—context,subject,orientation,and connection—and manifests distinct objectives and characteristics at three levels:value,narrative essence,and practice.This article synthesizes the general core principles and practical steps of narrative dialogue and argues that narrative dialogue constitutes a recognizable,analyzable,and teachable core component in the clinical practice of narrative medicine.It bridges narrative medicine theory with clinical practice and provides a new breakthrough point for the systematic construction of narrative medicine education and clinical paths.

Current medical education faces an imbalance between technical rationality and humanistic spirit,with medical students’ empathy declining as their training progresses.Narrative medicine offers a new path for reform.This paper systematically elaborates on the talent cultivation pathway of “five-dimension education integration and innovation” constructed by Sun Yat-sen University since 2017 under the guiding principle of five-dimension education (moral,intellectual,physical,aesthetic,and labor education) based on narrative medicine.This study innovatively proposes a teaching framework of “one body and two wings” and extends GUO Liping’s “little red flower” model to construct a “five-dimension education-little red flower” interdisciplinary collaborative teaching model,which takes the narrative medicine course cluster as the “body” and clinical practice and humanistic experience as the two “wings,” achieving deep integration of the five dimensions of education.At the practical level,a three-stage progressive closed loop of “sprouting-deepening-transformation” has been established,with a four-step teaching method of “demonstration analysis-collaborative writing-independent writing-reflection internalization” formed at the transformation stage,along with a “1∶1 interdisciplinary collaboration” general education course for all first-year students.Teaching evaluations show that the curriculum effectively enhances medical students’ empathy and communication initiative,with non-medical students benefiting particularly significantly.This practical model validates and extends the application boundaries of localized narrative medicine theory,realizing a conceptual leap from cultivating “technical executors” to nurturing future caregivers” and providing a practical model and operational experience for reference in the reform of medical humanities education in the context of emerging medical education in China.

It has been 15 years since the introduction of narrative medicine into China.The growing of medical humanistic demand,the gradual improvement of industry recognition,and the continuous support of relevant national policies have provided good opportunities for the development of narrative medicine.The current development of narrative medicine faces both opportunities and challenges.The continuous accumulation of favorable conditions provides strong support for the standardized promotion of narrative medicine,while there are still obvious shortcomings,mainly manifested in the weak foundation of the discipline and the unclear path of practice and research.Although the exploration of localization has begun to bear fruit,the overall development still needs to be deepened.China has an improving environment and outstanding potential for the development of narrative medicine.At the same time,it faces many problems such as discipline construction,practical research,and localization deepening,presenting a pattern characterized by coexistence of opportunities and challenges.

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.

目的 了解“健康中国”战略背景下肿瘤学专业型硕士研究生人文素养的现状与培养需求,探索符合肿瘤专科特色的人文素养培养路径。方法 采用便利抽样法,于2024年12月选取中南大学湘雅医院、湘雅二医院、湘雅三医院、湖南省肿瘤医院、中山大学肿瘤防治中心的放射肿瘤学专业型硕士研究生52人进行问卷调查。问卷涵盖人文素养认知、肿瘤防治政策知晓度、医德观念、沟通技能需求4个维度。结果 52名学生中,49人(94.2%)认为需要接受系统的医学人文教育,仅4人(7.6%)认为所在学校非常重视该教育,7人(13.4%)认为人文资源完全满足需求。学生对“健康中国”癌症防治目标知晓率仅为38.5%。医德观念总体积极,但82.7%的学生认为最需提升沟通交流能力,78.8%认为需加强法律法规知识。结论 肿瘤学专业型硕士研究生人文素养培养存在“认知高、供给低、实践弱”的矛盾,亟待从课程体系、临床实践、评价机制三方面进行系统化改革,构建与肿瘤专科深度融合、贯穿培养全程的人文教育新模式。

Objective To identify the core demands of three key stakeholder groups—oncology patients,family caregivers,and healthcare professionals—regarding family meetings in oncology wards based on the tripartite framework of stakeholder theory (ST),family systems theory (FST),and timing it right framework (TIR) and delineate the role positioning and functional transition of oncology ward head nurses,thus providing empirical evidence for developing a head nurse-led multidisciplinary team (MDT) family meeting model. Methods A descriptive qualitative study was conducted.Semi-structured interviews were performed with 31 participants recruited from Peking Cancer Hospital,and the Colaizzi's seven-step method was adopted to extract and refine themes. Results A total of 12 core needs were summarized,including 4 from patients,5 from family caregivers,and 3 from healthcare professionals.Meanwhile,five functional requirements of head nurses were concluded in terms of role reshaping,full-process closed-loop management,and competency development. Conclusions Family meetings in oncology wards need to balance the diverse needs of all stakeholders.Head nurses have evolved from performers into meeting leaders,and their pivotal role is the key to the regular operation of such meetings.