A response to 'How does faculty development innovation cross cultures?: Adapting narrative medicine to Asia'.

Dear Editor

We read with great interest the paper by Ho and Charon ([1]) on adapting narrative medicine for Asian contexts. As Asian medical students educated in the UK, we share unique perspectives on its limitations and provide suggestions for further development.

Lack of exposure to humanities is not the only factor limiting the integration of narrative medicine. In Asian culture, divulging our personal lives and being vulnerable is perceived as a sign of weakness and an unnecessary burden to others. This is an important but challenging factor to address in the cross-cultural context.

Furthermore, in fast-paced clinical environments, time pressure may be a barrier to applying the principles of narrative interviewing. In our experience, students also hesitate to do so as we second-guess the varying preferences of our educational supervisors on case presentations. Some prefer cogent and 'medical' histories, whilst others prefer a comprehensive history. Our default is thus 'short and sweet' so we do not waste our supervisor's time – another Asian mindset. These barriers are just some of many challenges in integrating narrative medicine into the Asian context, and time is needed to foster changes in mindset.

We would also like to explore the impact of the training program on other end-users like patients and medical students. Specifically, we would like to understand their perspective on narrative interviews and employ targeted, validated qualitative or quantitative tools such as Kirkpatrick Taxonomy to evaluate this (Smidt et al. [2]). Comprehensive analysis enables understanding of how narrative medicine translates to better outcomes for medical education and patient care. In addition, some questions remain unanswered – what percentage of patients were willing to divulge their concerns? How long did it take for them to be comfortable sharing their perspectives? How would this work in hospital environments where the patient has never met the clinician before?

In summary, we applaud the authors for paving the way in this promising and integral field of medicine. However, its implementation in the Asian context poses far more challenges than we'd hope and will take time to address. To achieve our end goal of seamless integration of narrative medicine in Asia, we need to first start by understanding the perspectives of both students and patients.

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.