The influence of narrative medicine on medical students' readiness for holistic care practice: A realist synthesis.

Background: The increasing focus on technical skills and efficiency in medical education often overshadows humanistic aspects, creating gaps in preparing clinicians for holistic patient care. Narrative Medicine, integrating storytelling and reflective practices, offers a promising approach to addressing these challenges.

Objective: This study explores how Narrative Medicine interventions influence medical students' readiness for holistic care by examining the mechanisms, contexts and outcomes that underpin its effectiveness.

Methods: A realist synthesis was conducted following Pawson's five-stage methodology with a two-phase search strategy across four databases and grey literature. Phase 1 (2008-2018) yielded 10 studies; Phase 2 (2018-2025) added 3, totalling 13. Studies were included if they focused on Narrative Medicine interventions, involved medical students and examined holistic care outcomes. Studies were assessed for credibility, theoretical depth and trustworthiness. Context-Mechanism-Outcome (CMO) configurations were iteratively synthesised using ATLAS.ti, ensuring rigour and consistency in accordance with RAMESES standards.

Results: A total of 13 studies, predominantly from U.S. medical schools and hospitals and one from the Netherlands, involving 1158 participants, were analysed. Nine CMO configurations were identified across three contexts: Storytelling Activities, Storytelling Skills and Engaging with Stories. These contexts activated mechanisms such as Deep Observation, Reflection, and Peer Learning, which contributed to outcomes including Enhanced Holistic Patient Connection, Improved Patient Care and Enhanced Self-Perspective. Notably, Peer Learning showed a weaker linkage to these outcomes, reflecting variability in the effectiveness of Narrative Medicine interventions. Emotional resistance, including avoidance and disengagement, highlighted challenges in implementing Narrative Medicine effectively.

Conclusion: Narrative Medicine enhances relational competence, empathy and reflective practice, aligning with the principles of holistic care. Addressing barriers such as emotional discomfort and variability in outcomes requires adaptable formats and supportive environments. This study underscores Narrative Medicine's transformative potential in medical education and offers actionable insights for its integration into diverse learning contexts.