# Development and Validation of Narrative Competence Scale for Medical Students

## TL;DR

This paper introduces a validated scale to assess medical students' ability to understand and reflect on patient stories, which is important for improving patient-centered care.

## Contribution

The study presents a new, validated tool for measuring narrative competence in medical students using a four-dimensional framework.

## Key findings

- The NCS-MS showed strong internal consistency with Cronbach’s α ranging from 0.797 to 0.942.
- Confirmatory factor analysis confirmed a good fit for the four-factor model of narrative competence.

## Abstract

Narrative competence in medicine enabled physicians to listen to patients’ illness experiences, construct their narratives, and enhance reflective practice, empathy, humanistic literacy, and person-centered care. However, systematic research and clear definitions for measurable indicators of narrative competence assessment were lacking. This study aimed to develop and validate a narrative competence scale for medical students.

A 57-item draft scale was developed, and categorized into four dimensions and eleven sub-dimensions after interdisciplinary literature review. Three rounds of the Delphi method were conducted with eleven experts specializing in narrative medicine. Pilot testing involved 200 fifth- and sixth-year medical students in Taiwan (136 males, 64 females). Confirmatory factor analysis CFA) and Cronbach’s α were used to evaluate the NCS-MS’s reliability and validity.

The NCS-MS was refined through three rounds of the Delphi method, focusing on item revisions and sub-dimension definitions. The results of CFA indicated a good fit for the four-factor model (RMSEA = 0.055, SRMR = 0.045, GFI = 0.911, NFI = 0.926, IFI = 0.971, CFI = 0.970). The Cronbach’s α coefficients for the four dimensions ranged from 0.797 to 0.942, with an overall α of 0.972, demonstrating excellent internal consistency reliability.

The NCS-MS effectively evaluated the narrative competence of medical students. From the perspective of narrative medicine, the NCS-MS served as a research or teaching assessment tool for assessing medical students’ narrative competence in narrative medicine research, instructional design, and implementation.