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3 Listening to Learn Narrative Strategies and Interpretive Practices in Clinical Education Melinda M. Swenson and Sharon L. Sims Introduction Clinical education in the health professions arises from a long tradition of lecture, demonstration, mentoring, apprenticeship, practice, memorization, repetition, and objective testing. The focus has been on content and the achievement of teacher-directed outcomes. This traditional model has worked well in the past, but is being challenged as the world of healthcare undergoes rapid and unpredictable change. No longer can the teacher lecture from last year’s notes or use the same written exam semester after semester. The classroom instructor cannot stay current without constant attention to and direct experiential contact with the clinical world. One of the problems with traditional, contentdriven education (in addition to the obvious one created when content exceeds the ability to keep up with it) is that it conflates content application with thinking. Indeed, any clinical curriculum driven by content alone is suspect by its very nature (Diekelmann & Diekelmann, 2000). This article describes the experience of students (and teachers) in an innovative master’s program in nursing, one that uses new pedagogies in a Narrative-Centered Curriculum (Swenson & Sims, 2000).1 Our pedagogies focus on seeking, hearing, responding to, reflecting on, and interpreting clinical and personal stories of students, patients, preceptors, and teachers. We discuss the results of teaching and learning using a variety of narrative approaches, including reading and writing clinical 154 Listening to Learn 155 stories and case studies, listening to stories from patients and clinicians, and discussing and reflecting on how clinical stories can enhance and transform clinical practice. These pedagogical strategies, employed in a site-specific advanced practice nursing program, could be adapted and modified to use in any clinical discipline. We blend traditional techniques (classroom discussion, written assignments, preceptored clinical practice) and unconventional approaches (narrative, interpretive, and reflective strategies). The combined pedagogies use narrative thinking to call forth reflective listening in students, teachers, and clinicians, and result in learning situated in experience. Educational and Philosophical Bases for the Curriculum Schön refers to formalistic, traditional thinking in clinical practice as technical rationalism (1983, p. 50). He contrasts this concept with knowing-in-action and reflection-in-action, which are more effective in the unique and uncertain contexts so common in clinical situations. Knowledge of content does not require any particular attention or reflection unless one is concerned with simply acquiring more content, or doing more complex tasks, or doing more things at once. Teachers and clinicians know that content knowledge is not enough, yet cling to traditional pedagogies privileging content and procedural knowledge because these strategies are familiar and comfortable. In this approach, we agree with Bateson (1994). Bateson approaches narrative not only as story, but as a powerful vehicle for vicarious experience and subsequent change. She writes: “Our species thinks in metaphors and learns through stories” (p. 11). Similarly, Coles (1990) proposes that viewing science as a series of narratives is revolutionary, and that stories are the origin of change in thinking and in skilled practices. Narratives are the connection between experience and interpretation. As teachers, we are concerned with the discrepancy between our commitment to empirically grounded clinical practice and our preference for qualitative research. Our conviction is that nursing, as both an art and a science, is a holistic and integrated discipline that should not be compartmentalized into “quantitative” and “qualitative” components. We also believe that nursing and other human science disciplines are interpretive in nature, especially at the advanced practice level, because we focus on individual people and their unique experiences. If we expect clinicians to be mindful listeners and thoughtful practitioners, then the 156 swenson and sims teaching and learning offered must also be interpretive in nature. The Narrative-Centered Curriculum2 enables teachers to “put their minds where their hearts are” in the realm of teaching and learning and to use pedagogical approaches reflecting both a scientific and a phenomenological and experiential3 view of the world of clinical practice. Bringing narratives into clinical education and practice may serve to improve the art of healthcare, while preserving critical aspects of empirical science. Another foundation for our educational approaches lies in interpretive and narrative pedagogy. Diekelmann (2001) developed her new pedagogies to meet rapidly changing needs in clinical nursing. Narrative Pedagogy is not a single teaching or curricular strategy, but rather an approach that creates an opening for all kinds of teaching and learning to co-occur in classroom and clinical arenas. Narrative Pedagogy is a way...

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