How could narrative medicine support healthcare professionals’ linguistic skills and sense of social belonging? Anna Ovaska, Sonja Sulkava, Viola Parente-Čapková and Riitta Jytilä share their experiences of developing a new narrative medicine reading group model in Finland.
Narrative medicine programs can today be found almost all over the world, but they are usually directed at first language speakers. As a result, not much attention has been paid to questions about language and culture in narrative medicine’s approach to healthcare. One of the main goals of narrative medicine is to enhance the narrative competencies of healthcare professionals – the ability to listen to, acknowledge and absorb the stories of patients (Charon et al. 2017). Likewise, there is growing evidence that this can help to create a more humanistic and patient-centered healthcare (Charon et al. 2017; Milota et al. 2019). But what is the role of language, linguistic awareness and linguistic and cultural belonging in narrative medicine?
Physicians from all over the world have, in the past 25 years, attended narrative medicine training at core English-speaking institutions, like Columbia University in New York. For them, narrative medicine (when practiced in English) has also often been a second or third language and a cultural learning experience, although this is rarely reflected on. Like elsewhere in medical humanities (see Wilson 2023), the field has been led either by English speakers or by L1 speakers. The latter is the case in countries like Germany, Italy, Denmark and Finland, where narrative medicine is taught in national languages (regarding the Finnish context, see Tynan, Ovaska and Slotte 2024).
At the same time, more and more healthcare professionals all over the world work in languages other than their first language. As social and healthcare systems are rapidly changing, and there is more work-based immigration, especially in Europe, a multilingual perspective on narrative medicine is urgently needed.
As Steven Wilson argues in his “Manifesto for a Multilingual Medical Humanities,” there is a need for linguistic hospitality that creates meaningful spaces of relationship and connection. He emphasizes the importance of attending to “those places and spaces – those border-crossings – where cultures and peoples meet, and where translational encounters give access to other outlooks” (Wilson 2023, n. p.). We suggest that narrative medicine groups, which emphasize not only narrative competence but also linguistic and cultural awareness, could be one such space.
In Finland, our project “Words for Care: Literature, Healthcare and Democracy” (Kone Foundation 2024–2026) offers narrative medicine training for social and healthcare professionals who speak Finnish as a first or as a second language. Reading literary fiction and creative writing has often been used in both medical education and in language learning, but as we were planning the project, we noticed that these perspectives have rarely been brought together. In order to take better account of the multilingual nature of the healthcare system in Finland, we are developing a reading group model that provides a novel way to learn Finnish language and culture for healthcare professionals who have immigrated to Finland as adults.
Our reading groups thus integrate perspectives from narrative medicine and cultural language learning. Both approaches emphasize close reading of fictional texts, along with discussions and creative/reflective writing exercises based on these texts. While narrative medicine focuses on enhancing participants’ narrative competence (Charon et al. 2017), cultural language learning uses literature and shared close reading to cultivate careful attention to language, its nuances, and the ways in which language and culture shape meaning-making (Jytilä and Kekki 2022; Westö 2022; Parente-Čapková 2023). The goal is to support linguistic skill development, as well as linguistic and cultural awareness – the ability to reflect on and think critically about language and its uses, and about the ways social and cultural structures shape thinking and perception.
The Finnish healthcare system, immigration and linguistic demands
In Finland, like in many other countries, there is a shortage of healthcare professionals, and work-based immigration of healthcare professionals is encouraged. However, requirements for physicians’ Finnish language proficiency, for example, are high. In addition to being fluent in medical terms, physicians must accurately understand what patients say, be able to discuss complex and/or sensitive topics and be aware of the specificities of the local culture.
To obtain a license to work in the Finnish healthcare system, physicians from outside the European Union and European Economic Area must prove their language proficiency, as well as their clinical skills and knowledge of the Finnish healthcare system. The three-phase examination also includes a practical exam, which involves treating real healthcare center patients. Completing the licensing process often takes several years, with an average duration of three years (Kiuru et al. 2021). Physicians who have graduated within the EU must also prove sufficient proficiency in the Finnish language.
Language training for doctors learning Finnish is scarce and project-funded. Especially scarce is language training for physicians who have already obtained the level of language proficiency required for the license to work. Courses combining cultural language learning and narrative medicine have the potential to offer these physicians a meaningful way to advance their language skills. We also believe that language and narrative competence can be learned together, and the reading group can become a shared learning experience and a meeting space for the different linguistic, cultural and professional perspectives of the participants (see also Jytilä and Kekki 2022; Westö 2022; Parente-Capkova 2023). A sense of linguistic belonging and being part of a community is also important for the wellbeing of healthcare professionals (see Pitkänen & Vaattovaara 2024). We suggest that a narrative medicine reading group can be a place for such community building, where it is possible to develop one’s linguistic and cultural skills without the pressures of the clinical environment.
Reading groups as a space for reflection and linguistic hospitality
During the courses, we read poems, short stories or novels together in Finnish, examine new words and phrases, write short creative texts and share them. The course readings are carefully selected to invite multiple approaches to questions of healthcare and to guide readers in paying attention to how language conveys subjective and cultural meanings, tones and emotions. The texts invite multiple interpretations and afford close attention to language and the way it is used. Facilitator-led discussions in the whole group alternate with peer discussions in small groups. Facilitators try to encourage participants of all language levels to engage in discussion and share their perspectives and interpretations of literary texts, as well as their own writings. The aim is to focus attention on both the linguistic and cultural aspects of the texts, as well as on the ways our interpretations are language-bound and culturally shaped.
In addition to being a creative way to learn the Finnish language and to get acquainted with the Finnish society, the reading groups offer an opportunity to be inspired by literature or shared experiences and discuss together with colleagues and literary scholars important topics such as suffering, the finiteness of life and embodiment, which tend to be neglected amid the busyness of daily tasks. Literature is also a space where language can be reflected on – and used in “strange” ways that differ from everyday uses, or that reveal something completely new about language, both for L1 and L2 speakers.
To understand what participants gain from the reading groups, we interview them, collect written reflections and feedback, and analyze their writing exercises. In addition to language proficiency, a good physician needs narrative competence, the ability to listen to patients’ stories. Working with fictional narratives in the group offers the possibility to practice these skills through experience, but without the pressures of clinical work and responsibilities for patients. We have aimed to keep the hierarchy in the groups as flat as possible, with emphasis on dialogue and on the fact that all participants are learners: both language and professional learning are understood as lifelong processes, in any and all languages one happens to speak (Jytilä and Kekki 2022; Parente-Čapková 2023). All participants (both “facilitators” and “students”) exchange views on language, literature, health, illness and society, and reflect on the interpretation of the text we read together.
When discussing the value of narrative medicine in healthcare, the focus is often on how reading and creative writing can improve patient encounters, listening skills and communication. This is of course important, but narrative medicine also has potential to support participants’ professional wellbeing, sense of connection to others and sense of community (see Sinha et al. 2024). These are particularly important for healthcare professionals who are adjusting to a new culture and language. Our hope is that a narrative medicine reading group that takes into account different linguistic and cultural perspectives, as well as forms of linguistic and cultural vulnerability (see e.g. Paananen et al. 2023), can become a space for linguistic hospitality and transboundary thinking that promotes the participants’ sense of agency and social and professional belonging.
About the authors
Anna Ovaska (literary scholar), Sonja Sulkava (physician), Viola Parente-Čapková (literary scholar and translator) and Riitta Jytilä (literary scholar) work on the project “Words for Care: Literature, Healthcare and Democracy” (Kone Foundation 2024–2026). The project brings together narrative scholars, physicians, psychologists, linguists and writers who speak Finnish both as a first and as a second language. Other members of the project are Laura Karttunen, Niina Kekki, Elina Renko, Carita Roivas, Alexandra Salmela and Jussi Valtonen. You can find out more about the project on our website: https://sites.utu.fi/sotete.
References
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