Exploring core competence in first-year medical students through narrative medicine and peer-assisted learning: a mixed-methods study

Abstract

Early development of core competencies is essential in medical education, yet traditional medical curricula often struggle to bridge the gap between biomedical knowledge and humanistic application. Drawing on social constructivism, this study examines an integrated Narrative Medicine (NM) and Peer-Assisted Learning (PAL) model designed to facilitate the transition from foundational knowledge to contextualized professional application. An explanatory sequential mixed-methods design was employed. A 19-indicator Knowledge-Skills-Attitude (KSA) scale was developed via a Delphi process and evaluated for preliminary psychometric properties. Following a 10-month intervention with 128 first-year students (Experimental n = 64; Control n = 64), hybrid thematic analysis of 14 in-depth interviews explored the underlying pedagogical mechanisms. The experimental group reported significantly higher self-reported core competency scores than the control group (77.42 ± 7.45 vs. 68.00 ± 7.31; p < 0.001; Cohen's d = 1.28). At the item level, critical thinking and empathy-driven awareness did not reach statistical significance. Qualitative findings suggested that participants perceived narrative features of the integrated package as a catalyst for meaning-making, while peer-assisted elements were viewed as providing social scaffolding necessary for skill development. This exploratory study provides preliminary evidence that the integrated NM-PAL model may support students' self-reported development of contextualized clinical competence and early professional identity. By providing a low-pressure collaborative environment, the model may support early reflective engagement that could be foundational to professional development, warranting further longitudinal and confirmatory research.