From "Customary Morality" to "Reflective Morality": a physician's personalized competence development facilitated by narrative medicine.
5 affiliations
- 1School of Education, South China Normal University, Guangzhou, China.
- 2School of Medicine, Jinan University, Guangzhou, China.
- 3Faculty of Humanities and Arts, Macau University of Science and Technology, Macau, China.
- 4Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- 5Department of Joint Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Abstract
Background
Contemporary medicine faces ethical complexity arising from biotechnological advances, the growth of patients' needs, and the occurrence of cross-cultural value conflicts. These challenges expose the limits of customary morality, an unreflective and habit-driven moral framework prevalent in traditional medical training. This situation demands a more dynamic, context-sensitive, and humanistic form of moral commitment from physicians, while also requiring the development of professional competence. Narrative medicine provides a potential solution to this problem, yet its theoretical foundation remains insufficiently articulated.Method
In this paper, we propose that John Dewey's moral growth model of "reflective morality" provides a coherent and generative foundation for narrative medicine and links this process to competence development within competency-based medical education (CBME).Results
The core tools of narrative medicine, close reading and reflective writing, are grounded in Dewey's moral development model, which encompasses habit, impulse, and deliberative intelligence. Reflection on habitual behavior during narrative practice works as a corrective to clinical habits, affective responses are examined and integrated through affiliation and reflection, and contextual deliberative intelligence is cultivated through reflective practice. These practices facilitate physicians' moral development, enable them to develop moral perceptiveness, decision-making capabilities, and initiative, and help them progress from passive moral conformity to active ethical agency, thereby enacting the transition from Dewey's philosophical "customary morality" to "reflective morality". This framework further facilitates the cultivation of personalized competency, a dimension of professional competence essential to patient-centered care yet resistant to conventional training.Conclusion
This paper provides a Deweyan theoretical foundation for narrative medicine by interpreting its reflective practices through Dewey's distinction between customary and reflective morality. It proposes a habit-impulse-intelligence framework to explain the moral developmental mechanisms through which narrative medicine may influence physicians' professional formation, connecting this process to the cultivation of personalized competence.
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BibTeX
@article{bai2026from,
title = {{From "Customary Morality" to "Reflective Morality": a physician's personalized competence development facilitated by narrative medicine.}},
author = {Jian Bai and Nannan Shi and Jiayi Cheng and Yunyi Li and Guorong She and Fanqiang Zheng and Xin Cheng},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1956818},
url = {https://europepmc.org/article/MED/42908695},
note = {CC BY},
}
RIS
TY - JOUR
TI - From "Customary Morality" to "Reflective Morality": a physician's personalized competence development facilitated by narrative medicine.
AU - Jian Bai
AU - Nannan Shi
AU - Jiayi Cheng
AU - Yunyi Li
AU - Guorong She
AU - Fanqiang Zheng
AU - Xin Cheng
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1956818
UR - https://europepmc.org/article/MED/42908695
AB - Background Contemporary medicine faces ethical complexity arising from biotechnological advances, the growth of patients' needs, and the occurrence of cross-cultural value conflicts. These challenges expose the limits of customary morality, an unreflective and habit-driven moral framework prevalent in traditional medical training. This situation demands a more dynamic, context-sensitive, and humanistic form of moral commitment from physicians, while also requiring the development of professional competence. Narrative medicine provides a potential solution to this problem, yet its theoretical foundation remains insufficiently articulated.Method In this paper, we propose that John Dewey's moral growth model of "reflective morality" provides a coherent and generative foundation for narrative medicine and links this process to competence development within competency-based medical education (CBME).Results The core tools of narrative medicine, close reading and reflective writing, are grounded in Dewey's moral development model, which encompasses habit, impulse, and deliberative intelligence. Reflection on habitual behavior during narrative practice works as a corrective to clinical habits, affective responses are examined and integrated through affiliation and reflection, and contextual deliberative intelligence is cultivated through reflective practice. These practices facilitate physicians' moral development, enable them to develop moral perceptiveness, decision-making capabilities, and initiative, and help them progress from passive moral conformity to active ethical agency, thereby enacting the transition from Dewey's philosophical "customary morality" to "reflective morality". This framework further facilitates the cultivation of personalized competency, a dimension of professional competence essential to patient-centered care yet resistant to conventional training.Conclusion This paper provides a Deweyan theoretical foundation for narrative medicine by interpreting its reflective practices through Dewey's distinction between customary and reflective morality. It proposes a habit-impulse-intelligence framework to explain the moral developmental mechanisms through which narrative medicine may influence physicians' professional formation, connecting this process to the cultivation of personalized competence.
SN - 2296-858X
ER -