The narrative has the function of reshaping, representing, and structuring the human language in a text. It is composed and filled with experiences, values, ways of inhabiting, seeing and thinking the world. Once the human experiences and actions are in the narrative, its reading and interpretation can explore the social, economic and cultural conditions [8, 21]. In this study, narratives were used to stimulate students’ reflection, to access their perception of humanization, and to allow them to recognize their values and expectations, as well as relevant experiences lived by the students before entering the medical graduation.
The interpretation of the text also allows researchers to evaluate students’ ability to organize their actions and experiences in the narrative, expressing the signs, rules, and norms that give direction to their lives [8, 21]. Thus, the fragments of lived stories constructed the narratives of the students, the interaction with other people in circumstances of illness or good health, and the consequent happy or unhappy feelings which facilitated their reflection about humanization and the construction of their narratives.
The use of narratives in medical training was described as a strategy to develop critical thinking and to discuss several aspects of practice lived or observed by the students [10, 11, 14, 17, 22]. It is a stimulus to reflection about the practice in medical training, and an opportunity to apply the reflection pedagogy of Paulo Freire, a constructivist method based on a sequence of action-reflection-action. It means that after the learner has experiences the teacher gives him or her the opportunity to think about those experiences and to resignify. The next step is for the student to return to the practice and try to find a way to do better [23] .
Other learning objectives related to the use of narratives were to develop communication skills, empathy, and professionalism, and to access the student's feelings in case the patient died [15, 24]. The student's narratives were also used to evaluate the program and the hidden curriculum, and for the teacher to better get to know the students [22]. Authors affirmed that the use of narratives in medical training helps students to consider the humanistic dimension of their patients and access their own emotions [10, 25, 26].
Many aspects of the contemporary world were present in the student's narratives, with the sense of humanization based on the idea of transforming the environment and the society in which they live as observed in their answers to some of the contemporary ills, such as crises involving the healthcare field and extreme social inequalities. The latter is of particular importance especially for developing countries such as Brazil. For these students, the possibility of transforming their lives and society was one of the reasons to choose a medical career as their colleagues said in the previous study [27].
The narratives of this study demonstrated that students establish relationships between humanization and sensitivity toward the cultural aspects of each patient. The students said it is necessary to listen to patients, to know about their history, culture, habits, and to be willing to help them not only in a clinical setting but with hospitalization and when treating them with prescriptions. They also showed humanistic values when they attributed importance in healthcare to human relationships and commitment to human happiness.
The effects of technical-scientific advances can be clearly seen in modern medicine when, at times, it separates physical, psychological, social and cultural aspects. Some authors affirm that physicians and medical students give more importance to scientific rationality than to the social, cultural, and psychological dimensions to understanding the patient and his or her disease [28]. Kumagai (2014) emphasizes the humanist aspect of the medical profession. The construction of a humanized relationship between healthcare professionals and patients requires ethical behavior, dialogue, and feedback. In this context, it is possible to fuse their horizons as each human being involved is considered, valued, and potentiated.
This group of students demonstrated an understanding of the social and cultural constructs present in the personal life of each human being, in this case, doctors and patients, and how they interfere with the relationship between them. Curiously, the respondents of this study were young people in the first week of medical school. Accordingly, we can affirm that they entered school with values inherent in their future profession, but the medical program will add complexity and sometimes cause these values to change [29–32].
The meaning of humanization for these students is related to the "doing" and the "how to do" in medical practice, including the ethical, cultural and professional dimensions. They also recognize that the technical and scientific knowledge is linked to the ethical behavior aimed at human development and commitment to the life and happiness of others.
The strengths of this study lie in the use of narratives with undergraduates to promote student reflection, to create a baseline about their concepts and values, to get to know the freshmen better, all the while helping us in the educational planning. Another strength is to bring about new perspectives of humanization to the medical education. Its weakness is the fact that the vision presented by the students is a snapshot of the moment and the social context at the time of data collection. The analysis and conclusions are valid for this universe of medical students, and generalization is not possible.