Abstract
BACKGROUND: Global medical education frameworks (WFME, ACGME) stress integrating early clinical exposure (ECE) and humanistic cultivation, but traditional ECE (including some Chinese models) prioritizes procedural familiarity over empathy/doctor‒patient communication, failing the biopsychosocial model. Narrative medicine (NM) fosters empathy but is rarely integrated into undergraduate ECE. In alignment with 2022 China Undergraduate Medical Education Standards, this study tests an NM-integrated “Early Clinical Practice” course for clinical undergraduates. METHODS: The mixed-methods study included 600 clinical undergraduates from the 2023 Southern Medical University. A 32-hour mandatory course (8 h theory: career planning, healthcare systems, NM; 24 h practice: hospital visits, holiday practice) was implemented. The data were obtained from prescourse (520 valid) and postcourse (546 valid) surveys, clinical skill assessments, and 582 reflective reports and were analyzed via SPSS 26.0 and thematic analysis. RESULTS: Following the course, 84.25% participants reported an increase in professional enthusiasm, 82.23% had gained preliminary clinical reasoning. Additionally, 71.79% had enhanced humanistic awareness, and 69.23% had applied NM techniques.The mean score for clinical skills was notably high (empathy: 85.60 ± 5.98). Over 90% of the reflective reports noted career/humanistic gains. CONCLUSIONS: The NM-integrated course effectively boosts undergraduates’ professional identity, clinical reasoning, and humanistic literacy. Future optimization of NM practices and holiday arrangements is needed based on Kirkpatrick’s evaluation model. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-026-08885-6.