The following steps should be taken into consideration when planning a Narrative Learning experience on AMR/AMS:

1. Define AMR/AMS Learning Objectives and Narrative Focus: Clearly identify the specific AMR/AMS themes, learning objectives, or desired attitudinal shifts that the narrative approach will address (e.g., understanding the patient experience with an MDRO, highlighting the importance of prudent antibiotic prescribing, illustrating successful IPC measures, communicating AMR risks to the public). (Nori et al., 2019, used real-world patient stories to engage medical students with AS and AMR).
2. Source or Develop Compelling AMR/AMS Narratives:
   • Real-world patient/professional stories: Collect and ethically share (with consent and anonymization) authentic stories from patients affected by AMR, healthcare professionals grappling with stewardship dilemmas, farmers who have successfully reduced AMU, or public health officials managing outbreaks. (Nori et al., 2019, used patient stories; Bell and Wozniak, 2024, advocate for showing lived experiences of AMR through digital stories).
   • Fictional or Composite Narratives: Develop well-crafted fictional stories or composite case studies based on real events that effectively illustrate key AMR/AMS principles or challenges.
   • Participant-Generated Stories: Create opportunities for learners themselves to construct and share their own AMR/AMS-related narratives or reflections.
   • Digital Storytelling: Utilize digital tools to create short videos or multimedia presentations that combine images, voice-over, and text to tell impactful AMR stories. (McCall et al., 2023; Bell & Wozniak, 2024).
3. Create a Safe and Conducive Environment for Sharing and Listening: Especially when dealing with personal or sensitive AMR experiences, establish a psychologically safe, respectful, and non-judgmental environment that encourages open sharing and empathetic listening. Define ground rules for confidentiality and constructive dialogue.
4. Select Appropriate Storytelling Format and Delivery Method: Choose the format based on the audience, objectives, and resources: oral storytelling by a skilled narrator or expert, facilitated anecdote circles, reading of written narratives, screening of video/digital stories, or interactive storytelling sessions.
5. Facilitate Structured Reflection and Meaning-Making: After stories are shared, a skilled facilitator must guide participants in structured reflection and discussion. This involves prompting learners to identify key messages, explore emotional responses, connect the narrative to their own experiences or professional roles, analyze underlying AMR/AMS issues, and consider implications for future actions or practice changes. (Cole, 2009, notes storytelling stimulates thought and reflection).
6. Anecdote Circles: For this specific technique, pose a clear, focused question related to an AMR/AMS experience (e.g., “Share a brief instance where you felt challenged by an antibiotic request,” or “Describe a small change you made that improved infection control”). Participants take turns sharing very brief anecdotes, followed by group reflection on emerging themes.

Facilitator’s role: Select or guide the development of appropriate and impactful AMR/AMS narratives. Create and maintain a safe and respectful sharing environment. If telling stories, do so engagingly and effectively. Skillfully facilitate post-narrative reflection and discussion, helping participants to deconstruct the story, extract key learnings, make personal connections, and consider application to their AMR/AMS responsibilities. Ensure discussions remain constructive and focused on learning objectives.

Participant’s role: Listen actively, attentively, and empathetically to the stories shared. If sharing their own narratives, do so honestly and respectfully within the established safe space. Engage thoughtfully in reflective discussions, offering interpretations, connecting with the experiences of others, and considering how the narratives and ensuing discussions impact their understanding, attitudes, and potential actions regarding AMR/AMS.

Methods

• Qualitative Analysis of Reflections: Assessment of written or oral reflections, journal entries, or discussion forum contributions for depth of understanding, evidence of critical thinking, emotional engagement, empathy development, and connection of narrative themes to AMR/AMS principles and personal/professional practice.
• Changes in Attitudes and Beliefs: Pre- and post-narrative session surveys or questionnaires to measure shifts in attitudes towards AMR, antibiotic use, IPC, or empathy towards those affected by resistant infections.
• Observation of Discussions: Facilitator observation of the quality of group discussions, the level of engagement, and the types of insights shared by participants.
• Participant-Generated Narratives: Evaluation of stories or case studies created by learners as an output of the learning experience, assessing their understanding and ability to communicate AMR/AMS concepts narratively.
• Feedback on the Narrative Experience: Collecting participant feedback on the impact of the stories, the effectiveness of the facilitation, and the overall value of the Narrative Learning approach. (Ahmed et al., 2020, evaluated educational theatre for AMR, a form of narrative, using pre/post questionnaires and audience feedback).

Tools

Structured reflection prompts or worksheets. Rubrics for assessing reflective writing or presentations. Validated scales for measuring empathy or specific attitudes related to AMR/AMS. Pre-post knowledge and attitude questionnaires. Qualitative data analysis software for analyzing discussion transcripts or written reflections. Feedback forms specifically designed for narrative-based sessions.