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Teo YH, Peh TY, Abdurrahman ABHM, Lee ASI, Chiam M, Fong W, Wijaya L, Krishna LKR. A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore. Singapore Med J 2024; 65:313-325. [PMID: 34823327 PMCID: PMC11232710 DOI: 10.11622/smedj.2021224] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore. METHODS A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used. RESULTS A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. CONCLUSION The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.
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Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Tan Ying Peh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Assisi Hospice, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, United Kingdom
- Centre of Biomedical Ethics, National University of Singapore, Singapore
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Xue M, Sun H, Xue J, Zhou J, Qu J, Ji S, Bu Y, Liu Y. Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial. BMC MEDICAL EDUCATION 2023; 23:38. [PMID: 36653810 PMCID: PMC9850682 DOI: 10.1186/s12909-023-04026-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/12/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Narrative medicine has become a solution to cultivate medical students' ability of empathy and humanistic care. However, the role of narrative medicine is lacking in the study of professionalism. The aim of this study was to analyze the effects of narrative medical theory learning and narrative writing on professionalism, empathy and humanistic care ability of nursing students. METHODS This cluster randomized controlled trial was conducted between June 2021 and June 2022 in two universities in Jiangsu, China. The participants of this study were 85 nursing students who were randomly divided into the intervention group (n = 43) or the control group (n = 42). Participants in the intervention group were trained in narrative medical theory learning and narrative writing based on a Web-based platform, while those in the control group were not. Self-report questionnaires of professionalism, empathy and humanistic care ability were used before and after intervention. RESULTS The results showed that the professionalism score of the intervention group was (68.7 ± 6.8 vs. 64.5 ± 7.5; P = 0.005), empathy (99.4 ± 15.7 vs. 92.2 ± 14.6; P = 0.014) and humanistic care ability (127.6 ± 20.0 vs. 113.3 ± 18.8; P = 0.004) were better than the control group. CONCLUSION The results of this quantitative study suggest that narrative medical theory education and narrative writing based on the network platform can promote the development of professionalism, empathy and humanistic care ability of nursing undergraduates.
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Affiliation(s)
- Mengxin Xue
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Huiping Sun
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jin Xue
- Guangling College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jingxin Zhou
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Junchao Qu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Siqi Ji
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yuan Bu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yongbing Liu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China.
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Mordang SBR, Vanassche E, Smeenk FWJM, Stassen LPS, Könings KD. Residents' identification of learning moments and subsequent reflection: impact of peers, supervisors, and patients. BMC MEDICAL EDUCATION 2020; 20:484. [PMID: 33267810 PMCID: PMC7709399 DOI: 10.1186/s12909-020-02397-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The clinical workplace offers residents many opportunities for learning. Reflection on workplace experiences drives learning and development because experiences potentially make residents reconsider existing knowledge, action repertoires and beliefs. As reflective learning in the workplace cannot be taken for granted, we aimed to gain a better insight into the process of why residents identify experiences as learning moments, and how residents reflect on these moments. METHODS This study draws on semi-structured interviews with 33 medical residents. Interviews explored how residents identified learning moments and how they reflected on such moments, both in-action and on-action. Aiming for extensive explanations on the process of reflection, open-ended questions were used that built on and deepened residents' answers. After interviews were transcribed verbatim, a within-case and cross-case analysis was conducted to build a general pattern of explanation. RESULTS The data analysis yielded understanding of the crucial role of the social context. Interactions with peers, supervisors, and patients drive reflection, because residents want to measure up to their peers, meet supervisors' standards, and offer the best patient care. Conversely, quality and depth of reflection sometimes suffer, because residents prioritize patient care over learning. This urges them to seek immediate solutions or ask their peers or supervisor for advice, rather than reflectively deal with a learning moment themselves. Peer discussions potentially enhance deep reflection, while own supervisor involvement sometimes feels unsafe. DISCUSSION Our results adds to our understanding of the social-constructivist nature of reflection. We suggest that feelings of self-preservation during interactions with peers and supervisors in a highly demanding work environment shape reflection. Support from peers or supervisors helps residents to instantly deal with learning moments more easily, but it also makes them more dependent on others for learning. Since residents' devotion to patient care obscures the reflection process, residents need more dedicated time to reflect. Moreover, to elaborate deeply on learning moments, a supportive and safe learning climate with peers and supervisors is recommended.
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Affiliation(s)
- Serge B R Mordang
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Eline Vanassche
- Centre for Innovation and the Development of Teacher and School, University of Leuven, Leuven, Belgium
| | - Frank W J M Smeenk
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, and Catharina Hospital Eindhoven, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karen D Könings
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Ament Giuliani Franco C, Franco RS, Cecilio-Fernandes D, Severo M, Ferreira MA, de Carvalho-Filho MA. Added value of assessing medical students' reflective writings in communication skills training: a longitudinal study in four academic centres. BMJ Open 2020; 10:e038898. [PMID: 33158823 PMCID: PMC7651724 DOI: 10.1136/bmjopen-2020-038898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/13/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study describes the development and implementation of a model to assess students' communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students' reflections in the assessment of communication skills. DESIGN Third-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods. SETTING AND PARTICIPANTS The communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students. OUTCOME MEASURES The students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach's alpha, dimensionality and the person's correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections' depth, and the Thematic Score (TS) to map and grade reflections' themes. RESULTS The Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE. CONCLUSIONS Assessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods-possibly a metacognitive domain.
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Affiliation(s)
| | - Renato Soleiman Franco
- Medicine School and Post-Graduate Program in Bioethics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health and Public Health and Forensic Sciences, and Medical Education Department, University of Porto Medical School, Porto, Portugal
| | - Maria Amélia Ferreira
- Public Health and Forensic Sciences, and Medical Education Department, University of Porto Faculty of Medicine, Porto, Portugal
| | - Marco Antonio de Carvalho-Filho
- Internal Medicine, University of Minho School of Medicine, Braga, Portugal
- CEDAR - Center for Educational Development and Research in Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
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Naeimi L, Asghari F, Nedjat S, Mirzazadeh A, Abbaszadeh M, Sima AR, Mortaz Hejri S. Turning unprofessional behaviors around using Holmes' reflection approach: a randomized controlled study. J Med Ethics Hist Med 2020; 13:12. [PMID: 33194143 PMCID: PMC7602044 DOI: 10.18502/jmehm.v13i12.4388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022] Open
Abstract
Many medical schools around the world have included professionalism training in their formal curriculum. However, these efforts may not be adequate; given the exposure of students to unprofessional behaviors in the clinical settings. In the present study, we aimed to design, implement, and evaluate a longitudinal program to improve professionalism among medical students upon their transition to clinical settings. A total of 75 medical students were enrolled in the study and randomly assigned to two groups. The control group did not receive any training, while for the intervention group; a 10-hour program through 16 weeks was organized based on the Holmes' reflection approach. The effectiveness of the program was evaluated by measuring three outcomes in both groups. Data analysis was performed using paired t-test and Multiple Linear Regression. Scores of judgment of professionalism increased in the intervention group (from 7.56 to 10.17; P< 0.001), while there was no significant improvement in the control group's scores. Students' attitudes towards professionalism and their professional behaviors did not change significantly. Based on our findings, the Holmes reflection approach helps students improve their cognitive base of professionalism. Long-term follow-up and further qualitative studies will help us better understand the effects of this approach on other desirable outcomes.
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Affiliation(s)
- Leila Naeimi
- Researcher, Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Medical Education Development Center, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Fariba Asghari
- Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saharnaz Nedjat
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azim Mirzazadeh
- Associate Professor, Department of Medical Education, Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahsa Abbaszadeh
- Assistant Professor, Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Reza Sima
- Assistant Professor, Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Mortaz Hejri
- Assistant Professor, Department of Medical Education, Educational Development Center, Tehran University of Medical Sciences, Tehran, Iran.
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Ong YT, Kow CS, Teo YH, Tan LHE, Abdurrahman ABHM, Quek NWS, Prakash K, Cheong CWS, Tan XH, Lim WQ, Wu J, Tan LHS, Tay KT, Chin A, Toh YP, Mason S, Radha Krishna LK. Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019. MEDICAL TEACHER 2020; 42:636-649. [PMID: 32065016 DOI: 10.1080/0142159x.2020.1724921] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction: Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.Methods: Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism.Results: 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism.Conclusion: Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.
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Affiliation(s)
- Yun Ting Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl Shumin Kow
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lorraine Hui En Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Wei Sheng Quek
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kishore Prakash
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiu Hui Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Qiang Lim
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiaxuan Wu
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Laura Hui Shuen Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Annelissa Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore, Singapore
| | - Ying Pin Toh
- Family Medicine Residency, National University Health System, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, Liverpool, England
| | - Lalit Kumar Radha Krishna
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, Liverpool, England
- Education Department, Duke-NUS Graduate Medical School, Singapore, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
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The role of reflective practice in healthcare professions: Next steps for pharmacy education and practice. Res Social Adm Pharm 2019; 15:1476-1479. [DOI: 10.1016/j.sapharm.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
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Baker SE, Escamilla K, Ngo SH, Camp ME. Incorporating Critical Reflection Activities into Psychiatry Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:209-214. [PMID: 30229472 DOI: 10.1007/s40596-018-0972-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Kristin Escamilla
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Sandra H Ngo
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Mary E Camp
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Armitage-Chan E, May SA. Identity, environment and mental wellbeing in the veterinary profession. Vet Rec 2018; 183:68. [DOI: 10.1136/vr.104724] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/12/2018] [Accepted: 06/04/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Elizabeth Armitage-Chan
- LIVE Centre; Department of Clinical Science and Services; Royal Veterinary College; Hatfield UK
| | - Stephen A May
- LIVE Centre; Department of Clinical Science and Services; Royal Veterinary College; Hatfield UK
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Armitage-Chan E, May SA. Developing a Professional Studies Curriculum to Support Veterinary Professional Identity Formation. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 45:489-501. [PMID: 29897316 DOI: 10.3138/jvme.1216-192r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Professional studies teaching in medical and veterinary education is undergoing a period of change. Traditional approaches, aiming to teach students professional values and behaviors, are being enhanced by curricula designed to support students' professional identity formation. This development offers the potential for improving student engagement and graduates' mental well-being. The veterinary professional identity associated with emotional resilience and success in practice incorporates complexity in professional decision making and the importance of context on behaviors and actions. The veterinarian must make decisions that balance the sometimes conflicting needs of patient, clients, veterinarian, and practice; their subsequent actions are influenced by environmental challenges such as financial limitations, or stress and fatigue caused by a heavy workload. This article aims to describe how curricula can be designed to support the development of such an identity in students. We will review relevant literature from medical education and the veterinary profession to describe current best practices for supporting professional identity formation, and then present the application of these principles using the curriculum at the Royal Veterinary College (RVC) as a case study. Design of a "best practice" curriculum includes sequential development of complex thinking rather than notions of a single best solution to a problem. It requires managing a hidden curriculum that tends to reinforce a professional identity conceived solely on clinical diagnosis and treatment. It includes exposure to veterinary professionals with different sets of professional priorities, and those who work in different environments. It also includes the contextualization of taught content through reflection on workplace-learning opportunities.
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Affiliation(s)
- Elizabeth Armitage-Chan
- Veterinary Education, Royal Veterinary College, Hawkshead Lane, University of London, North Mymms, Hatfield, Hertfordshire AL9 7TA UK.
| | - Stephen A May
- Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA UK
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Findyartini A, Sudarsono NC. Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach. BMC MEDICAL EDUCATION 2018; 18:88. [PMID: 29716581 PMCID: PMC5930750 DOI: 10.1186/s12909-018-1206-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/20/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students' perceptions of their personal identity formation and professional development following completion of the course. METHODS This qualitative study, adopting a phenomenological design, uses the participants' reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation. RESULTS Three main themes were revealed. First, students highlighted the strength of small group activities in helping them 'internalise the essential concepts'. Second, the role-model shadowing supported their understanding of 'what kind of medical doctors they would become'. Third, the field work allowed them to identify 'what the "noble values" are and how to implement them in daily practice'. CONCLUSION By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.
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Affiliation(s)
- Ardi Findyartini
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nani Cahyani Sudarsono
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Grus CL, Shen-Miller D, Lease SH, Jacobs SC, Bodner KE, Van Sickle KS, Veilleux J, Kaslow NJ. Professionalism: A Competency Cluster Whose Time Has Come. ETHICS & BEHAVIOR 2018. [DOI: 10.1080/10508422.2017.1419133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - Sue C. Jacobs
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University
| | - Kimberly E. Bodner
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri
| | | | | | - Nadine J. Kaslow
- Department of Psychiatry and Behavioral Science, Emory University
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13
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Patrick AC. A review of teaching ethics in the dental curriculum: challenges and future developments. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2017; 21:e114-e118. [PMID: 27495741 DOI: 10.1111/eje.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
This study considers the role and status of the teaching of ethics on the dental undergraduate curriculum. The study reviews current developments in the delivery of dental ethics education and in particular focuses on the development of new pedagogies and curricula content. The study then critically considers the consequences of a squeezed curricula and the consequent reliance on professional regulation as shorthand for the ethical development of students. The study concludes that, although great strides have been made in improving the teaching of ethics in dental education, further dialogue is needed to better include patient views and develop a more theoretically robust approach to self-reflection.
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Affiliation(s)
- A C Patrick
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Borgstrom E, Morris R, Wood D, Cohn S, Barclay S. Learning to care: medical students' reported value and evaluation of palliative care teaching involving meeting patients and reflective writing. BMC MEDICAL EDUCATION 2016; 16:306. [PMID: 27887622 PMCID: PMC5124265 DOI: 10.1186/s12909-016-0827-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/20/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Over recent years there has been an increase in teaching of both palliative care and reflective practice in UK medical schools. The palliative care teaching at the University of Cambridge School of Clinical Medicine is multi-faceted and involves students writing reflective essays after individually meeting patients approaching the end of life during their final year general practice and hospital medicine placements. This paper draws on two studies examining this teaching element to analyse what the students found valuable about it and to comment on the practice of meeting patients and subsequent reflective writing. METHODS Two studies have explored students' perceptions of these course components. The first was a thematic analysis of 234 reflective essays from 123 students written in 2007-2008, including examining what students wrote about the exercise itself. The second project involved a semi-structured questionnaire that students completed anonymously; this paper reports on the free text elements of that study [sample size =107]. Since similar themes were found in both studies, the coding structures from each project were compared and combined, enabling triangulation of the findings around what the students found valuable from the palliative care teaching involving meeting patients and reflective writing. RESULTS Overall, students reported that these components of the palliative care teaching are valuable. Four main themes were identified as aspects that students valued: (1) dedicated time with patients, (2) learning about wider elements of treatment and holistic care, (3) practicing communication skills, and (4) learning about themselves through reflective writing. Some students expressed a dislike for having to formally write a reflective essay. CONCLUSION It is possible to arrange for all of the medical students to individually meet at least two patients receiving palliative or end of life care. Students found these encounters valuable and many wrote about the benefit of formally writing about these experiences. Students reported finding this model useful in widening their skill-set and understanding of palliative care.
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Affiliation(s)
- Erica Borgstrom
- Faculty of Wellbeing, Education and Language Studies, Open University, Milton Keynes, MK7 6AA UK
| | - Rachel Morris
- Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR UK
| | - Diana Wood
- University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SP UK
| | - Simon Cohn
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1N 9SH UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR UK
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Munzer BW, Love J, Shipman BL, Byrne B, Cico SJ, Furlong R, Khandelwal S, Santen SA. An Analysis of the Top-cited Articles in Emergency Medicine Education Literature. West J Emerg Med 2016; 18:60-68. [PMID: 28116010 PMCID: PMC5226765 DOI: 10.5811/westjem.2016.10.31492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Dissemination of educational research is critical to improving medical education, promotion of faculty and ultimately patient care. The objective of this study was to identify the top 25 cited education articles in the emergency medicine (EM) literature and the top 25 cited EM education articles in all journals, as well as report on the characteristics of the articles. Methods Two searches were conducted in the Web of Science in June 2016 using a list of education-related search terms. We searched 19 EM journals for education articles as well as all other literature for EM education-related articles. Articles identified were reviewed for citation count, article type, journal, authors, and publication year. Results With regards to EM journals, the greatest number of articles were classified as articles/reviews, followed by research articles on topics such as deliberate practice (cited 266 times) and cognitive errors (cited 201 times). In contrast in the non-EM journals, research articles were predominant. Both searches found several simulation and ultrasound articles to be included. The most common EM journal was Academic Emergency Medicine (n = 18), and Academic Medicine was the most common non-EM journal (n=5). A reasonable number of articles included external funding sources (6 EM articles and 13 non-EM articles.) Conclusion This study identified the most frequently cited medical education articles in the field of EM education, published in EM journals as well as all other journals indexed in Web of Science. The results identify impactful articles to medical education, providing a resource to educators while identifying trends that may be used to guide EM educational research and publishing efforts.
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Affiliation(s)
- Brendan W Munzer
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Jeffery Love
- Georgetown University Hospital/Washington Hospital Center, Department of Emergency Medicine, Washington, D.C
| | - Barbara L Shipman
- University of Michigan, Alfred Taubman Health Sciences Library, Ann Arbor, Michigan
| | - Brendan Byrne
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan; Naval Medical Center Portsmouth, Department of Emergency Medicine, Portsmouth, Virginia
| | - Stephen J Cico
- Indiana University, Department of Emergency Medicine, Indianapolis, Indiana
| | - Robert Furlong
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Sorabh Khandelwal
- Ohio State University, Department of Emergency Medicine, Columbus, Ohio
| | - Sally A Santen
- University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan
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Hoffman LA, Shew RL, Vu TR, Brokaw JJ, Frankel RM. Is Reflective Ability Associated With Professionalism Lapses During Medical School? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:853-7. [PMID: 26760059 DOI: 10.1097/acm.0000000000001094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Recently, many have argued that learning to reflect on one's experiences is a critical component of professional identity formation and of professionalism. However, little empirical evidence exists to support this claim. This study explored the association between reflective ability and professionalism lapses among medical students. METHOD The authors conducted a retrospective case-control study of all students who matriculated at Indiana University School of Medicine from 2001 to 2009. The case group (n = 70) included those students who had been cited for a professionalism lapse during medical school; the students in the control group (n = 230) were randomly selected from the students who had not been cited for a professionalism lapse. Students' professionalism journal entries were scored using a validated rubric to assess reflective ability. Mean reflection scores were compared across groups using t tests, and logistic regression analysis was used to assess the relationship between reflective ability and professionalism lapses. RESULTS Reflection scores for students in the case group (2.46 ± 1.05) were significantly lower than those for students in the control group (2.82 ± 0.83) (P = .01). A lower reflection score was associated with an increased likelihood that the student had been cited for a professionalism lapse (odds ratio = 1.56; P < .01). CONCLUSIONS This study revealed a significant relationship between reflective ability and professionalism, although further study is needed to draw any conclusions regarding causation. These findings provide quantitative evidence to support current anecdotal claims about the relationship between reflection and professionalism.
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Affiliation(s)
- Leslie A Hoffman
- L.A. Hoffman is assistant professor, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, Indiana. R.L. Shew is senior lecturer, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana. T.R. Vu is associate professor of clinical medicine and associate director of the medicine clerkship, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. J.J. Brokaw is associate professor, vice chair for education, and director, Indiana University Center for Anatomical Sciences Education, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana. R.M. Frankel is professor of medicine, Department of Medicine, and director, Walther Program in Palliative Care Research and Education, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana
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Cowen VS, Kaufman D, Schoenherr L. A review of creative and expressive writing as a pedagogical tool in medical education. MEDICAL EDUCATION 2016; 50:311-319. [PMID: 26896016 DOI: 10.1111/medu.12878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/13/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT The act of writing offers an opportunity to foster self-expression and organisational abilities, along with observation and descriptive skills. These soft skills are relevant to clinical thinking and medical practice. Medical school curricula employ pedagogical approaches suitable for assessing medical and clinical knowledge, but teaching methods for soft skills in critical thinking, listening and verbal expression, which are important in patient communication and engagement, may be less formal. Creative and expressive writing that is incorporated into medical school courses or clerkships offers a vehicle for medical students to develop soft skills. The aim of this review was to explore creative and expressive writing as a pedagogical tool in medical schools in relation to outcomes of medical education. METHODS This project employed a scoping review approach to gather, evaluate and synthesise reports on the use of creative and expressive writing in US medical education. Ten databases were searched for scholarly articles reporting on creative or expressive writing during medical school. Limitation of the results to activities associated with US medical schools, produced 91 articles. A thematic analysis of the articles was conducted to identify how writing was incorporated into the curriculum. RESULTS Enthusiasm for writing as a pedagogical tool was identified in 28 editorials and overviews. Quasi-experimental, mixed methods and qualitative studies, primarily writing activities, were aimed at helping students cognitively or emotionally process difficult challenges in medical education, develop a personal identity or reflect on interpersonal skills. The programmes and interventions using creative or expressive writing were largely associated with elective courses or clerkships, and not required courses. CONCLUSIONS Writing was identified as a potentially relevant pedagogical tool, but not included as an essential component of medical school curricula.
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Affiliation(s)
- Virginia S Cowen
- Rutgers University School of Health Related Professions, Institute for Complementary and Alternative Medicine, Newark, NJ, USA
| | - Diane Kaufman
- New Jersey Medical School, University Behavioral Healthcare, Rutgers University, Newark, NJ, USA
| | - Lisa Schoenherr
- Department of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers University, Newark, NJ, USA
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Könings KD, van Berlo J, Koopmans R, Hoogland H, Spanjers IAE, ten Haaf JA, van der Vleuten CPM, van Merriënboer JJG. Using a Smartphone App and Coaching Group Sessions to Promote Residents' Reflection in the Workplace. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:365-70. [PMID: 26556297 DOI: 10.1097/acm.0000000000000989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PROBLEM Reflecting on workplace-based experiences is necessary for professional development. However, residents need support to raise their awareness of valuable moments for learning and to thoughtfully analyze those learning moments afterwards. APPROACH From October to December 2012, the authors held a multidisciplinary six-week postgraduate training module focused on general competencies. Residents were randomly assigned to one of four conditions with varying degrees of reflection support; they were offered (1) a smartphone app, (2) coaching group sessions, (3) a combination of both, or (4) neither type of support. The app allowed participants to capture in real time learning moments as a text note, audio recording, picture, or video. Coaching sessions held every two weeks aimed to deepen participants' reflection on captured learning moments. Questionnaire responses and reflection data were compared between conditions to assess the effects of the app and coaching sessions on intensity and frequency of reflection. OUTCOMES Sixty-four residents participated. App users reflected more often, captured more learning moments, and reported greater learning progress than nonapp users. Participants who attended coaching sessions were more alert to learning moments and pursued more follow-up learning activities to improve on the general competencies. Those who received both types of support were most alert to these learning moments. NEXT STEPS A simple mobile app for capturing learning moments shows promise as a tool to support workplace-based learning, especially when combined with coaching sessions. Future research should evaluate these tools on a broader scale and in conjunction with residents' and students' personal digital portfolios.
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Affiliation(s)
- Karen D Könings
- K.D. Könings is assistant professor, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. J. van Berlo is senior ICT developer, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. R. Koopmans is professor of general internal medicine, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. H. Hoogland was associate professor, Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands, at the time this work was completed. He is now retired. I.A.E. Spanjers is researcher, ResearchNed, Nijmegen, the Netherlands. J.A. ten Haaf is project manager, E-learning, University Library, Maastricht University, Maastricht, the Netherlands. C.P.M. van der Vleuten is professor of education, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands. J.J.G. van Merriënboer is professor of learning and instruction, Department of Educational Development and Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Dennhardt S, Apramian T, Lingard L, Torabi N, Arntfield S. Rethinking research in the medical humanities: a scoping review and narrative synthesis of quantitative outcome studies. MEDICAL EDUCATION 2016; 50:285-99. [PMID: 26896014 DOI: 10.1111/medu.12812] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/25/2015] [Accepted: 06/03/2015] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The rise of medical humanities teaching in medical education has introduced pressure to prove efficacy and utility. Review articles on the available evidence have been criticised for poor methodology and unwarranted conclusions. To support a more nuanced discussion of how the medical humanities work, we conducted a scoping review of quantitative studies of medical humanities teaching. METHODS Using a search strategy involving MEDLINE, EMBASE and ERIC, and hand searching, our scoping review located 11 045 articles that referred to the use of medical humanities teaching in medical education. Of these, 62 studies using quantitative evaluation methods were selected for review. Three iterations of analysis were performed: descriptive, conceptual, and discursive. RESULTS Descriptive analysis revealed that the medical humanities as a whole cannot be easily systematised based on simple descriptive categories. Conceptual analysis supported the development of a conceptual framework in which the foci of the arts and humanities in medical education can be mapped alongside their related epistemic functions for teaching and learning. Within the framework, art functioned as expertise, as dialogue or as a means of expression and transformation. In the discursive analysis, we found three main ways in which the relationship between the arts and humanities and medicine was constructed as, respectively, intrinsic, additive and curative. CONCLUSIONS This review offers a nuanced framework of how different types of medical humanities work. The epistemological assumptions and discursive positioning of medical humanities teaching frame the forms of outcomes research that are considered relevant to curriculum decision making, and shed light on why dominant review methodologies make some functions of medical humanities teaching visible and render others invisible. We recommend the use of this framework to improve the rigor and relevance of future explorations of the efficacy and utility of medical humanities teaching.
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Affiliation(s)
- Silke Dennhardt
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Tavis Apramian
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Nazi Torabi
- Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
| | - Shannon Arntfield
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Tricio J, Woolford M, Escudier M. Dental students' reflective habits: is there a relation with their academic achievements? EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2015; 19:113-121. [PMID: 25041110 DOI: 10.1111/eje.12111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Reflection is regarded as an important and essential component of healthcare professionals' education and practice. This cross-sectional study aimed to explore the levels of reflection habits of dental students and clinical and PhD postgraduate trainees and to establish the relationship between students' reflection and their academic performance. MATERIALS AND METHODS A total of 324 subjects (208 females, 56% ≥23 years of age) from King's College London Dental Institute, consisting of 281 undergraduate and 43 postgraduate trainees, responded to the invitation to participate and completed an online self-reported Reflection Questionnaire; this assesses two levels of non-reflective actions (Habitual Action and Understanding) and two levels of reflective actions (Reflection and Critical Reflection). Reflection results were compared amongst different cohorts and correlated with students' academic performance. RESULTS Reflection Questionnaire mean scores were 10.7 for Habitual Action, 17.3 for Understanding, 17.0 for Reflection and 14.4 for Critical Reflection, with significant differences between cohorts of undergraduate students, clinical postgraduates and PhD trainees. Reflection and Critical Reflection mean scores were higher as students climbed courses. Further, those ≥24 years of age and those with previous university degrees demonstrated higher reflective habits, whilst there was no gender difference. Additionally, the assessment programme methods correlated differently to the Reflection Questionnaire scores. DISCUSSION The Reflection Questionnaire's internal reliability was acceptable. The most common approaches used by both students and trainees were Understanding and Reflection, whilst those with high Understanding scores also tended to have good Reflective scores. Further, multiple choice questions encouraged students to 'understand', whilst ill-defined problems, such as those from essays to clinical reasoning cases, increased this to the reflection scale. CONCLUSION To foster reflective thinking, tutoring should primarily be focused on younger students (≤23 years old) and those without a previous university degree. Further, a wide variety of assessment methods is suggested to stimulate different reflective constructs.
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Affiliation(s)
- J Tricio
- King's College London Dental Institute, London, UK; Faculty of Dentistry, University of los Andes, Santiago, Chile
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Miller-Kuhlmann R, O'Sullivan PS, Aronson L. Essential steps in developing best practices to assess reflective skill: A comparison of two rubrics. MEDICAL TEACHER 2015; 38:75-81. [PMID: 25923234 DOI: 10.3109/0142159x.2015.1034662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Medical education lacks best practices for evaluating reflective writing skill. Reflection assessment rubrics include the holistic, reflection theory-based Reflection-on-Action and the analytic REFLECT developed from both reflection and narrative-medicine literatures. To help educators move toward best practices, we evaluated these rubrics to determine (1) rater requirements; (2) score comparability; and (3) response to an intervention. METHODS One-hundred and forty-nine third-year medical students wrote reflections in response to identical prompts. Trained raters used each rubric to score 56 reflections, half written with structured guidelines and half without. We used Pearson's correlation coefficients to associate overall rubric levels and independent t-tests to compare structured and unstructured reflections. RESULTS Reflection-on-Action training required for two hours; two raters attained an interrater-reliability = 0.91. REFLECT training required six hours; three raters achieved an interrater-reliability = 0.84. Overall rubric correlation was 0.53. Students given structured guidelines scored significantly higher (p < 0.05) on both rubrics. CONCLUSIONS Reflection-on-Action and REFLECT offer unique educational benefits and training challenges. Reflection-on-Action may be preferred for measuring overall quality of reflection given its ease of use. Training on REFLECT takes longer but it yields detailed data on multiple dimensions of reflection that faculty can reference when providing feedback.
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Hayton A, Kang I, Wong R, Loo LK. Teaching Medical Students to Reflect More Deeply. TEACHING AND LEARNING IN MEDICINE 2015; 27:410-416. [PMID: 26507999 DOI: 10.1080/10401334.2015.1077124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PROBLEM Although many studies have examined the importance of reflective writing in medical education, there is a scarcity of evidence for any particular intervention to improve the quality of reflection among medical students. Historically, students on our Internal Medicine clerkship were given a written reflection assignment without explanation of critical reflection. To facilitate the development of deeper reflection, a new curriculum was introduced. INTERVENTION A 90-minute workshop on critical reflection was introduced at the start of the Internal Medicine rotation. Key components included a video clip stimulating reflection, small- and large-group exercises, and a faculty member's personal reflection. Students were then asked to write two reflection papers. To minimize bias, the names and dates were removed from each reflection paper and combined with reflection papers from a historical control group. Four faculty used a previously validated tool, the REFLECT rubric, to independently grade the written reflection papers as nonreflective (as a 1), thoughtful action (2), reflection (3), or critical reflection (4). The final grade of each paper was determined by consensus among the graders. CONTEXT The 90-minute workshop was given once at the beginning of each 10-week requisite Internal Medicine clerkship to 3rd-year medical students. OUTCOME One hundred fifty-five papers written after the workshop were compared to 155 papers from a preworkshop historical control group. The primary analysis showed the number of students writing "critical reflection" papers increased after the educational intervention, from 14% to 47% (p = .0002). The effect size using Cohen's d was 0.62. The kappa statistic used to measure interrater reliability among the four graders was 0.37. LESSONS LEARNED Through a 90-minute reflection workshop more 3rd-year students were able to demonstrate the potential for "critical reflection" compared to previous students not exposed to this teaching. Strengths include the large sample size of written reflection papers submitted throughout an entire academic year and blinded grading of papers that minimized bias. The low interrater reliability is a limitation. We believe this curriculum could readily be adapted to a clerkship seeking to enhance learner reflection.
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Affiliation(s)
- Amy Hayton
- a Department of Medicine , Loma Linda University School of Medicine , Loma Linda , California , USA
| | - Ilho Kang
- a Department of Medicine , Loma Linda University School of Medicine , Loma Linda , California , USA
| | - Raymond Wong
- a Department of Medicine , Loma Linda University School of Medicine , Loma Linda , California , USA
| | - Lawrence K Loo
- a Department of Medicine , Loma Linda University School of Medicine , Loma Linda , California , USA
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Bergh AM, Van Staden CW, Joubert PM, Krüger C, Pickworth GE, Roos JL, Schurink WJ, Du Preez RR, Grey SV, Lindeque BG. Medical students' perceptions of their development of ‘soft skills’ Part II: The development of ‘soft skills’ through ‘guiding and growing’. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2006.10873436] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Lewin LO, Robert NJ, Raczek J, Carraccio C, Hicks PJ. An online evidence based medicine exercise prompts reflection in third year medical students. BMC MEDICAL EDUCATION 2014; 14:164. [PMID: 25106435 PMCID: PMC4132283 DOI: 10.1186/1472-6920-14-164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 07/17/2014] [Indexed: 05/25/2023]
Abstract
BACKGROUND Reflective practice is a desirable trait in physicians, yet there is little information about how it is taught to or learned by medical students. The purpose of this study was to determine whether an online Evidence Based Medicine (EBM) exercise with a face-to-face debriefing session would prompt third year medical students to reflect on their current skills and lead them to further reflection on clinical decision making in the future. METHODS All third year medical students at the University Of Maryland School Of Medicine who completed their pediatrics clerkship between 7/1/09 and 2/11/11 were required to complete the EBM exercise. Following completion each student received a personal report (Learning Profile) of their responses and attended a one hour large group debriefing session. Student responses to a survey following the debriefing sessions were analyzed using a post-test survey design with a single experimental cohort. RESULTS Ninety-five percent of students completing the debriefing survey indicated that the debriefing session helped them better understand their learning profiles; 68% stated that their profiles allowed them to evaluate themselves and their decisions. Sixty-three percent noted that participating in the exercise and the debrief would lead them to either learn more about EBM and use EBM more in the future or reflect more on their own decision making. CONCLUSIONS The EBM exercise was a successful way to introduce the concept of reflective practice to third year medical students, and the graphic Learning Profiles were effective instigators of discussion and reflection.
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Affiliation(s)
- Linda Orkin Lewin
- Department of Pediatrics, University of Maryland School of Medicine, 22 South Greene Street, 21201 Baltimore, MD, USA
| | - Nancy J Robert
- American Nurses Association, 8515 Georgia Avenue, 20910 Silver Spring, MD, USA
| | - John Raczek
- Instructional Technology Group, University Of Maryland School Of Medicine, 655 West Baltimore Street, 21201 Baltimore, MD, USA
| | - Carol Carraccio
- American Board of Pediatrics, 111 Silver Cedar Court, 27514 Chapel Hill, NC, USA
| | - Patricia J Hicks
- The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University Of Pennsylvania, 34th & 19104 Philadelphia, PA, USA
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Branch WT. Treating the whole patient: passing time-honoured skills for building doctor-patient relationships on to generations of doctors. MEDICAL EDUCATION 2014; 48:67-74. [PMID: 24330119 DOI: 10.1111/medu.12369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/11/2013] [Accepted: 08/27/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This paper aims to honour the Hippocratic Oath in modern practice by providing reflections on the development of ways for doctors to know the whole person that have accrued over the five decades to the present. METHODS I present a perspective piece, which includes personal reflections and cites relevant literature. RESULTS Powerful role models sustained the concept of knowing the whole patient in an era of scientific medicine. Beginning in the 1980s, skills allowing ordinary doctors to know the whole patient were made transparent to learners in courses and medical school curricula. As we approach the 2020s, increasing numbers of doctors have mastered these skills and are teaching them. CONCLUSIONS A modern way of practice is emerging; this emphasises the human side of medicine and its rewards, despite barriers such as those imposed by time limitations.
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Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25. MEDICAL TEACHER 2013; 35:e1252-66. [PMID: 23829342 DOI: 10.3109/0142159x.2013.789132] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught. METHODS Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism. RESULTS We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum. DISCUSSION Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.
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Affiliation(s)
- Hudson Birden
- University Centre for Rural Health, Lismore, New South Wales, Australia.
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Bennett D, McCarthy M, O'Flynn S, Kelly M. In the eye of the beholder: student perspectives on professional roles in practice. MEDICAL EDUCATION 2013; 47:397-407. [PMID: 23488759 DOI: 10.1111/medu.12114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
CONTEXT Learning about professional roles in clinical settings is confounded by the gap between espoused theory and the professional practice of the workplace. Workplace learning is grounded in that which is afforded to learners and individuals' engagement with those affordances. The meaning students make of the real-world performance of professional roles and how this relates to formal professionalism frameworks remain unclear. Construal of experience is individual. Professional roles are enacted in the eye of the beholder. In their reflections, student subjectivities, intentionalities and engagement with workplace affordances are revealed. Our research question was: How do students' perspectives of professional roles in practice, revealed through written reflections, relate to the formal professionalism curriculum? METHODS Year 3 students (n = 108) wrote reflections during hospital and community placements. Thematic content analysis was performed. A priori categories based on the CanMEDS Physician Roles Framework were used to map content. RESULTS A total of 107 students consented to the use of their reflections (n = 315). The CanMEDS roles of Communicator, Professional and Scholar predominated. Students were seen applying prior knowledge to new situations and reflecting on them. For some, the confirmation of previous learning was the outcome; for others, the mismatch between practice and the formal curriculum led to the questioning of both. The roles of Manager, Collaborator and Health Advocate were less frequently reflected upon. Differences between the affordances of hospital and community placements were seen. Means to address findings are discussed with reference to Billett's duality of workplace learning. CONCLUSIONS Reflective narratives reveal how students construe professional roles in practice. Mapping the content of reflections to a competency framework confirmed the mismatch between the formal and enacted curricula. Billett's duality of workplace learning provides a useful lens through which to identify means to address this, through the structural aspects of access and guidance, and through the promotion of individual engagement and reflection.
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Affiliation(s)
- Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
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Exploring the hidden curriculum: a qualitative analysis of clerks' reflections on professionalism in surgical clerkship. Am J Surg 2013; 205:426-33. [PMID: 23313441 DOI: 10.1016/j.amjsurg.2012.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 11/29/2012] [Accepted: 12/07/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Professionalism is an important part of the hidden curriculum that is gaining attention in surgical education. McMaster University, Hamilton, Ontario, Canada, has introduced a small group discussion model using critical incident reports (CIRs) to elicit students' reflections on ethical, communication, and professionalism challenges during surgical clerkship. We described the themes identified by surgical clerks in their CIRs. METHODS Using thematic analysis, 4 investigators coded 64 CIRs iteratively until conceptual saturation. Rigor and validity were ensured throughout the process. Data were further explored to compare the CIRs of junior and senior clerks. RESULTS Twenty-seven themes and 4 relationship domains emerged: the clerk's relationship to patients, the health care team, the health care system, and self. Challenges with communication, the consent process, and breaking bad news were most commonly cited. Theme frequencies differed between junior and senior clerks. CONCLUSIONS Small group discussions of critical incident reports allow surgical clerks to reflect on their developing professional relationships. The themes that have been identified can be used to guide professionalism education and uncover the hidden curriculum.
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Rodriguez E, Siegelman J, Leone K, Kessler C. Assessing professionalism: summary of the working group on assessment of observable learner performance. Acad Emerg Med 2012; 19:1372-8. [PMID: 23279244 DOI: 10.1111/acem.12031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/01/2012] [Indexed: 11/28/2022]
Abstract
Professionalism is one of the six Accreditation Council on Graduate Medical Education (ACGME) core competencies on which emergency medicine (EM) residents are assessed. However, very few assessment tools exist that have been rigorously evaluated in this population. One goal of the 2012 Academic Emergency Medicine consensus conference on education research in EM was to develop a research agenda for testing and developing tools to assess professionalism in EM residents. A literature review was performed to identify existing assessment tools. Recommendations on future research directions were presented at the consensus conference, and an agenda was developed.
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Affiliation(s)
- Elliot Rodriguez
- Department of Emergency Medicine; SUNY Upstate Medical University (ER); Syracuse; NY
| | - Jeffrey Siegelman
- Department of Emergency Medicine; Emory University (JS); Atlanta; GA
| | - Katrina Leone
- The Department of Emergency Medicine; Oregon Health & Sciences University (KL); Portland; OR
| | - Chad Kessler
- The Department of Emergency Medicine; University Illinois-Chicago (CK); Chicago; IL
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Bernard AW, Gorgas D, Greenberger S, Jacques A, Khandelwal S. The use of reflection in emergency medicine education. Acad Emerg Med 2012; 19:978-82. [PMID: 22818356 DOI: 10.1111/j.1553-2712.2012.01407.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Reflection is a cognitive process in which new information and experiences are integrated into existing knowledge structures and mental models, resulting in meaningful learning. Reflection often occurs after an experience is over, promoting professional development and lifelong learning. However, a reflective emergency physician (EP) is also able to apply reflection in real time: self-monitoring, coping with the unexpected, and quickly thinking on his or her feet to solve complicated, unique, and challenging clinical problems. Reflection is a skill that can be taught and developed in medical education. Evidence demonstrating the value of teaching reflection is emerging that substantiates longstanding educational theories. While a few educators have started to explore the use of reflection for emergency medicine (EM) learners, the potential for broader application exists. This review summarizes the literature regarding reflection in medical education and provides a basic primer for teaching reflection.
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Affiliation(s)
- Aaron W Bernard
- The Ohio State University College of Medicine, Columbus, OH, USA.
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Aronson L, Niehaus B, Hill-Sakurai L, Lai C, O'Sullivan PS. A comparison of two methods of teaching reflective ability in Year 3 medical students. MEDICAL EDUCATION 2012; 46:807-14. [PMID: 22803758 DOI: 10.1111/j.1365-2923.2012.04299.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
CONTEXT Little is known about best practices for teaching and learning reflection. We hypothesised that reflective ability scores on written reflections would be higher in students using critical reflection guidelines, or receiving feedback on reflective skill in addition to reflection content, or both, compared with those in students who received only a definition of reflection or feedback on reflection content alone. METHODS Using a 2 (guidelines) × 2 (feedback) × 2 (time) design, we randomly assigned half of our sample of 149 Year 3 medical students to receive critical reflection guidelines and the other half to receive only a definition of critical reflection. We then randomly divided both groups in half again so that one half of each group received feedback on both the content and reflective ability in their reflections, and the other received content feedback alone. The learners' performance was measured on the first and third written reflections of the academic year using a previously validated scoring rubric. We calculated descriptive statistics for the reflection scores and conducted a repeated-measures analysis of variance with two between-groups factors, guidelines and feedback, and one within-group factor, occasion, using the measure of reflective ability as the dependent variable. RESULTS We failed to find a significant interaction between guidelines and feedback (F = 0.51, d.f. = 1, 145, p = 0.48). However, the provision of critical reflection guidelines improved reflective ability compared with the provision of a definition of critical reflection only (F = 147.1, d.f. = 1, 145, p < 0.001). Feedback also improved reflective ability, but only when it covered reflective skill in addition to content (F = 6.5, d.f. = 1, 145, p = 0.012). CONCLUSIONS We found that the provision of critical reflection guidelines improved performance and that feedback on both content and reflective ability also improved performance. Our study demonstrates that teaching learners the characteristics of deeper, more effective reflection and helping them to acquire the skills they need to reflect well improves their reflective ability as measured by performance on reflective exercises.
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Affiliation(s)
- Louise Aronson
- Division of Geriatrics, School of Medicine, University of California San Francisco (UCSF), San Francisco, California 94118, USA.
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Wear D, Zarconi J, Garden R, Jones T. Reflection in/and writing: pedagogy and practice in medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:603-9. [PMID: 22450174 DOI: 10.1097/acm.0b013e31824d22e9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
During the past decade, "reflection" and "reflective writing" have become familiar terms and practices in medical education. The authors of this article argue that the use of the terms requires more thoughtfulness and precision, particularly because medical educators ask students to do so much reflection and reflective writing. First, the authors discuss John Dewey's thoughts on the elements of reflection. Then the authors turn the discussion to composition studies in an effort to form a more robust conception of reflective writing. In particular, they examine what the discipline of composition studies refers to as the writing process. Next, they offer two approaches to teaching composition: the expressivist orientation and the critical/cultural studies orientation. The authors examine the vigorous debate over how to respond to reflective writing, and, finally, they offer a set of recommendations for incorporating reflection and reflective writing into the medical curriculum.
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Affiliation(s)
- Delese Wear
- Northeast Ohio Medical University, Rootstown, Ohio 44272, USA.
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Chretien KC, Chheda SG, Torre D, Papp KK. Reflective writing in the internal medicine clerkship: a national survey of clerkship directors in internal medicine. TEACHING AND LEARNING IN MEDICINE 2012; 24:42-48. [PMID: 22250935 DOI: 10.1080/10401334.2012.641486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND PURPOSE Reflective writing programs have been implemented at many medical schools, but it is unclear to what extent and how they are structured. METHODS We surveyed the 107 Clerkship Directors of Internal Medicine member institutions on use of reflective writing assignments during the internal medicine clerkship. RESULTS Eighty-six of 107 (80%) institutional members completed the survey. Thirty-five percent reported having a reflective writing assignment, 48% did not, and 6% did not but were considering starting one within the next 2 years. Of the 30 assignments, most were partially structured (60%), involved small-group discussion (57%), and provided individual student feedback (73%). A minority (30%) contributed to the students' grade. Respondents believed assignments contributed to students' learning in multiple domains, most often Professionalism (97%) and Communication (77%). CONCLUSIONS Although reflective writing programs were common, variability existed in their structure. Further research is needed to determine how best to implement them.
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Bernard AW, Malone M, Kman NE, Caterino JM, Khandelwal S. Medical student professionalism narratives: a thematic analysis and interdisciplinary comparative investigation. BMC Emerg Med 2011; 11:11. [PMID: 21838887 PMCID: PMC3166891 DOI: 10.1186/1471-227x-11-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 08/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professionalism development is influenced by the informal and hidden curriculum. The primary objective of this study was to better understand this experiential learning in the setting of the Emergency Department (ED). Secondarily, the study aimed to explore differences in the informal curriculum between Emergency Medicine (EM) and Internal Medicine (IM) clerkships. METHODS A thematic analysis was conducted on 377 professionalism narratives from medical students completing a required EM clerkship from July 2008 through May 2010. The narratives were analyzed using established thematic categories from prior research as well as basic descriptive characteristics. Chi-square analysis was used to compare the frequency of thematic categories to prior research in IM. Finally, emerging themes not fully appreciated in the established thematic categories were created using grounded theory. RESULTS Observations involving interactions between attending physician and patient were most abundant. The narratives were coded as positive 198 times, negative 128 times, and hybrid 37 times. The two most abundant narrative themes involved manifesting respect (36.9%) and spending time (23.7%). Both of these themes were statistically more likely to be noted by students on EM clerkships compared to IM clerkships. Finally, one new theme regarding cynicism emerged during analysis. CONCLUSIONS This analysis describes an informal curriculum that is diverse in themes. Student narratives suggest their clinical experiences to be influential on professionalism development. Medical students focus on different aspects of professionalism depending on clerkship specialty.
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Affiliation(s)
- Aaron W Bernard
- The Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus OH, USA.
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Aronson L, Niehaus B, Lindow J, Robertson PA, O'Sullivan PS. Development and pilot testing of a reflective learning guide for medical education. MEDICAL TEACHER 2011; 33:e515-21. [PMID: 21942487 DOI: 10.3109/0142159x.2011.599894] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Reflection is increasingly incorporated into all levels of medical education but little is known about best practices for teaching and learning reflection. AIMS To develop a literature-based reflective learning guide for medical education and conduct a pilot study to determine whether (1) guide use enhances medical students' reflective writing skills and (2) reflective scores correlate with participant demographics and satisfaction. METHODS Guide development consisted of literature review, needs assessment, single institution survey, and educational leader consensus. The pilot cohort study compared professionalism reflections written with and without the guide by third-year medical students on their core obstetrics and gynecology rotation. Reflections were scored using a previously validated rubric. A demographics and satisfaction survey examined effects of gender and satisfaction, as well as qualitative analysis of optional written comments. Analyses used independent t-tests and Pearson's correlations. RESULTS We developed a two-page, literature-based guide in clinical Subjective-Objective-Assessment-Plan (SOAP) note format. There was a statistically significant difference, p < 0.001, in the reflection scores between groups, but no effects of gender or satisfaction. Student satisfaction with the guide varied widely. CONCLUSIONS A single exposure to a literature-based guide to reflective learning improved written reflections by third-year medical students.
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Burke AE, Rushton J, Guralnick S, Hicks P. Resident work duty hour requirements: medical educators' perspectives. Acad Pediatr 2010; 10:369-71. [PMID: 21075315 DOI: 10.1016/j.acap.2010.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ann E Burke
- Association of Pediatric Program Directors, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA.
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Abstract
BACKGROUND Review of studies published in medical education journals over the last decade reveals a diversity of pedagogical approaches and educational goals related to teaching reflection. AIM The following tips outline an approach to the design, implementation, and evaluation of reflection in medical education. METHOD The method is based on the available literature and the author's experience. They are organized in the sequence that an educator might use in developing a reflective activity. RESULTS The 12 tips provide guidance from conceptualization and structure of the reflective exercise to implementation and feedback and assessment. The final tip relates to the development of the faculty member's own reflective ability. CONCLUSION With a better understanding of the conceptual frameworks underlying critical reflection and greater advance planning, medical educators will be able to create exercises and longitudinal curricula that not only enable greater learning from the experience being reflected upon but also develop reflective skills for life-long learning.
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Affiliation(s)
- Louise Aronson
- Department of Medicine, Division of Geriatrics, University of California, 3333 California St, Suite 380, San Francisco, CA 94118, USA.
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Bryden P, Ginsburg S, Kurabi B, Ahmed N. Professing professionalism: are we our own worst enemy? Faculty members' experiences of teaching and evaluating professionalism in medical education at one school. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1025-34. [PMID: 20068427 DOI: 10.1097/acm.0b013e3181ce64ae] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To explore clinical faculty members' knowledge and attitudes regarding their teaching and evaluation of professionalism. METHOD Clinical faculty involved in medical education at University of Toronto Faculty of Medicine were recruited to participate in focus groups between 2006 and 2007 to discuss their knowledge, beliefs, and attitudes about teaching and evaluating professionalism and to determine their views regarding faculty development in this area. Focus groups were transcribed, analyzed, and coded for themes using a grounded theory approach. RESULTS Five focus groups consisting of 14 faculty members from surgical specialties, psychiatry, anesthesia, and pediatrics were conducted. Grounded theory analysis of the 188 pages of text identified three major themes: Professionalism is not a static concept, a gap exists between faculty members' real and ideal experience of teaching professionalism, and "unprofessionalism" is a persistent problem. Important subthemes included the multiple bases that exist for defining professionalism, how professionalism is learned and taught versus how it should be taught, institutional and faculty tolerance and silence regarding unprofessionalism, stress as a contributor to unprofessionalism, and unprofessionalism arising from personality traits. CONCLUSIONS All faculty expressed that teaching and evaluating professionalism posed a challenge for them. They identified their own lapses in professionalism and their sense of powerlessness and failure to address these with one another as the single greatest barrier to teaching professionalism, given a perceived dominance of role modeling as a teaching tool. Participants had several recommendations for faculty development and acknowledged a need for culture change in teaching hospitals and university departments.
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Bryan CS, Babelay AM. Building character: a model for reflective practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1283-1288. [PMID: 19707072 DOI: 10.1097/acm.0b013e3181b6a79c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In 1950, Harrison and colleagues proposed that the physician's ultimate and sufficient destiny should be to "build an enduring edifice of character." Recent work in philosophy underscores the importance of character ethics (virtue ethics) as a complement to ethical systems based on duty (deontology) or results (consequentialism). Recent work in psychology suggests that virtues and character strengths can, to at least some extent, be analyzed and taught. Building character might be enhanced by promoting among students, residents, and faculty a four-step method of reflective practice that includes (1) the details of a situation, (2) the relevant virtues, (3) the relevant principles, values, and ethical frameworks, and (4) the range of acceptable courses of action. Exercises using such a model bring together the major goals of ethics education in U.S. medical schools--teaching the set of skills needed for resolving ethical dilemmas and promoting virtue and professionalism among physicians.
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Affiliation(s)
- Charles S Bryan
- Department of Medicine, School of Medicine, Center for Bioethics and Medical Humanities, The University of South Carolina, Columbia, South Carolina, USA.
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Abstract
Reflection is a metacognitive process that creates a greater understanding of both the self and the situation so that future actions can be informed by this understanding. Self-regulated and lifelong learning have reflection as an essential aspect, and it is also required to develop both a therapeutic relationship and professional expertise. There are a variety of educational approaches in undergraduate, postgraduate and continuing medical education that can be used to facilitate reflection, from text based reflective journals and critical incident reports to the creative use of digital media and storytelling. The choice of approach varies with the intended outcomes, but it should also be determined by the user since everyone has a preferred style. Guided reflection, with supportive challenge from a mentor or facilitator, is important so that underlying assumptions can be challenged and new perspectives considered. Feedback also has an important role to enhance reflection. There is little research evidence to suggest that reflection improves quality of care but the process of care can be enhanced.
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Cohn FG, Shapiro J, Lie DA, Boker J, Stephens F, Leung LA. Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:587-96. [PMID: 19704191 DOI: 10.1097/acm.0b013e31819f6ecc] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE To examine students' responses to reflective practice assignments used in medical ethics and professionalism education. The study goals include an examination of what reflective writing reveals about students' personal and professional values, identification of the narrative typologies students use to tell stories of ethical dilemmas, and a determination of the usefulness of reflective writing in informing ethics/professionalism curricula assessment and development. METHOD This study employed a mixed-methods design generating both descriptive data and interpretive analysis. Students' reflective writing assignments, guided by a series of six questions designed to elicit students' perceptions of moral conflicts they have encountered and their personal and professional ethical values, were collected from three successive cohorts of third-year medical students (n = 299) from July 2002 to January 2006 during an obstetrics-gynecology clerkship at the University of California, Irvine, School of Medicine. Content, thematic, and global narrative analyses of students' reflective writing were conducted, drawing on content analysis, grounded theory, and narrative methodologies. RESULTS Values conflicts usually were patient centered (181; 60.5%) and student centered (172; 57.5%), without much regard for important contextual issues such as patients' socioeconomic status, insurance coverage, or culture. Common personal values included religious beliefs (82; 27.4%), respect (72; 24.1%), and the Golden Rule (66; 22.1%); frequent professional values were respect (72; 25.1%), beneficence (71; 23.7%), nonmaleficence (69; 23.1%), and autonomy (65; 21.7%). Whereas 35.5% (106) claimed to have addressed conflicts, 23.4% (70) said they did nothing. Restitution narratives (113; 37.8%) dominated. CONCLUSIONS This analytic approach facilitated assessment of student values, conflict sources, and narrative types. Findings reveal aspects of the influence of the hidden curriculum and can inform strategies for effective implementation of bioethics/professionalism curricula.
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Affiliation(s)
- Felicia G Cohn
- Department of Internal Medicine, University of California, Irvine School of Medicine, Irvine, California 92697, USA
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Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:551-8. [PMID: 19704185 DOI: 10.1097/acm.0b013e31819fbaa2] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Assessing professionalism is hampered by varying definitions and these definitions' lack of a clear breakdown of the elements of professionalism into aspects that can be measured. Professionalism is multidimensional, so a combination of assessment tools is required. In this study, conducted during 2007-2008, the authors aimed to match assessment tools to definable elements of professionalism and to identify gaps where professionalism elements are not well addressed by existing assessment tools. METHOD The authors conducted literature reviews of definitions of professionalism and of relevant assessment tools, clustered the definitions of professionalism into assessable components, and clustered assessment tools of a similar nature. They then created a "blueprint" whereby the elements of professionalism are matched to relevant assessment tools. RESULTS Five clusters of professionalism were formed: adherence to ethical practice principles, effective interactions with patients and with people who are important to those patients, effective interactions with people working within the health system, reliability, and commitment to autonomous maintenance / improvement of competence in oneself, others, and systems. Nine clusters of assessment tools were identified: observed clinical encounters, collated views of coworkers, records of incidents of unprofessionalism, critical incident reports, simulations, paper-based tests, patients' opinions, global views of supervisor, and self-administered rating scales. CONCLUSIONS Professionalism can be assessed using a combination of observed clinical encounters, multisource feedback, patients' opinions, paper-based tests or simulations, measures of research and/or teaching activities, and scrutiny of self-assessments compared with assessments by others. Attributes that require more development in their measurement are reflectiveness, advocacy, lifelong learning, dealing with uncertainty, balancing availability to others with care for oneself, and seeking and responding to results of an audit.
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Ackerman A, Graham M, Schmidt H, Stern DT, Miller SZ. Critical events in the lives of interns. J Gen Intern Med 2009; 24:27-32. [PMID: 18972091 PMCID: PMC2607494 DOI: 10.1007/s11606-008-0769-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 04/16/2008] [Accepted: 08/14/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities. OBJECTIVE To evaluate the most critical events in the lives of interns. PARTICIPANTS Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict. MEASUREMENTS We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts. MAIN RESULTS The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician-patient relationship. CONCLUSION The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents' emerging professional identities.
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Affiliation(s)
- Alexandra Ackerman
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA.
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Branch WT, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, Mitchell GA, Inui TS. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:117-25. [PMID: 19116489 DOI: 10.1097/acm.0b013e3181900f8a] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To successfully design and implement longitudinal faculty development programs at five medical schools, and to determine whether faculty participants were perceived to be more effective humanistic teachers. METHOD Promising teachers were chosen from volunteers to participate in groups at each of the medical schools. Between September 2004 and September 2006, the facilitators jointly designed and implemented a curriculum for enhancing humanistic teaching using previously defined learning goals that combined experiential learning of skills with reflective exploration of values. Twenty-nine participants who completed 18 months of faculty development at the five medical schools were compared with 47 controls drawn from the same schools in the final six months of the two-year project. For comparison, the authors developed a 10-item questionnaire, the Humanistic Teaching Practices Effectiveness Questionnaire (HTPE), to be filled out by medical students and residents taught by participants or control faculty. Items were designed to measure previously identified themes and domains of humanism. Control faculty were similar to participants by gender, specialty, and years of experience. RESULTS Thirty-four (75%) of the original 45 enrollees completed the programs at the five schools. Faculty participants outperformed their peer controls on all 10 items of the HTPE questionnaire. Results were statistically significant (P < .05) and sufficiently robust (8%-13% differences) to suggest practical importance. CONCLUSIONS A longitudinal faculty development process that combines experiential learning of skills and reflective exploration of values in the setting of a supportive group process was successfully accomplished and had a positive impact on participants' humanistic teaching.
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Affiliation(s)
- William T Branch
- Division of General Internal Medicine, 49 Jesse Hill Jr. Drive, Suite 446, Atlanta, GA 30303, USA.
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Affiliation(s)
- John G. Lovas
- Department of Oral and Maxillofacial Sciences, Faculty of Dentistry; Dalhousie University
| | - David A. Lovas
- Cambridge Hospital and Clinical Fellow, Harvard Medical School; Dalhousie University
| | - P. Michael Lovas
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine; Dalhousie University
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Ginsburg S, Lingard L, Regehr G, Underwood K. Know when to rock the boat: how faculty rationalize students' behaviors. J Gen Intern Med 2008; 23:942-7. [PMID: 18612721 PMCID: PMC2517907 DOI: 10.1007/s11606-007-0401-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND When faculty evaluate medical students' professionalism, they make judgments based on the observation of behaviors. However, we lack an understanding of why they feel certain behaviors are appropriate (or not). OBJECTIVE To explore faculty's reasoning around potential student behaviors in professionally challenging situations. DESIGN Guided interviews with faculty who were asked to respond to 5 videotaped scenarios depicting students in professionally challenging situations. SUBJECTS Purposive sample of 30 attending Internists and surgeons. APPROACH Transcripts were analyzed using modified grounded theory to search for emerging themes and to attempt to validate a previous framework based on student responses. RESULTS Faculty's reasoning around behaviors were similar to students' and were categorized by three general themes: Imperatives (e.g., take care of patients, behave honestly, know your place), Affect (factors relating to a student's "gut instincts" or personality), or Implications (for the student, patients, and others). Several new themes emerged, including "know when to fudge the truth", "do what you're told", and "know when to step up to the plate". These new codes, along with a near ubiquitous reference to Affect, suggests that faculty feel students are responsible for knowing when (and how) to bend the rules. Potential reasons for this are discussed. CONCLUSIONS Although faculty are aware of the conflicts students face when encountering professional challenges, their reliance on students to "just know" what to do reflects the underlying complexity and ambiguity that surrounds decision making in these situations. To fully understand professional decision-making, we must acknowledge and address these issues from both students' and faculty's points of view.
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Affiliation(s)
- Shiphra Ginsburg
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Hill-Sakurai LE, Lee CA, Schickedanz A, Maa J, Lai CJ. A professional development course for the clinical clerkships: developing a student-centered curriculum. J Gen Intern Med 2008; 23:964-8. [PMID: 18612725 PMCID: PMC2517931 DOI: 10.1007/s11606-008-0527-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Although professional development is addressed throughout the medical school curriculum, it is particularly salient to third-year students as they become integral members of health care teams. AIM We present a professional development curriculum for third-year medical students. SETTING Urban medical school. PROGRAM DESCRIPTION In 2005, our curriculum consisted of 3 large group panels, each followed by a small group, occurring after the first, third, and last clerkship. Before each small group, students prepared critical incident reports, which led to focused group reflection. The individual topics were, respectively: (1) transition to clerkship learning; (2) challenges to professional behavior; and (3) medical errors. In 2006, based on student feedback, we piloted a revised student-centered panel on professionalism that was based entirely on themes from students' critical incident reports. PROGRAM EVALUATION Students rated the curriculum well overall. In 2005-2006, the small groups ranged from 3.95 to 3.98 (SD 0.88) on a 5-point Likert scale (1 = poor, 5 = excellent) and the panels ranged from 3.54 to 4.41 (SD 0.9). The pilot panel in 2006 was rated 4.38 (SD 0.80). The most common professionalism themes generated from 185 critical incident reports were communication, compassionate patient care, accountability, and team collaboration. DISCUSSION A professional development curriculum, consisting of panels, small groups, and critical incident reports, can promote reflection among third-year medical students.
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Affiliation(s)
- Laura E Hill-Sakurai
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA.
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How resident unprofessional behavior is identified and managed: a program director survey. Am J Obstet Gynecol 2008; 198:692.e1-4; discussion 692.e4-5. [PMID: 18538156 DOI: 10.1016/j.ajog.2008.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 01/03/2008] [Accepted: 03/10/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine how unprofessional behavior by residents is identified/ managed within residency programs, and under what conditions concerns are communicated to potential employers. STUDY DESIGN A web-based survey was emailed to 241 directors of US obstetrics and gynecology residency programs. RESULTS 141 program directors (PDs) responded (58%). 84% of PDs indicated that problems with professionalism most commonly come to their attention through personal communication. Methods of addressing the problem included expression of expectation of improvement (95%), psychological counseling (68%), placing resident on probation (59%), and dismissal (30%). The majority of PDs felt remediation was not completely successful. All PDs are willing to communicate professionalism concerns to potential employers, but 42% provide this information only if asked. CONCLUSION Resident unprofessional behavior is a common problem for program directors, and remediation is challenging. PDs are willing to express concerns to potential employers, but a significant percentage indicate concerns only if asked.
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Thomas PA, Goldberg H. Tracking reflective practice-based learning by medical students during an ambulatory clerkship. J Gen Intern Med 2007; 22:1583-6. [PMID: 17786523 PMCID: PMC2219797 DOI: 10.1007/s11606-007-0315-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 06/25/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the use of web and palm digital assistant (PDA)-based patient logs to facilitate reflective learning in an ambulatory medicine clerkship. DESIGN Thematic analysis of convenience sample of three successive rotations of medical students' patient log entries. SETTING Johns Hopkins University School of Medicine. PARTICIPANTS MS3 and MS4 students rotating through a required block ambulatory medicine clerkship. INTERVENTIONS Students are required to enter patient encounters into a web-based log system during the clerkship. Patient-linked entries included an open text field entitled, "Learning Need." Students were encouraged to use this field to enter goals for future study or teaching points related to the encounter. MEASUREMENT AND MAIN RESULTS The logs of 59 students were examined. These students entered 3,051 patient encounters, and 51 students entered 1,347 learning need entries (44.1% of encounters). The use of the "Learning Need" field was not correlated with MS year, gender or end-of-clerkship knowledge test performance. There were strong correlations between the use of diagnostic thinking comments and observations of therapeutic relationships (Pearson's r=.42, p<0.001), and between diagnostic thinking and primary interpretation skills (Pearson's r=.60, p<0.001), but not between diagnostic thinking and factual knowledge (Pearson's r =.10, p=.46). CONCLUSIONS We found that when clerkship students were cued to reflect on each patient encounter with the electronic log system, student entries grouped into categories that suggested different levels of reflective thinking. Future efforts should explore the use of such entries to encourage and track habits of reflective practice in the clinical curriculum.
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Affiliation(s)
- Patricia A Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 9033, Baltimore, Maryland, USA.
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Saunders PA, Tractenberg RE, Chaterji R, Amri H, Harazduk N, Gordon JS, Lumpkin M, Haramati A. Promoting self-awareness and reflection through an experiential mind-body skills course for first year medical students. MEDICAL TEACHER 2007; 29:778-84. [PMID: 17852720 PMCID: PMC4372185 DOI: 10.1080/01421590701509647] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND This research examines student evaluations of their experience and attitudes in an 11 week mind-body skills course for first year medical students. AIMS The aim is to understand the impact of this course on students' self-awareness, self-reflection, and self-care as part of their medical education experience. METHODS This study uses a qualitative content analysis approach to data analysis. The data are 492 verbatim responses from 82 students to six open-ended questions about the students' experiences and attitudes after a mind-body skills course. These questions queried students' attitudes about mind-body medicine, complementary medicine, and their future as physicians using these approaches. RESULTS The data revealed five central themes in students' responses: connections, self discovery, stress relief, learning, and medical education. CONCLUSIONS Mind-body skills groups represent an experiential approach to teaching mind-body techniques that can enable students to achieve self-awareness and self-reflection in order to engage in self-care and to gain exposure to mind-body medicine while in medical school.
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Affiliation(s)
- Pamela A Saunders
- Department of Neurology, Georgetown University, Washington, DC 20057, USA.
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