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Pestka B. Using Reflective Practice to Enhance Student Professionalism. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241250172. [PMID: 38736714 PMCID: PMC11084998 DOI: 10.1177/23821205241250172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
Reflective practice, critically reflecting on one's actions or attitudes to engage in the process of continuous adaptation and learning, has proven to be an effective strategy for improved patient care. Additionally, literature supports applying reflective practice for professional growth in medical providers. When contemplating professionalism training in physician assistant (PA) education, it is important to consider how to obtain buy-in from students. One way to do this is to link professionalism to the students' future career as a PA. The School of Physician Assistant Studies at Pacific University (the Program) created an Online Orientation Reflective Practice Assignment that was implemented during online orientation. Students were prompted to use reflective practice to create detailed "plans for success." The goal of this assignment was to reduce common professionalism missteps students often experienced. Data regarding the number of professionalism encounters per cohort, broken down into occurrences by curricular phase (didactic vs clinical), was tracked and collated using Microsoft® Excel®. The data was analyzed to determine trends. Implementation of the Online Reflective Practice Assignment for all PA students at the beginning of their education has increased student awareness of the Program's, and the profession's, expectations regarding professionalism and accountability. Thus far, the resulting number of professionalism missteps have not decreased year-over-year. We hypothesize that this is due to the difficulty meeting increased administrative expectations and burdens put on students during the pandemic. Students' use of reflective practice to review what went wrong and to create plans to avoid missteps in the future allows them to focus on productive next steps in building their professional identity. Implementation of the Online Orientation Reflective Practice Assignment has better prepared students for the expectations of the PA profession and provided them with a solid foundation to build their professional identity throughout their education and into their careers.
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Affiliation(s)
- Brandy Pestka
- School of Physician Assistant Studies, Pacific University College of Health Professions, Hillsboro, OR, USA
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Laughlin BS, Langley N, Patel SH, Kough K, Ernst B, Ashman JB, Rule WG, Vern-Gross TZ. Attitudes and Perception of the REFLECT Communication Curriculum for Clinical Oncology Graduate Medical Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1786-1791. [PMID: 37349641 PMCID: PMC10656312 DOI: 10.1007/s13187-023-02333-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
Communication and interpersonal skills are essential components of oncology patient care. The REFLECT (Respect, Empathy, Facilitate Effective Communication, Listen, Elicit Information, Compassion, and Teach Others) curriculum is a novel framework to improve and refine physician/patient interactions for oncology graduate medical trainees. We seek to evaluate the attitudes and perceptions of the REFLECT communication curriculum among oncology trainees. Seven-question and 8-question Likert scale surveys (1 = not beneficial and 5 = beneficial) were distributed to resident/fellow participants and faculty mentors, respectively. Questions asked trainees and faculty about their perceptions of improvement in communication, handling of stressful situations, the value of the curriculum, and overall impression of the curriculum. Descriptive statistics determined the survey's baseline characteristics and response rates. Kruskal-Wallis rank sum tests were used to compare the distribution of continuous variables. Thirteen resident/fellow participants completed the participant survey. Six (43.6%) Radiation Oncology trainees and 7 (58.3%) Hematology/Oncology fellows completed the trainee survey. Eight (88.9%) Radiation Oncologists and 1 (11.1%) Medical Oncologist completed the observer survey. Faculty and trainees generally felt that the curriculum increased communication skills. Faculty responded more favorably to the program's impact on communication skills (median 5.0 vs. 4.0, p = 0.008). Faculty were more assertive about the curriculum's capabilities to improve a learner's ability to handle stressful situations (median 5.0 vs. 4.0, p = 0.003). Additionally, faculty had a more favorable overall impression of the REFLECT curriculum than the residents/fellows (median 5.0 vs. 4.0, p < 0.001). Radiation Oncology residents felt more strongly that the curriculum enhanced their ability to handle stressful topics, compared to Heme/Onc fellows (median 4.5 vs. 3.0, range 1-5, p = 0.379). Radiation Oncology trainees felt more consistently that the workshops improved their communication skills, compared to Heme/Onc fellows (median 4.5 vs. 3.5, range 1-5, p = 0.410). The overall impression between Rad Onc resident and Heme/Onc fellows was similar (median 4.0, p = 0.586). Conclusions: Overall, the REFLECT curriculum enhanced communication skills of trainees. Oncology trainees and faculty physicians feel that the curriculum was beneficial. As interactive skills and communication is critical to build positive interactions, further work is needed to improve the REFLECT curriculum.
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Affiliation(s)
- Brady S Laughlin
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
| | - Natalie Langley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | | | - Brenda Ernst
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Tamara Z Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
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Kennie-Kaulbach N, Gormley H, Davies H, Whelan AM, Framp H, Price S, Janke KK. Indicators, influences, and changes in professional identity formation in early experiential learning in community pharmacy. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:S1877-1297(23)00078-3. [PMID: 37121867 DOI: 10.1016/j.cptl.2023.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/17/2023] [Accepted: 04/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Experiential education is a key area in the pharmacy curriculum that professional identity formation (PIF) occurs. However, little is known about PIF influences and supports for pharmacy students during early experiential placements. The study aimed to explore pharmacy student PIF in an early experiential rotation in community pharmacy using reflective writing. EDUCATIONAL ACTIVITY AND SETTING First-year pharmacy students completed written reflections describing their professional identity and influencing experiences, before and after a four-week community introductory pharmacy practice experience. Qualitative content analysis of the written reflections was performed using three analytical approaches: (1) deductive coding based on professional identity indicators; (2) inductive coding to identify influences; and (3) inductive coding of field notes to identify changes between pre- and post-written reflections. FINDINGS Twelve students participated. All participants described discrete professional attributes and behaviors and valuing a patient-centered approach as part of their professional identity. Participants reported observation of pharmacists, the curriculum, and previous work experience influenced PIF prior to the experiential rotation. A strong influencer of PIF during the rotation was observation of pharmacist preceptors, whereas participants' own experiences were described less often. Changes in professional identity among participants were subtle and categorized as affirmation, acquisition, and growth. SUMMARY Pharmacy students' markers and influencers of PIF should be considered when developing curricular experiences and preceptor development that support PIF. The use of professional identity indicators and analysis of written reflections as a method to uncover PIF, shows promise and warrants further investigation.
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Affiliation(s)
- Natalie Kennie-Kaulbach
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Hannah Gormley
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Harriet Davies
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Anne Marie Whelan
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Heidi Framp
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Sheri Price
- Faculty of Health, School of Nursing, Dalhousie University, 5869 University Avenue, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Kristin K Janke
- University of Minnesota College of Pharmacy, 7-159 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455, United States.
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Teo KJH, Teo MYK, Pisupati A, Ong RSR, Goh CK, Seah CHX, Toh YR, Burla N, Koh NSY, Tay KT, Ong YT, Chiam M, Fong W, Wijaya L, Goh SPL, Krishna LKR. Assessing professional identity formation (PIF) amongst medical students in Oncology and Palliative Medicine postings: a SEBA guided scoping review. Palliat Care 2022; 21:200. [PMID: 36397067 PMCID: PMC9673314 DOI: 10.1186/s12904-022-01090-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Introduction to a multi-professional team who are working and caring for the dying, and facing complex moral and ethical dilemmas during Oncology and Palliative Medicine postings influence a medical student's professional identity formation (PIF). However, limited appreciation of PIF, inadequate assessments and insufficient support jeopardise this opportunity to shape how medical students think, feel and act as future physicians. To address this gap, a systematic scoping review (SSR) of PIF assessment methods is proposed. METHODS A Systematic Evidence-based Approach (SEBA) guided SSR of assessments of PIF in medical schools published between 1st January 2000 and 31st December 2021 in PubMed, Embase, ERIC and Scopus databases was carried out. Included articles were concurrently content and thematically analysed using SEBA's Split Approach and the themes and categories identified were combined using SEBA's Jigsaw Perspective. The review hinged on the following questions: "what is known about the assessment of professional identity formation amongst medical students?", "what are the theories and principles guiding the assessment of professional identity formation amongst medical students?", "what factors influence PIF in medical students?", "what are the tools used to assess PIF in medical students?", and "what considerations impact the implementation of PIF assessment tools amongst medical students?". RESULTS Two thousand four hundred thirty six abstracts were reviewed, 602 full-text articles were evaluated, and 88 articles were included. The 3 domains identified were 1) theories, 2) assessment, and 3) implementation in assessing PIF. Differing attention to the different aspects of the PIF process impairs evaluations, jeopardise timely and appropriate support of medical students and hinder effective implementation of PIF assessments. CONCLUSION The Krishna-Pisupati model combines current theories and concepts of PIF to provide a more holistic perspective of the PIF process. Under the aegis of this model, Palliative Care and Oncology postings are envisaged as Communities of Practice influencing self-concepts of personhood and identity and shaping how medical students see their roles and responsibilities as future physicians. These insights allow the forwarding of nine recommendations to improve assessments of PIF and shape the design of a PIF-specific tool that can direct timely and personalized support of medical students.
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Affiliation(s)
- Kelly Jia Hui Teo
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Mac Yu Kai Teo
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Anushka Pisupati
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Rui Song Ryan Ong
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Chloe Keyi Goh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Claire Hui Xian Seah
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - You Ru Toh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Neha Burla
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Natalie Song Yi Koh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Kuang Teck Tay
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Min Chiam
- grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Warren Fong
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore General Hospital, Singapore, 169854 Singapore
| | - Limin Wijaya
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Division of Infectious Disease, Singapore General Hospital, 16 College Road, Block 6 Level 7, Singapore General Hospital, Singapore, 169854 Singapore
| | - Suzanne Pei Lin Goh
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,KK Women’s and Children Hospital, 100 Bukit Timah Rd, Singapore, 229899 Singapore
| | - Lalit Kumar Radha Krishna
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.10025.360000 0004 1936 8470Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK ,grid.4280.e0000 0001 2180 6431Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore ,The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, PalC, 308436 Singapore ,grid.10025.360000 0004 1936 8470Health Data Science, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
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George M, Brown T, Yu ML. The relationship between resilience, reflective thinking and professionalism in Australian undergraduate occupational therapy students. Scand J Occup Ther 2021; 29:229-241. [PMID: 33831320 DOI: 10.1080/11038128.2021.1908421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Professionalism is a key attribute that occupational therapy students must establish throughout their education. Resilience and reflective thinking are two skills that may underpin students' professionalism. OBJECTIVE To investigate whether resilience and reflective thinking are predictive of undergraduate occupational therapy students' professionalism. METHODS 152 occupational therapy undergraduate students completed the Professionalism Assessment Tool (PAT); the Resilience at University Scale (RAU); and the Reflective Thinking Scale (RTS). Regression analyses with bootstrapping were completed. RESULTS Regression models revealed that multiple domains of resilience and reflective thinking were predictive of the following professionalism variables: Reliability, Responsibility and Accountability (R2=0.080, p = 0.002); Lifelong Learning and Adaptability (R2=0.084, p = 0.01); Relationships with Others (R2=0.046, p = 0.03); and Citizenship and Professional Engagement (R2=0.110, p = 0.004). Common independent variables among these models included RTS Reflection, RAU Managing Stress and RAU Finding Your Calling. CONCLUSIONS AND SIGNIFICANCE This preliminary evidence revealed that when working together, factors of resilience and reflective thinking were predictive of occupational therapy student professionalism. Incorporating a greater focus on these skills into the occupational therapy education curriculum may help enhance student professionalism. Further research on resilience and reflective thinking, and the potential links to professionalism, is recommended.
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Affiliation(s)
- Madeline George
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Australia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Australia
| | - Mong-Lin Yu
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Australia
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Rozental L, Meitar D, Karnieli-Miller O. Medical students' experiences and needs from written reflective journal feedback. MEDICAL EDUCATION 2021; 55:505-517. [PMID: 33141960 DOI: 10.1111/medu.14406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Reflective ability is an important skill for enhancing professionalism and developing communication skills. To improve reflective ability, medical educators encourage use of written reflective journals, for which feedback is important. It is difficult for educators to anticipate how their feedback will be perceived. Therefore, this study examined students' experiences with educators' written feedback on reflective journals. METHODS A qualitative, immersion/crystallization analysis of 60 written feedback texts to 15 medical students (30 identified by students as meaningful and 30 as less meaningful) and in-depth semi-structured interviews with these students. We did not define 'meaningful', to leave room for students' own interpretations. We analysed the feedback to identify what it includes (its components) and analysed the interviews to learn about students' experiences of receiving the feedback and the specific components. RESULTS Students experienced five components as meaningful: supportive and encouraging statements; legitimisation of their emotions; educators sharing personal-professional experiences; asking questions to enhance reflection; and focusing on the students' main concern. These components enhanced students' willingness to read and learn from the feedback. Three components were experienced as less meaningful: detached, impersonal feedback; negative tone (criticism); and technical issues, for example brevity. These disappointing and hurtful components led students to pay less attention to the feedback or to invest less effort in future written assignments. CONCLUSIONS The present study identified components in written reflective journal feedback texts and the experience and needs of students who received them. It showed the complexity of writing reflective feedback because of the need to support students through it, help them deal with emotions, identify and focus on personal content that matters to them, and provide opportunities to develop and enhance their reflective ability, while being mindful of their emotional state. To help educators in this challenging task, a self-assessment mnemonic ('FEEDBACK') for use before sending the initial feedback was developed.
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Affiliation(s)
- Lior Rozental
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Meitar
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hanlon CD, Frosch EM, Shochet RB, Buckingham Shum SJ, Gibson A, Goldberg HR. Recognizing Reflection: Computer-Assisted Analysis of First Year Medical Students' Reflective Writing. MEDICAL SCIENCE EDUCATOR 2021; 31:109-116. [PMID: 34457870 PMCID: PMC8368857 DOI: 10.1007/s40670-020-01132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Reflective writing is used throughout medical education to help students navigate their transformation into medical professionals. Assessment of reflective writing, however, is challenging; each available methodology of assessment has distinct advantages and disadvantages. We tested if combining two independent assessment mechanisms-a faculty-designed rubric and Academic Writing Analytics (AWA), an automated technique-could be used together to form a more robust form of evaluation. METHODS We obtained reflective essays written by first year medical students as part of a clinical skills course. Faculty scored essays using a rubric designed to evaluate Integration, Depth, and Writing. The same essays were subjected to AWA analysis, which counted the number of reflective phrases indicative of Context, Challenge, or Change. RESULTS Faculty scored the essays uniformly high, indicating that most students met the standard for reflection as described by the rubric. AWA identified over 1400 instances of reflective behavior within the essays, and there was significant variability in how often different types of reflective phrases were used by individual students. CONCLUSIONS While data from faculty assessment or AWA alone is sufficient to evaluate reflective essays, combining these methods offer a richer and more valuable understanding of the student's reflection.
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Affiliation(s)
| | - Emily M. Frosch
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD USA
| | | | | | - Andrew Gibson
- Information Science, Queensland University of Technology, Brisbane, Australia
| | - Harry R. Goldberg
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD USA
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Karnieli-Miller O, Michael K, Gothelf AB, Palombo M, Meitar D. The associations between reflective ability and communication skills among medical students. PATIENT EDUCATION AND COUNSELING 2021; 104:92-98. [PMID: 32624329 DOI: 10.1016/j.pec.2020.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Assess associations between medical students' reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions. METHODS We analyzed 66 medical students' reflective ability, using 'REFLECT' rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. 'BAS' and 'SPIKES' questionnaires measured students' communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills. RESULTS Significant positive correlations between students' reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients' needs and address emotions. CONCLUSIONS High reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically. PRACTICE IMPLICATIONS Encourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients' reactions to them. This process may help students develop competency to share and tailor difficult information sensitively-a critical skill when communicating bad news.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Keren Michael
- Department of Human Services, Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel
| | - Ayelet Brand Gothelf
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Palombo
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Family Medicine, Clalit Health Services, Dan-Petah Tikva District, Israel
| | - Dafna Meitar
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Karnieli-Miller O. Reflective practice in the teaching of communication skills. PATIENT EDUCATION AND COUNSELING 2020; 103:2166-2172. [PMID: 32684444 DOI: 10.1016/j.pec.2020.06.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
Reflective practice is encouraged in medical education in general and in teaching communication skills in particular to develop into a reflective practitioner. However, the term is complex to understand and multidimensional thus challenging to grasp, describe and teach. Furthermore, though used frequently little guidance exists on how to promote reflective ability in teaching communication skills. This paper builds on a keynote address delivered at the International Conference of Communication in Healthcare (ICCH 2019) and is based on the vast literature on reflection and the author's personal experience as a researcher and educator. It discusses the components of reflective practice as well as exemplifies the importance of reflective practice to student's capability to learn communication skills.
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Affiliation(s)
- Orit Karnieli-Miller
- Tel Aviv University, Department of Medical Education, Sackler School of Medicine, 79968, Tel Aviv, Israel.
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10
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Wilkins EB. Facilitating Professional Identity Development in Healthcare Education. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/tl.20391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Krupat E, Dienstag JL, Padrino SL, Mayer JE, Shore MF, Young A, Chaudhry HJ, Pelletier SR, Reis BY. Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:888-895. [PMID: 31895703 DOI: 10.1097/acm.0000000000003145] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Recognizing that physicians must exhibit high levels of professionalism, researchers have attempted to identify the precursors of clinicians' professionalism difficulties, typically using retrospective designs that trace sanctioned physicians back to medical school. To better establish relative risk for professionalism lapses in practice, however, this relationship must also be studied prospectively. Therefore, this study investigated the sequelae of medical school professionalism lapses by following students with medical school professionalism problems into residency and practice. METHOD Beginning in 2014, 108 graduates from Harvard Medical School and Case Western Reserve University School of Medicine who appeared before their schools' review boards between 1993 and 2007 for professionalism-related reasons were identified, as well as 216 controls matched by sex, minority status, and graduation year. Prematriculation information and medical school performance data were collected for both groups. Outcomes for the groups were studied at 2 points in time: ratings by residency directors, and state medical board sanctions and malpractice suits during clinical practice. RESULTS Compared with controls, students who appeared before their schools' review boards were over 5 times more likely to undergo disciplinary review during residency (16% vs 3%, respectively) and almost 4 times more likely to require remediation or counseling (35% vs 9%, respectively). During clinical practice, 10% of those who had made review board appearances were sued or sanctioned vs 5% of controls. Logistic regression for these outcomes indicated, however, that professional lapses in medical school were not the only, or even the most important, predictor of problems in practice. CONCLUSIONS Students with professionalism lapses in medical school are significantly more likely to experience professionalism-related problems during residency and practice, although other factors may also play an important predictive role.
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Affiliation(s)
- Edward Krupat
- E. Krupat is associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. J.L. Dienstag is interim dean for faculty affairs and professor of medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. S.L. Padrino is assistant dean for clinical sciences, and assistant professor, Departments of Medicine and Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: http://orcid.org/0000-0001-5637-5870. J.E. Mayer Jr is professor of surgery, Boston Children's Hospital, Boston, Massachusetts. M.F. Shore, deceased, was professor emeritus, Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0002-5517-5874. H.J. Chaudhry is president and chief executive officer, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0003-3356-1106. S.R. Pelletier is senior project manager, Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts. B.Y. Reis is director, Predictive Medicine Group, Harvard Medical School and Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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Mak-van der Vossen M, Teherani A, van Mook W, Croiset G, Kusurkar RA. How to identify, address and report students' unprofessional behaviour in medical school. MEDICAL TEACHER 2020; 42:372-379. [PMID: 31880194 DOI: 10.1080/0142159x.2019.1692130] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students' unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the 'failure to fail' phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arianne Teherani
- Department of Medicine and Center for Faculty Educators, University of California, School of Medicine, San Francisco, CA, USA
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Gerda Croiset
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Williams JC, Ireland T, Warman S, Cake MA, Dymock D, Fowler E, Baillie S. Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:389-404. [PMID: 31108006 DOI: 10.1111/eje.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/16/2019] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care. MATERIALS AND METHODS A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost. RESULTS A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour. CONCLUSIONS Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.
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Affiliation(s)
- Julie C Williams
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Tony Ireland
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Sheena Warman
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Martin A Cake
- School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western Australia, Australia
| | - David Dymock
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Ellayne Fowler
- Centre for Medical Education, University of Bristol, Bristol, UK
| | - Sarah Baillie
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
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Burgess R, Vanstone M, Mountjoy M, Grierson L. Key differences between severity of disciplinary issues and medical student insights. MEDICAL EDUCATION 2019; 53:824-832. [PMID: 31134687 DOI: 10.1111/medu.13910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/21/2018] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT This study explores the reliability of tools designed to rate the type of remediable medical student offences, their severity, and the quality of student insight in response to the remediation, and tests the relationships between these three constructs. METHODS Data were collected via retrospective appraisal of remediation files from the 2009-2016 incoming classes of McMaster University's medical programme. Across two studies, 12 faculty members categorised the offences by type (academic or professionalism), and rated severity and insight by way of single anchored Likert scales. In Study 1, Krippendorff's alpha and independent, two-way, consistency type, average measures (k = 6), random-effects inter-rater reliability analyses were conducted to assess the inter-rater reliability of ratings of the measures. In Study 2, independent samples t-tests were conducted for the severity and insight measures as a function of offence type. Pearson correlations were used to assess the relationship between severity and insight as a function of offence type. RESULTS High inter-rater reliability was found with respect to the type of offence (α = 0.86), severity (0.92) and student insight (0.88). Mean (±standard deviation) ratings of severity are significantly higher for professionalism (4.37 ± 1.20) than academic offences (2.89 ± 1.25), t(73) = -5.3, p < 0.001, |d| = 1.21, whereas the opposite is true for ratings of insight, (professionalism, 3.19 ± 1.37; academic, 4.48 ± 1.01), t(73) = 4.6, p < 0.001, |d| = 1.07. Ratings of severity and insight are moderately negatively correlated for both academic (r = -0.64, p < 0.001, n = 38) and professionalism offences (r = -0.57, p < 0.001, n = 37). CONCLUSIONS Professionalism offences are perceived as more severe and are associated with lower insight than academic offences, pointing to the difficulty that learners face in assessing the constitution of a professionalism offence. This illustrates a need for deeper consideration about remedial strategies for lapses in professionalism.
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Affiliation(s)
- Raquel Burgess
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate Medical Education Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate Medical Education Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Education Research, Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate Medical Education Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate Medical Education Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Education Research, Innovation and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Mak-van der Vossen MC, de la Croix A, Teherani A, van Mook WNKA, Croiset G, Kusurkar RA. Developing a two-dimensional model of unprofessional behaviour profiles in medical students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:215-232. [PMID: 30387053 PMCID: PMC6484089 DOI: 10.1007/s10459-018-9861-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/23/2018] [Indexed: 05/12/2023]
Abstract
Standardized narratives or profiles can facilitate identification of poor professional behaviour of medical students. If unprofessional behaviour is identified, educators can help the student to improve their professional performance. In an earlier study, based on opinions of frontline teachers from one institution, the authors identified three profiles of medical students' unprofessional behaviour: (1) Poor reliability, (2) Poor reliability and poor insight, and (3) Poor reliability, poor insight and poor adaptability. The distinguishing variable was Capacity for self-reflection and adaptability. The current study used Nominal Group Technique and thematic analysis to refine these findings by synthesizing experts' opinions from different medical schools, aiming to develop a model of unprofessional behaviour profiles in medical students. Thirty-one experienced faculty, purposively sampled for knowledge and experience in teaching and evaluation of professionalism, participated in five meetings at five medical schools in the Netherlands. In each group, participants generated ideas, discussed them, and independently ranked these ideas by allocating points to them. Experts suggested ten different ideas, from which the top 3 received 60% of all ranking points: (1) Reflectiveness and adaptability are two distinct distinguishing variables (25%), (2) The term reliability is too narrow to describe unprofessional behaviour (22%), and (3) Profiles are dynamic over time (12%). Incorporating these ideas yielded a model consisting of four profiles of medical students' unprofessional behaviour (accidental behaviour, struggling behaviour, gaming-the-system behaviour and disavowing behaviour) and two distinguishing variables (reflectiveness and adaptability). The findings could advance educators' insight into students' unprofessional behaviour, and provide information for future research on professionalism remediation.
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Affiliation(s)
- Marianne C Mak-van der Vossen
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Anne de la Croix
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- LEARN! Academy, Vrije Universiteit, Amsterdam, The Netherlands
| | - Arianne Teherani
- Center for Faculty Educators, School of Medicine, University of California San Francisco, San Francisco, USA
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Gerda Croiset
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Bouayed H, Dost S, Hussain T. Medical students' reflective writings about challenging patient encounters: A final year medical students perspective. MEDICAL TEACHER 2019; 41:235. [PMID: 30282509 DOI: 10.1080/0142159x.2018.1513643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Hichem Bouayed
- a School of Medicine , Kings College London , London , UK
| | - Samiullah Dost
- a School of Medicine , Kings College London , London , UK
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Wald HS, White J, Reis SP, Esquibel AY, Anthony D. Grappling with complexity: Medical students' reflective writings about challenging patient encounters as a window into professional identity formation. MEDICAL TEACHER 2019; 41:152-160. [PMID: 29944035 DOI: 10.1080/0142159x.2018.1475727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been understudied. METHODS The authors developed an IRW curriculum within a Family Medicine Clerkship (FMC) and analyzed students? reflections about challenging/difficult patient encounters using immersion-crystallization qualitative analysis. RESULTS The qualitative analysis identified 26 unique emergent themes and five distinct thematic categories (1. Role of emotions, 2. Role of cognition, 3. Behaviorally responding to situational context, 4. Patient factors, and 5. External factors) as well as an emergent PIF model from a directed content analysis. The model describes students? backgrounds, emotions and previous experiences in medicine merging with external factors and processed during student?patient interactions. The RWs also revealed that processing often involves polarities (e.g. empathy/lack of empathy or encouragement/disillusionment) as well as dissonance between idealized visions and lived reality. CONCLUSIONS IRW facilitates and ideally supports grappling with the lived reality of medicine; uncovering a "positive hidden curriculum" within medical education. The authors propose engaging learners in guided critical reflection about complex experiences for meaning-making within a safe learning climate as a valuable way to cultivate reflective, resilient professionals with "prepared" minds and hearts for inevitable challenges of healthcare practice.
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Affiliation(s)
- Hedy S Wald
- a Department of Family Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Jordan White
- a Department of Family Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Shmuel P Reis
- a Department of Family Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA
- b Department of Medical Education , Hebrew University/Hadassah , Jerusalem , NY , USA
| | - Angela Y Esquibel
- c Department of Family Medicine , Mayo Clinic Health System Franciscan Healthcare in La Crosse , La Crosse , WI , USA
| | - David Anthony
- a Department of Family Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA
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Wald HS, Anthony D, White J, Reis S, Esquibel A. Interactive reflective writing-enhanced reflection and professional identity formation in medical education - in reply to (1) Hichem Bouayed, Samiullah Dost, and Tanzeel Hussian and (2) Alexander Morgan, James Moore and Alexander Duff. MEDICAL TEACHER 2019; 41:236-237. [PMID: 30663478 DOI: 10.1080/0142159x.2018.1543861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Hedy S Wald
- a Family Medicine, Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - David Anthony
- a Family Medicine, Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Jordan White
- b Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Shmuel Reis
- c Medical Education , Hebrew University Hadassah Medical School , Jerusalem , Israel
| | - Angela Esquibel
- d Mayo Clinic Health System Franciscan Healthcare in La Crosse Family Medicine , La Crosse , WI , USA
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Ainsworth MA, Szauter KM. Student response to reports of unprofessional behavior: assessing risk of subsequent professional problems in medical school. MEDICAL EDUCATION ONLINE 2018; 23:1485432. [PMID: 29912668 PMCID: PMC6008585 DOI: 10.1080/10872981.2018.1485432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND An early concern note (ECN) program is used by some medical schools to identify, counsel, and intervene when students exhibit unprofessional behavior. Student maturity, insight, propensity for reflection, and receptiveness to feedback have been suggested as predictors of future behavior. OBJECTIVE We hypothesized that (a) classifying students with a first ECN based on their response to the report would identify students at risk of repeat ECNs better than the action that prompted it and (b) receipt of multiple ECNs would identify students at risk of adverse academic events. DESIGN For this study, 459 ECNs were classified based on students' (1) recognition that their behavior was inappropriate and (2) acceptance of responsibility for the behavior. Student academic progress and receipt of subsequent ECNs were tracked. RESULTS Students who recognized their behavior was inappropriate and accepted responsibility after an initial ECN received subsequent ECNs at lower rates (14-19%) than students who disagreed with the significance of their behavior or were resistant to accepting responsibility (36-59%). Students with limited insight and adaptability appeared to be at highest risk. Seventy-one percent of students with three or more ECNs encountered adverse academic events during enrollment. CONCLUSION Student reactions to reports of unprofessional behavior may be useful as a tool to help assess risk of recurrent lapses. Students with diminished capacity to recognize behaviors as unprofessional or accept responsibility for them appear to be at highest risk for additional adverse academic and professionalism events while in medical school.
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Affiliation(s)
- Michael A. Ainsworth
- Department of Internal Medicine and Senior Associate Dean for Educational Performance, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen M. Szauter
- Department of Internal Medicine and Assistant Dean, Educational Affairs, University of Texas Medical Branch, Galveston, TX, USA
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Hoffman LA, Mehta R, Vu TR, Frankel RM. Experiences of Female and Male Medical Students With Death, Dying, and Palliative Care: One Size Does Not Fit All. Am J Hosp Palliat Care 2017; 35:852-857. [PMID: 29262696 DOI: 10.1177/1049909117748616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Medical students learn about death, dying, and palliative care (DDPC) through formal curricular offerings and informal clinical experiences; however, the lessons learned in the clinic may be at odds with the formal curriculum. Reflective writing is a means for students to "bracket" their DDPC experiences and reconcile conflicts between the formal and informal curriculum. OBJECTIVES The aim of this study is to compare the level of reflection demonstrated in medical students' narratives on DDPC with other experiences and to examine the domains of professionalism that students perceive to be prevalent in their DDPC experiences. METHODS Third-year medical students submitted professionalism narratives during their internal medicine clerkship. We identified a subset of narratives related to DDPC (n = 388) and randomly selected control narratives (n = 153). We assessed the level of reflection demonstrated in the narratives using a validated rubric and analyzed the professionalism domains that students identified as relevant to their experience. RESULTS There was no difference in reflective level between DDPC and control narratives. Within the DDPC group, female students demonstrated higher reflection (2.24 ± 0.71) than male students (2.01 ± 0.77; P < .001). Caring, compassion and communication, and honor and integrity were prominent among DDPC narratives. More females identified caring, compassion, and communication as relevant to their DDPC experiences, whereas more males identified altruism. CONCLUSION Males and females have different perceptions of DDPC experiences, and female students appear to be more deeply impacted. These findings can help clinical faculty engage students more effectively with this challenging topic.
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Affiliation(s)
- Leslie A Hoffman
- 1 Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, IN, USA
| | - Rakesh Mehta
- 2 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Robert Vu
- 2 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard M Frankel
- 2 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,3 Regenstrief Institute, Indianapolis, IN, USA.,4 Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
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Mak-van der Vossen M, van Mook W, van der Burgt S, Kors J, Ket JC, Croiset G, Kusurkar R. Descriptors for unprofessional behaviours of medical students: a systematic review and categorisation. BMC MEDICAL EDUCATION 2017; 17:164. [PMID: 28915870 PMCID: PMC5603020 DOI: 10.1186/s12909-017-0997-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/04/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Developing professionalism is a core task in medical education. Unfortunately, it has remained difficult for educators to identify medical students' unprofessionalism, because, among other reasons, there are no commonly adopted descriptors that can be used to document students' unprofessional behaviour. This study aimed to generate an overview of descriptors for unprofessional behaviour based on research evidence of real-life unprofessional behaviours of medical students. METHODS A systematic review was conducted searching PubMed, Ebsco/ERIC, Ebsco/PsycINFO and Embase.com from inception to 2016. Articles were reviewed for admitted or witnessed unprofessional behaviours of undergraduate medical students. RESULTS The search yielded 11,963 different studies, 46 met all inclusion criteria. We found 205 different descriptions of unprofessional behaviours, which were coded into 30 different descriptors, and subsequently classified in four behavioural themes: failure to engage, dishonest behaviour, disrespectful behaviour, and poor self-awareness. CONCLUSIONS This overview provides a common language to describe medical students' unprofessional behaviour. The framework of descriptors is proposed as a tool for educators to denominate students' unprofessional behaviours. The found behaviours can have various causes, which should be explored in a discussion with the student about personal, interpersonal and/or institutional circumstances in which the behaviour occurred. Explicitly denominating unprofessional behaviour serves two goals: [i] creating a culture in which unprofessional behaviour is acknowledged, [ii] targeting students who need extra guidance. Both are important to avoid unprofessional behaviour among future doctors.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
- Department for General Practice and Elderly Care Management, VU Medical Center, Amsterdam, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Education Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Stéphanie van der Burgt
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Joyce Kors
- AVAG Midwifery Academy Amsterdam Groningen, Amsterdam, the Netherlands
| | - Johannes C.F. Ket
- Medical Library, University Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gerda Croiset
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Rashmi Kusurkar
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
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Developing a Physician׳s Professional Identity Through Medical Education. Am J Med Sci 2017; 353:101-108. [DOI: 10.1016/j.amjms.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022]
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Tucker CR, Choby BA, Moore A, Parker RS, Zambetti BR, Naids S, Scott J, Loome J, Gaffney S. Speaking up: using OSTEs to understand how medical students address professionalism lapses. MEDICAL EDUCATION ONLINE 2016; 21:32610. [PMID: 27814779 PMCID: PMC5097152 DOI: 10.3402/meo.v21.32610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/31/2016] [Accepted: 09/26/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Objective-structured teaching encounters (OSTEs) are used across many disciplines to assess teaching ability. The OSTE detailed in this paper assesses 191 fourth-year medical students' (M4) ability to identify and address lapses in professionalism based on Association of American Medical Colleges' professionalism competencies. The research questions addressed are How frequently do M4s address professionalism lapses observed during an OSTE? What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE? METHODS Standardized patients (SPs) and standardized learners (SLs) were recruited and trained to participate in a standardized encounter with specific cognitive, social, and behavioral errors, including professionalism lapses. M4s viewed this encounter and then offered feedback to the SL, while remotely observed by faculty. Post-encounter, the SL and faculty completed identical checklists to assess both teaching readiness and ability to address professionalism concerns. RESULTS An analysis of frequencies showed that six of the Association of American Medical Colleges' nine professional competencies were addressed in the checklist and/or discussed in the focus group. Analysis of transcribed debriefing sessions confirmed that M4s did not consistently address professionalism lapses by their peers. CONCLUSIONS In focus groups, M4s indicated that, while they noticed professionalism issues, they were uncomfortable discussing them with the SLs. Findings of the current study suggest how medical educators might support learners' ability to address lapses in professionalism as well as topics for future research.
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Affiliation(s)
- Constance R Tucker
- Faculty Development, McGlothlin Medical Education Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA;
| | - Beth A Choby
- Department of Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew Moore
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Scott Parker
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Benjamin R Zambetti
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah Naids
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jillian Scott
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer Loome
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sierra Gaffney
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
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