The Patient Experience Debrief Interview: How Conversations With Hospitalized Families Influence Medical Student Learning and Reflection

A systematic scoping review on group non-written reflections in medical education

BACKGROUND

Medical education is tasked with shaping how medical students and physicians think, feel and act as professionals, or their Professional Identity Formation (PIF). This process has traditionally rested upon imparting knowledge; integrating sociocultural, professional and organizational expectations and codes of conduct; inculcating program and practice beliefs, values and principles (belief systems); and imbuing shared identities - quintessential elements that, together, comprise the socialization process. Key to supporting this socialization process is reflective practice. However, regnant approaches to mobilizing reflective cycles are faced with resource, personnel and time constraints, hindering efforts to nurture PIF. Group non-written reflections (GNWR) - broadly defined as facilitator-led discussions of shared reflective experiences within groups of learners - may prove to be an effective compromise. To address diverse approaches and a lack of effective understanding, we propose a systematic scoping review (SSR) to map the current use of GNWR in medical training and its role in shaping PIF.

METHODS

Guided by the Systematic Evidence-Based Approach (SEBA)'s constructivist ontological and relativist epistemological position, this SSR in SEBA searched for articles on GNWR published in PubMed, Embase, Psychinfo, CINAHL, ERIC, ASSIA, SCOPUS, Google Scholar, Open Grey, GreyLit and ProQuest databases. The data found was concurrently analyzed using thematic and direct content analysis. Complementary themes and categories identified were combined, creating the domains that framed the discussion.

RESULTS

Of the 8560 abstracts and 336 full-text articles reviewed, 98 articles were included. The four domains identified were: (1) Indications of use and their value; (2) Structure and how they can be used; (3) Models of reflective practice in GNWR; and (4) Features of communities of practice and the socialisation process.

CONCLUSION

This SSR in SEBA concludes that GNWR does impact PIF when effectively structured and supported. The Krishna-Pisupati Model for PIF platforms a model that explains GNWR's effects of PIF and advances fourteen recommendations to maximize GNWR use.

Exploring the complexity of acute inpatient mental health nurses experience of chemical restraint interventions: Implications on policy, practice and education

Chemical restraint research is growing with multiple healthcare disciplines increasing focused on understanding uses, harms of restraint and restraint reduction in inpatient mental health settings. Despite increased restraint research relatively little is known about nurses' experiences of administering chemical restraint. The research question guiding this study was: what are mental health nurses' experiences of using chemical restraint interventions in times of behavioural emergency on adult inpatient acute mental health units? The purpose of the research was to understand direct care nurses' first-hand experiences in use of chemical restraint interventions. Eight adult acute inpatient mental health nurses were interviewed using hermeneutic phenomenological method. The aim of this paper to discuss three themes that emerged in the research which clearly highlight the complex ethical issues and education needs of mental health nurses who use chemical restraint: working within constraints, making medication choices, and transitioning from novice to expert. Research findings indicated a need for further focus on medication best practice, policy development and nurse education. These exploratory research findings can be used to both inform and challenge dominant inpatient mental health practice to guide nurses, health care leaders, and policy makers by increasing understanding of the complex ethical decision-making required for use of chemical restraint interventions. Education strategies can be developed from the findings which highlight integral ways that nurses make meaning in their administering of chemical restraint, and their accompanied insights into the complex clinical and ethical decision-making aspects involved in nursing care.

Medical student perspectives on conducting patient experience debrief interviews with hospitalized children and their families

PURPOSE

To explore how medical students completing a pediatric clerkship viewed the benefits and barriers of debrief interviews with hospitalized patients and families.

METHODS

In this study, focus groups were conducted with pediatric clerkship students after completion of a debrief interview. The constant comparative method was used with Mezirow's transformative learning theory as a lens to explore perceptions of the benefits and challenges of performing the interview.

RESULTS

Focus groups revealed five benefits and two challenges. The benefits were that the debrief interviews helped students (1) humanize patients and appreciate social and environmental influences on patient health, (2) assess caregiver/patient understanding about care to correct misunderstandings, (3) actively involve caregivers/patients in treatment plan development, (4) engage patients in active expression of questions/concerns, and (5) recognize the value of their own role on the healthcare team. The challenges were that students felt (1) a lack of knowledge to answer caregivers'/patients' questions about diagnoses and (2) discomfort responding to caregiver/patient frustration, anxiety, or sadness. Student feedback on feasibility and implementation led to guidelines for selecting patients and conducting small group discussions after the debrief interviews.

CONCLUSIONS

Debrief interviews offer a unique approach for learners to explore patient perspectives during hospitalization through direct patient engagement and dialogue, contributing to professional development, empathy, and potentially more positive patient care experiences.

The Positivism Paradigm of Research

Research paradigms guide scientific discoveries through their assumptions and principles. Understanding paradigm-specific assumptions helps illuminate the quality of findings that support scientific studies and identify gaps in generating sound evidence. This article focuses on the research paradigm of positivism, examining its definition, history, and assumptions (ontology, epistemology, axiology, methodology, and rigor). Positivism is aligned with the hypothetico-deductive model of science that builds on verifying a priori hypotheses and experimentation by operationalizing variables and measures; results from hypothesis testing are used to inform and advance science. Studies aligned with positivism generally focus on identifying explanatory associations or causal relationships through quantitative approaches, where empirically based findings from large sample sizes are favored-in this regard, generalizable inferences, replication of findings, and controlled experimentation have been principles guiding positivist science. Criteria for evaluating the quality of positivist research are discussed. An example from health professions education is provided to guide positivist thinking in study design and implementation.

Focal Length Fluidity: Research Questions in Medical Education Research and Scholarship

Research and scholarship in health professions education has been shaped by intended audience (i.e., producers vs users) and the purpose of research questions (i.e., curiosity driven or service oriented), but these archetypal dichotomies do not represent the breadth of scholarship in the field. Akin to an array of lenses required by scientists to capture images of a black hole, the authors propose the analogy of lenses with different focal lengths to consider how different kinds of research questions can offer insight into health professions research-a microscope, a magnifying glass, binoculars, and telescopes allow us to ask and answer different kinds of research questions. They argue for the relevance of all of the different kinds of research questions (or focal lengths); each provides important insight into a particular phenomenon and contributes to understanding that phenomenon in a different way. The authors propose that research questions can move fluidly across focal lengths. For example, a theoretical question can be made more pragmatic through asking "how" questions ("How can we observe and measure a phenomenon?"), whereas a pragmatic question can be made more theoretic by asking a series of "why" questions ("Why are these findings relevant to larger issues?"). In summary, only through the combination of lenses with different focal lengths, brought to bear through interdisciplinary work, can we fully comprehend important phenomena in health professions education and scholarship-the same way scientists managed to image a black hole.