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Makarem NN, Rahme DV, Brome D, Saab BR. Grading reflective essays: the construct validity and reliability of a newly developed Tool- GRE-9. BMC MEDICAL EDUCATION 2023; 23:870. [PMID: 37974119 PMCID: PMC10655370 DOI: 10.1186/s12909-023-04845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The main objective of this study is to assess the construct validity and reliability of the Grading Reflective Essays-9 (GRE-9). METHODS This study took place in a major tertiary academic medical center in Beirut, Lebanon. 104 reflective essays written by years 1-3 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 2 trained raters who independently scored the essays using GRE-9. GRE-9 scores were then correlated with scores on communication skills OSCE stations and in-training examinations to investigate, respectively, convergent and divergent validity. One of the 2 raters scored the essays twice one month apart to assess the reliability of the GRE-9 using intra rater reliability and internal consistency. RESULTS There was a weak, non-significant correlation between GRE-9 score and In training examination (ITE) score (r = - .213, p = .395). There was a moderate, non-significant correlation between GRE-9 scores and the Objective structured clinical examination (OSCE) communication station scores (r = - .412 p = .162). The correlation coefficient between trails 1 and 2 was significant (r = .832, p = .000). Intra class correlation coefficient (ICC) analysis demonstrated almost perfect intra-rater agreement (0.819; 95% CI: 0.741-0.875) of the test ratings over time. CONCLUSIONS GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial intra-rater reliability and evidence of divergent validity. The study found non-significant correlations between reflective writing scores OSCE communication scores demonstrating a lack of relationship between reflective writing and this measure of performance.
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Affiliation(s)
- Nisrine N Makarem
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Diana V Rahme
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Dayana Brome
- Psychology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem R Saab
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Price N, Jowsey T, Weller J. Reflecting on insight and insights into reflection: a systematic review of insight and reflection in post graduate medical education. ANZ J Surg 2023; 93:2589-2599. [PMID: 37749849 DOI: 10.1111/ans.18693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Clinicians recognize insight as important for safe independent medical practice. Clinical education literature focuses on self-reflection. The aim of this review is to describe how clinical educators conceptualize reflection and ask is it analogous to how clinicians conceptualize insight? METHODS Using PRISMA guidelines, a systematic review of the literature around insight and reflection in postgraduate medical education was undertaken. A thematic analysis of the concepts of insight and reflection was performed. RESULTS A total of 75 reports were included in the analysis. The literature focussed predominantly on reflection with little discussion of insight. Three main themes were generated: episodic reflection; cyclic reflection; reflection as a state. Reflection as a state seemed to be the professional quality most often aspired to but was less well defined in terms of educational interventions. When more than one model was described, it was often with a reflective state being the ideal that episodic or cyclic reflection may approximate. It is not clear that it is possible to progress up the hierarchy. CONCLUSION We present a novel description of a hierarchy from discrete episodes of reflection, to cyclic processes that involve reflection, through to a state in which the practitioner is reflective. There is no unified understanding of how an individual ascends this hierarchy, or a cohesive description of what insight is for an independent medical practitioner. This review highlights the need for research into how practicing clinicians conceptualize and characterize insight in their training and practice.
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Affiliation(s)
- Neil Price
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Lanocha N, Mahoney D. Fostering Humanism Through Stories: A Plea for Narrative Medicine in Palliative Care Education. J Pain Symptom Manage 2023; 65:e229-e231. [PMID: 35151800 DOI: 10.1016/j.jpainsymman.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/19/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Natalie Lanocha
- Oregon Health and Science University (N.L.), Portland, Oregon, USA; Texas Children's Hospital, Baylor College of Medicine (D.M.), Houston, Texas, USA.
| | - Daniel Mahoney
- Oregon Health and Science University (N.L.), Portland, Oregon, USA; Texas Children's Hospital, Baylor College of Medicine (D.M.), Houston, Texas, USA
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Lim RBT, Tan CGL, Hoe KWB, Teng CWC, Müller AM, Azfar J, Narayanasamy S, Liow CH. Correlates, motivating factors, and barriers of engaging in regular self-reflection among public health students in higher education-A mixed methods approach. Front Public Health 2022; 10:1023439. [PMID: 36408036 PMCID: PMC9670312 DOI: 10.3389/fpubh.2022.1023439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Despite the wide implementation of self-reflection in higher education, the body of literature has predominantly focused on students from the clinical health sciences rather than public health. The objective of this study was to evaluate the correlates as well as to explore the motivating factors and barriers of engaging in regular self-reflection among public health students in higher education. We used a mixed methods approach (explanatory sequential design), comprising a cross-sectional survey (quantitative phase) followed by in-depth interviews (qualitative phase). We evaluated the association between reflection frequency as well as the perceptions and facilitators in reflection using the modified Breslow-Cox proportional hazards regression model. Prevalence ratio (PR) was generated. Thematic data analysis was carried out to analyse the qualitative data. Quantitative findings revealed being a regular reflector was positively associated with being more motivated to learn when one applied self-reflection (adjusted PR 1.60, 95% CI 1.17-2.20), the perception of being more prepared for a public health career in the future (adjusted PR 1.28, 95% CI 1.02-1.60), as well as being given enough opportunities to carry out self-reflection in the public health modules (adjusted PR 1.24, 95% CI 1.05-1.45). Qualitative findings revealed most students started their self-reflection mainly due to extrinsic factors such as institutional support, social support, teacher influence and environmental influence. Of these, the most prominent was teacher influence, indicating that they are key agents in promoting self-reflection. Students expressed that it would be important to cultivate intrinsic motivation to sustain their practice of self-reflection along the learning journey such as for the development of career-related professional skills. Other than intrinsic motivation, environmental influences were also important to promote continual reflection among students such as the availability of ample opportunities. Prominent barriers to address included external student factors such as the imbalanced power relationship between teacher and student, and internal student factors such as the perception that self-reflection was too cumbersome and time consuming.
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Gaetani M, Min KS, Proulx C, Mema B. Reflection, refraction, resilience: the transformative potential of art. Can J Anaesth 2022; 69:568-571. [PMID: 34782998 PMCID: PMC8592672 DOI: 10.1007/s12630-021-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Melany Gaetani
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kyung-Seo Min
- Department of History of Art, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine Proulx
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Briseida Mema
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Shapiro J, McMullin J, Miotto G, Nguyen T, Hurria A, Nguyen MA. Medical Students' Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:603-625. [PMID: 34779996 PMCID: PMC8664798 DOI: 10.1007/s10912-021-09713-2] [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] [Accepted: 09/30/2021] [Indexed: 05/09/2023]
Abstract
INTRODUCTION This study examines differences in students' perceived value of three artmaking modalities (poetry, comics, masks) and whether the resulting creative projects offer similar or different insights into medical students' professional identity formation. METHODS Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students' original work. RESULTS Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities. DISCUSSION Regardless of type of artmaking, students express concern about encroachments of training on personal identity but hoped that personal and professional selves could be integrated.
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Affiliation(s)
- Johanna Shapiro
- Department of Family Medicine, School of Medicine, UC Irvine Medical Center, University of California Irvine, rte 81, bldg. 200, rm 835, 101 City Dr. South, Orange, CA, 92868, USA.
| | - Juliet McMullin
- Department of Anthropology, University of California Riverside, Riverside, CA, USA
| | | | - Tan Nguyen
- Department of Family Medicine, School of Medicine, UC Irvine Medical Center, University of California Irvine, rte 81, bldg. 200, rm 835, 101 City Dr. South, Orange, CA, 92868, USA
| | - Anju Hurria
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Orange, CA, 92868, USA
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Cunningham H, Taylor DS, Desai UA, Ender KL, Glickstein J, Krishnan US, Richards BF, Charon R, Balmer DF. Reading the Self: Medical Students' Experience of Reflecting on Their Writing Over Time. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1168-1174. [PMID: 33149084 DOI: 10.1097/acm.0000000000003814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate students' experience (over time) with meta-reflection writing exercises, called Signature Reflections. These exercises were used to strengthen reflective capacity, as part of a 4-year reflective writing portfolio curriculum that builds on a recognized strategy for reflection (narrative medicine) and employs longitudinal faculty-mentors. METHOD In 2018, the authors conducted 5 focus groups with 18 third-year students from the Columbia University Vagelos College of Physicians and Surgeons class of 2019 to examine students' experience with Signature Reflections. Using an iterative, thematic approach, they developed codes to reflect common patterns in the transcripts, distilled conceptually similar codes, and assembled the code categories into themes. RESULTS Three core themes (safe space, narrative experience, mirror of self) and 1 overarching theme (moving through time) were identified. Students frequently experienced relief at having a safe reflective space that promoted grappling with their fears or vulnerabilities and highlighted contextual factors (e.g., trusted faculty-mentors, protected time) that fostered a safe space for reflection and exploration. They often emphasized the value of tangible documentation of their medical school journey (narrative experience) and reported using Signature Reflections to examine their emerging identity (mirror of self). Overlapping with the core themes was a deep appreciation for the temporal perspective facilitated by the Signature Reflections (moving through time). CONCLUSIONS A longitudinal narrative medicine-based portfolio curriculum with pauses for meta-reflection allowed students, with faculty support, to observe their trajectory through medical school, explore fears and vulnerabilities, and narrate their own growth. Findings suggest that narrative medicine curricula should be required and sufficiently longitudinal to facilitate opportunities to practice the skill of writing for insight, foster relationships with faculty, and strengthen students' temporal perspectives of their development.
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Affiliation(s)
- Hetty Cunningham
- H. Cunningham is associate professor of pediatrics, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0003-1686-0497
| | - Delphine S Taylor
- D.S. Taylor is associate professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-1999-0388
| | - Urmi A Desai
- U.A. Desai is assistant professor of medicine, Center for Family and Community Medicine, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Katherine L Ender
- K.L. Ender is assistant professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Julie Glickstein
- J. Glickstein is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Usha S Krishnan
- U.S. Krishnan is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0002-5733-6096
| | - Boyd F Richards
- B.F. Richards is professor of pediatrics, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-1864-7238
| | - Rita Charon
- R. Charon is professor of medicine, Department of Medicine, and professor of medical humanities & ethics, Department of Medical Humanities & Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-6003-5219
| | - Dorene F Balmer
- D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-6805-4062
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Moniz T, Golafshani M, Gaspar CM, Adams NE, Haidet P, Sukhera J, Volpe RL, de Boer C, Lingard L. How Are the Arts and Humanities Used in Medical Education? Results of a Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1213-1222. [PMID: 33830951 DOI: 10.1097/acm.0000000000004118] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Although focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine. METHOD The authors conducted a scoping review in 2019 to identify how the arts and humanities are used to educate physicians and interprofessional learners across the medical education continuum in Canada and the United States. A search strategy involving 7 databases identified 21,985 citations. Five reviewers independently screened the titles and abstracts. Full-text screening followed (n = 4,649). Of these, 769 records met the inclusion criteria. The authors performed descriptive and statistical analyses and conducted semistructured interviews with 15 stakeholders. RESULTS The literature is dominated by conceptual works (n = 294) that critically engaged with arts and humanities approaches or generally called for their use in medical education, followed by program descriptions (n = 255). The literary arts (n = 197) were most common. Less than a third of records explicitly engaged theory as a strong component (n = 230). Of descriptive and empirical records (n = 424), more than half concerned undergraduate medical education (n = 245). There were gaps in the literature on interprofessional education, program evaluation, and learner assessment. Programming was most often taught by medical faculty who published their initiatives (n = 236). Absent were voices of contributing artists, docents, and other arts and humanities practitioners from outside medicine. Stakeholders confirmed that these findings resonated with their experiences. CONCLUSIONS This literature is characterized by brief, episodic installments, privileging a biomedical orientation and largely lacking a theoretical frame to weave the installments into a larger story that accumulates over time and across subfields. These findings should inform efforts to promote, integrate, and study uses of the arts and humanities in medical education.
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Affiliation(s)
- Tracy Moniz
- T. Moniz is associate professor, Department of Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; ORCID: https://orcid.org/0000-0002-5078-4611
| | - Maryam Golafshani
- M. Golafshani is a second-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn M Gaspar
- C.M. Gaspar is a PhD candidate, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada; ORCID: https://orcid.org/0000-0003-0412-5495
| | - Nancy E Adams
- N.E. Adams is associate librarian and assistant dean of foundational sciences, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-0534-6716
| | - Paul Haidet
- P. Haidet is director of medical education research, Woodward Center for Excellence in Health Sciences Education, Penn State College of Medicine, Hershey, Pennsylvania
| | - Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Rebecca L Volpe
- R.L. Volpe is associate professor and vice chair for education, Department of Humanities, Penn State College of Medicine, and director, Clinical Ethics Consultation Service, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-3406-9498
| | - Claire de Boer
- C. de Boer is director, The Doctors Kienle Center for Humanistic Medicine, and founding director, Center Stage Arts in Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania. She is president, National Organization for Arts in Health, San Diego, California
| | - Lorelei Lingard
- L. Lingard is professor, Department of Medicine, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Huang CD, Jenq CC, Liao KC, Lii SC, Huang CH, Wang TY. How does narrative medicine impact medical trainees' learning of professionalism? A qualitative study. BMC MEDICAL EDUCATION 2021; 21:391. [PMID: 34289848 PMCID: PMC8296619 DOI: 10.1186/s12909-021-02823-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/09/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Narrative medicine (NM) is an approach involving narrative skills and is regarded as a model for medical humanism and effective medical practice. This study aims to explore how NM impacts medical trainees' learning of professionalism during a clerkship in a Taiwanese clinical setting. METHODS A qualitative interview study adopting a purposive sampling method was undertaken. Thirty medical trainees participated in this study, including five fifth-year medical students (MSs), ten sixth-year MSs, nine seventh-year MSs, and six postgraduate year (PGY) trainees. Thematic framework analysis was applied, and a modified realist evaluation approach was further used to analyse the interview data. RESULTS We identified self-exploration, reflection, and awareness of professional identity as mechanisms explaining how NM impacted professionalism learning in our participants. Furthermore, empathy, communication, doctor-patient relationship and understanding patients were identified as the outcomes of the NM intervention for trainees' learning of professionalism. CONCLUSIONS NM facilitates medical trainees' self-exploration, reflection, and awareness of professional identity, thereby affecting their learning of professionalism in clinical settings. Adopting NM as an educational intervention in undergraduate medical education could play an important role in professionalism learning, as trainees can thereby be supported to gradually develop self-exploration and reflection capabilities and heightened awareness of professional identity reflectively through a narrative process.
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Affiliation(s)
- Chien-Da Huang
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun Hua N. Rd., Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chang-Chyi Jenq
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun Hua N. Rd., Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Kuo-Chen Liao
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun Hua N. Rd., Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Department of General Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Shu-Chung Lii
- Department of Medical Humanities and Social Sciences, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chi-Hsien Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Tsai-Yu Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Liao KC, Peng CH, Snell L, Wang X, Huang CD, Saroyan A. Understanding the lived experiences of medical learners in a narrative medicine course: a phenomenological study. BMC MEDICAL EDUCATION 2021; 21:321. [PMID: 34090423 PMCID: PMC8180022 DOI: 10.1186/s12909-021-02741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Reflection and various approaches to foster reflection have been regarded as an indispensable element in enhancing professional practice across different disciplines. With its inherent potential to engage learners in reflection and improvement, narrative medicine has been adopted in various settings. However, the relevance and effectiveness of reflection remains underexplored in the context of narrative medicine, specifically in regard to the concern about variability of learner acceptance and the way learners really make sense of these reflective activities. This study aimed to explore what medical learners experience through narrative medicine and the meanings they ascribe to the phenomenon of this narrative-based learning. METHODS Using a transcendental phenomenology approach, twenty medical learners were interviewed about their lived experiences of taking a narrative medicine course during their internal medicine clerkship rotation. Moustakas' phenomenological analysis procedures were applied to review the interview data. RESULTS Six themes were identified: feeling hesitation, seeking guidance, shifting roles in narratives, questioning relationships, experiencing transformation, and requesting a safe learning environment. These themes shaped the essence of the phenomenon and illustrated what and how medical learners set out on a reflective journey in narrative medicine. These findings elucidate fundamental elements for educators to consider how narrative approaches can be effectively used to engage learners in reflective learning and practice. CONCLUSION Adopting Moustakas' transcendental phenomenology approach, a better understanding about the lived experiences of medical learners regarding learning in narrative medicine was identified. Learner hesitancy should be tackled with care by educators so as to support learners with strategies that address guidance, relationship, and learning environment. In so doing, medical learners can be facilitated to develop reflective capabilities for professional and personal growth.
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Affiliation(s)
- Kuo-Chen Liao
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Taoyuan, 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chang-Hsuan Peng
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Linda Snell
- Institute of Health Sciences Education and Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Xihui Wang
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Quebec, Canada
| | - Chien-Da Huang
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Chest and Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alenoush Saroyan
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Quebec, Canada
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Farrell LM, Buydens S, Bourgeois-Law G, Regehr G. Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:82-91. [PMID: 34249193 PMCID: PMC8263038 DOI: 10.36834/cmej.70224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration. METHODS This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops: Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis. RESULTS Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group. This sense of community created a safe space for reflection, while motivating ongoing efforts to learn the skill. Individual pre-reflection prepared individuals for group co-reflection; however, written narratives were not essential. CONCLUSION LFD initiatives should include an emphasis on ensuring opportunities for iterative attempts of teaching skills, guided self-reflection, and collaborative group reflection and learning to ensure sustainable change to teaching practices.
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Affiliation(s)
- Laura M Farrell
- Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Sarah Buydens
- Department of Family Medicine, University of British Columbia, British Columbia, Canada
| | - Gisele Bourgeois-Law
- Department of Obstetrics and Gynecology, University of British Columbia, British Columbia, Canada
| | - Glenn Regehr
- Department of Surgery, Faculty of Medicine, University of British Columbia, British Columbia
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Lanocha N. Lessons in Stories: Why Narrative Medicine Has a Role in Pediatric Palliative Care Training. CHILDREN-BASEL 2021; 8:children8050321. [PMID: 33922034 PMCID: PMC8143552 DOI: 10.3390/children8050321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 01/04/2023]
Abstract
Narrative medicine is introduced and explored as a potential tool for developing competency in medical training, including reduction of burnout, sustaining empathy, and allowing for reflective practice. Developing cultural humility, communication skills, ethics, community building, and advocacy are also reviewed as domains that may be bolstered by training in narrative. Applications specific to pediatric palliative care are suggested, along with avenues for further research.
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Affiliation(s)
- Natalie Lanocha
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA
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Shrivastava S, Shrivastava P. Encouraging reflection among medical undergraduate and postgraduate students for advancement of learning and development of skills. JOURNAL OF THE SCIENTIFIC SOCIETY 2021. [DOI: 10.4103/jss.jss_7_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shrivastava S, Shrivastava P. Inculcating the practice of reflection among medical students: Role of teachers. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2021. [DOI: 10.4103/mjmsr.mjmsr_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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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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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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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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Makarem NN, Saab BR, Maalouf G, Musharafieh U, Naji F, Rahme D, Brome D. Grading reflective essays: the reliability of a newly developed tool- GRE-9. BMC MEDICAL EDUCATION 2020; 20:331. [PMID: 32988408 PMCID: PMC7520967 DOI: 10.1186/s12909-020-02213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The main objective of this study is the development of a short reliable easy-to-use assessment tool in the aim of providing feedback to the reflective writings of medical students and residents. METHODS This study took place in a major tertiary academic medical center in Beirut, Lebanon. Seventy-seven reflective essays written by 18 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 3 raters using the newly developed scale to assess the scale reliability. Following a comprehensive search and analysis of the literature, and based on their experience in reflective grading, the authors developed a concise 9-item scale to grade reflective essays through repeated cycles of development and analysis as well as the determination of the inter-rater reliability (IRR) using intra-class correlation coefficients (ICC) and Krippendorff's Alpha. RESULTS The inter-rater reliability of the new scale ranges from moderate to substantial with ICC of 0.78, 95% CI 0.64-0.86, p < 0.01 and Krippendorff's Alpha was 0.49. CONCLUSIONS The newly developed scale, GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial inter-rater reliability. This will enable raters to objectively grade reflective essays and provide informed feedback to residents and students.
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Affiliation(s)
- Nisrine N Makarem
- Department of Family Medicine, American University of Beirut-Medical Center, Riad El-Solh, P. O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Basem R Saab
- Department of Family Medicine, American University of Beirut-Medical Center, Riad El-Solh, P. O Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Grace Maalouf
- Department of Family Medicine, American University of Beirut-Medical Center, Riad El-Solh, P. O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Umayya Musharafieh
- Department of Family Medicine, American University of Beirut-Medical Center, Riad El-Solh, P. O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Fadila Naji
- Department of Family Medicine, American University of Beirut-Medical Center, Riad El-Solh, P. O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Diana Rahme
- Department of Family Medicine, American University of Beirut-Medical Center, Riad El-Solh, P. O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Dayana Brome
- Department of Psychology, Haigazian University, Rue Mexique, Kantari, Riad el Solh, P.O.Box: 11-1748, Beirut, 11072090, Lebanon
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McGurr MJ. Writing centers, libraries, and medical and pharmacy schools. J Med Libr Assoc 2020; 108:84-88. [PMID: 31897055 PMCID: PMC6919988 DOI: 10.5195/jmla.2020.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/01/2019] [Indexed: 11/20/2022] Open
Abstract
Objective This study investigated the existence of writing centers at medical and pharmacy schools, the location of those writing centers in a library or elsewhere, and librarians' perceptions of how writing centers are viewed by students, faculty, and staff. Methods A twelve-question survey was sent to libraries affiliated with a medical and pharmacy school in the United States. Results Respondents were curious about writing centers, how they were viewed on campus, and how to start one. Overall, respondents described engagement with writing centers: 68% had a writing center on campus, 23% had a writing center in their library, and 11% had a writing center on the health sciences campus, including in the health sciences library. No respondents reported hearing negative comments from faculty or students about the writing centers, and 60% of respondents with writing centers that were available to medical and pharmacy students would recommend one to health sciences libraries without access to a writing center. Conclusion This exploratory study showed that the establishment of writing centers in health sciences libraries is a topic of interest. Future studies could further investigate health sciences libraries' roles in writing centers for pharmacy, medical, and other health sciences students.
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Affiliation(s)
- Melanie J McGurr
- Associate Professor of Bibliography and Head, Electronic Services, University of Akron, Akron, OH,
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20
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Brown A, Jauregui J, Ilgen JS, Riddell J, Schaad D, Strote J, Shandro J. Does the Medium Matter? Evaluating the Depth of Reflective Writing by Medical Students on Social Media Compared to the Traditional Private Essay Using the REFLECT Rubric. West J Emerg Med 2019; 21:18-25. [PMID: 31913813 PMCID: PMC6948677 DOI: 10.5811/westjem.2019.11.44263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/03/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction Social media is a novel medium to host reflective writing (RW) essays, yet its impact on depth of students’ reflection is unknown. Shifting reflection on to social platforms offers opportunities for students to engage with their community, yet may leave them feeling vulnerable and less willing to reflect deeply. Using sociomateriality as a conceptual framework, we aimed to compare the depth of reflection in RW samples submitted by medical students in a traditional private essay format to those posted on a secure social media platform. Methods Fourth-year medical students submitted a RW essay as part of their emergency medicine clerkship, either in a private essay format (academic year [AY] 2015) or onto a closed, password-protected social media website (AY 2016). Five raters used the Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT) to score 122 de-identified RW samples (55 private, 67 social media). Average scores on two platforms were compared. Students were also surveyed regarding their comfort with the social media experience. Results There were no differences in average composite REFLECT scores between the private essay (14.1, 95% confidence interval [CI], 12.0–16.2) and social media (13.7 95% CI, 11.4–16.0) submission formats (t [1,120] = 0.94, p = 0.35). Of the 73% of students who responded to the survey, 72% reported feeling comfortable sharing their personal reflections with peers, and 84% felt comfortable commenting on peers’ writing. Conclusion Students generally felt comfortable using social media for shared reflection. The depth of reflection in RW essays was similar between the private and social media submission formats.
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Affiliation(s)
- Alisha Brown
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Joshua Jauregui
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Jonathan S Ilgen
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Jeff Riddell
- Keck School of Medicine of University of Southern California, Department of Emergency Medicine, Los Angeles, California
| | - Douglas Schaad
- University of Washington, Department of Biomedical Informatics and Medical Education, Seattle, Washington
| | - Jared Strote
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Jamie Shandro
- University of Washington, Department of Emergency Medicine, Seattle, Washington
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21
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Warman SM. Experiences of recent graduates: reframing reflection as purposeful, social activity. Vet Rec 2019; 186:347. [PMID: 31826933 DOI: 10.1136/vr.105573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND During the Royal College of Veterinary Surgeons' (RCVS) Professional Development Phase, graduates are required to reflect on their progress. Reflection is often conceptualised as a solitary activity, which may contrast with day-to-day reflective activities in the workplace. This study drew on cultural-historical activity theory to understand how recently graduated veterinary surgeons engage in reflective activity. METHODS Data comprised RCVS documentation and semistructured interviews with 15 recent graduates from one veterinary school. Thematic analysis was used to describe a collective system of reflective activity and to identify contradictions in the system with the potential to limit outcomes of reflective activity. RESULTS Two overarching themes of contradictions were identified: 'social reflection' and 'formalising the informal'. Graduates need opportunities for talking and/or writing to progress worries into purposeful reflection, underpinned by a shared understanding of reflective activity with colleagues, and by working practices which prioritise and normalise reflective interaction. CONCLUSION These findings identify potential avenues to better support veterinary graduates as they negotiate the transition to working life, and suggest that reconsideration of the formal expectations of new veterinary graduates and their employers is timely.
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Affiliation(s)
- Sheena M Warman
- Bristol Veterinary School, University of Bristol, Bristol, UK
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22
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Shaffer VA, Bohanek J, Focella ES, Horstman H, Saffran L. Encouraging perspective taking: Using narrative writing to induce empathy for others engaging in negative health behaviors. PLoS One 2019; 14:e0224046. [PMID: 31613906 PMCID: PMC6793876 DOI: 10.1371/journal.pone.0224046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/03/2019] [Indexed: 12/30/2022] Open
Abstract
Societal expectations of self-care and responsible actions toward others may produce bias against those who engage in perceived self-harming behavior. This is especially true for health professionals, who have dedicated themselves to helping reduce the burden of illness and suffering. Research has shown that writing narratives can increase perspective taking and empathy toward other people, which may engender more positive attitudes. Two studies examined whether creating a fictional narrative about a woman who smokes cigarettes while pregnant could increase positive attitudes toward the woman who smokes and reduce the internal attributions made for her behavior. Across both experiments, the narrative writing intervention increased participants’ empathy and perspective taking, evoked more positive attitudes toward a woman who smokes cigarettes while pregnant, and increased external attributions for her behavior. This work supports our hypothesis that narrative writing would be an efficacious intervention promoting attitude change toward patients who engage in unhealthy, and often contentious, behaviors. This work also suggests that narrative writing could be a useful intervention for medical professionals and policy makers leading to more informed policy or treatment recommendations, encouraging empathy for patients, and engendering a stronger consideration of how external forces can play a role in someone’s seemingly irresponsible behavior.
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Affiliation(s)
- Victoria A. Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States of America
- * E-mail:
| | - Jennifer Bohanek
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States of America
| | - Elizabeth S. Focella
- Department of Health Sciences, University of Missouri, Columbia, MO, United States of America
| | - Haley Horstman
- Department of Communication, University of Missouri, Columbia, MO, United States of America
| | - Lise Saffran
- Department of Health Sciences, University of Missouri, Columbia, MO, United States of America
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Abstract
Nurturing student's development of interprofessional collaboration is fundamental. Assessment-For-Learning can use reflection as one technique to support students' growth. Thus, we investigated using reflective-writing within an interprofessional education (IPE) course using an exploratory mixed-methods design. In 2015, student-nurses, student-pharmacists, and student-physicians participated in an IPE course and completed self-assessments of student learning objectives (SLOs). In 2016, new cohorts of student-nurses, student-pharmacists, and student-physicians participated in the course and completed their self-assessments of SLOs; however, student-nurses and student-pharmacists also reflectively-wrote. Quantitatively comparing SLOs from 2015 cohorts with 2016 cohorts, we found that the effect-sizes (magnitude of difference) for those who reflectively-wrote (student-nurses and student-pharmacists) grew more than historical controls, whereas the effect-sizes remained unchanged for a control group (student-physicians) who did not reflectively-write. Qualitatively, initial and final reflective-writings were explored using content analysis. Initial reflective-writings helped students create a baseline for their final reflective-writings. In final reflective-writings, most students discussed their growth in understanding roles/responsibilities and communication, though limited growth was discussed for teams/teamwork and values/ethics. Thus, initial and final reflective-writings appeared useful within this IPE course. Initial reflective-writing further enhanced students' self-assessed IPE improvement and recorded students' baseline perceptions for later review, while final reflective-writings documented students' self-actualized IPE development.
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Whitmore CA, Sakai J, Mikulich-Gilbertson SK, Davies RD. A Four-Week Reflective Writing Program in the Psychiatry Clerkship: Testing Effects on Reflective Capacity. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:171-174. [PMID: 29704195 DOI: 10.1007/s40596-018-0926-2] [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: 11/29/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Reflective capacity is the ability to review and reconstruct the importance, emotional impact, and outcomes of an experience to give it added meaning and context. In medicine, greater reflective capacity is associated with greater empathy and diagnostic accuracy. This project implemented a four-week reflective writing curriculum for third-year medical students during their psychiatric clerkship. METHODS A single class of medical students participated in a pilot reflective writing program during their four-week Psychiatry Care Block. Students were provided with weekly writing prompts, and the reflective capacity of their writing assignments was assessed using the REFLECT rubric. RESULTS Medical students who participated in the reflective writing course demonstrated a significant increase in Wald Rubric reflective writing scores across the four-week clerkship. CONCLUSIONS These results suggest a short, four-week reflective writing curriculum can enhance reflective capacity in a class of third-year medical students.
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Affiliation(s)
| | - Joseph Sakai
- University of Colorado School of Medicine, Aurora, CO, USA
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Stojan JN, Sun EY, Kumagai AK. Persistent influence of a narrative educational program on physician attitudes regarding patient care. MEDICAL TEACHER 2019; 41:53-60. [PMID: 29490528 DOI: 10.1080/0142159x.2018.1436755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Educational approaches involving patient stories aim at enhancing empathy and patient-centered care; however, it is not known whether the influence of such programs on physician attitudes persists beyond medical school. MATERIALS AND METHODS The Family Centered Experience (FCE) paired preclinical medical students with patient families over two years and engaged students in reflective dialogs about the volunteers' stories. This study examined possible long-term influences on attitudes toward medicine and doctoring. Interviews were conducted with former students at the end of or after post-graduate training. All had completed the FCE between 4 and 10 years before the study. Thematic analysis was informed by a constructivist Grounded Theory approach. RESULTS Several themes were identified. The FCE made graduates aware of the patients' perspectives and impacted their clinical practice in specific ways, such as developing collaborative partnerships, conducting family meetings, and breaking bad news. The course had influenced career choices and interest in teaching. Finally, the FCE enhanced appreciation of the human dimensions of medicine, which graduates had drawn upon in subsequent years. CONCLUSIONS A program based on longitudinal interactions with individuals with chronic illness can have persistent influence by stimulating reflection on the patient's perspective and humanistic approaches to patient care.
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Affiliation(s)
- Jennifer N Stojan
- a Department Pediatrics , University of Michigan , Ann Arbor , MI , USA
- b Department of Medicine , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Eleanor Y Sun
- b Department of Medicine , University of Michigan Medical School , Ann Arbor , MI , USA
| | - Arno K Kumagai
- c Division of Endocrinology, Department of Medicine , Women's College Hospital and the Wilson Centre, University of Toronto , Toronto , ON , Canada
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Cunningham H, Taylor D, Desai UA, Quiah SC, Kaplan B, Fei L, Catallozzi M, Richards B, Balmer DF, Charon R. Looking Back to Move Forward: First-Year Medical Students' Meta-Reflections on Their Narrative Portfolio Writings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:888-894. [PMID: 29261540 PMCID: PMC5976514 DOI: 10.1097/acm.0000000000002102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The day-to-day rigors of medical education often preclude learners from gaining a longitudinal perspective on who they are becoming. Furthermore, the current focus on competencies, coupled with concerning rates of trainee burnout and a decline in empathy, have fueled the search for pedagogic tools to foster students' reflective capacity. In response, many scholars have looked to the tradition of narrative medicine to foster "reflective spaces" wherein holistic professional identity construction can be supported. This article focuses on the rationale, content, and early analysis of the reflective space created by the narrative medicine-centered portfolio at the Columbia University Vagelos College of Physicians and Surgeons. In January 2015, the authors investigated learning outcomes derived from students' "Signature Reflections," end-of-semester meta-reflections on their previous portfolio work. The authors analyzed the Signature Reflections of 97 (of 132) first-year medical students using a constant comparative process. This iterative approach allowed researchers to identify themes within students' writings and interpret the data. The authors identified two overarching interpretive themes-recognition and grappling-and six subthemes. Recognition included comments about self-awareness and empathy. Grappling encompassed the subthemes of internal change, dichotomies, wonder and questioning, and anxiety. Based on the authors' analyses, the Signature Reflection seems to provide a structured framework that encourages students' reflective capacity and the construction of holistic professional identity. Other medical educators may adopt meta-reflection, within the reflective space of a writing portfolio, to encourage students' acquisition of a longitudinal perspective on who they are becoming and how they are constructing their professional identity.
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Affiliation(s)
- Hetty Cunningham
- H. Cunningham is assistant professor of pediatrics, Department of Pediatrics, Columbia University Medical Center, New York, New York; ORCID: http://orcid.org/0000-0003-1686-0497. D. Taylor is associate professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-1999-0388. U.A. Desai is assistant professor of medicine, Center for Family and Community Medicine, Columbia University Medical Center, New York, New York. S.C. Quiah is education, assessment, and evaluation specialist, Center for Education Research and Evaluation, Columbia University Medical Center, New York, New York. B. Kaplan is a second-year medical student, University of North Carolina School of Medicine, Chapel Hill, North Carolina. L. Fei is a second-year medical student, Tulane University School of School, New Orleans, Louisiana. M. Catallozzi is assistant professor of pediatrics and population and family health, Columbia University Medical Center, New York, New York. B. Richards is professor of pediatrics and director of education research and scholarship, University of Utah School of Medicine, Salt Lake City, Utah. D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. R. Charon is professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0002-6003-5219
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Hester CN, Tsai JW. Saving Ourselves, Our Patients, and Our Profession: Making the Case for Narrative Competence in Pediatrics. Acad Pediatr 2018; 18:243-247. [PMID: 29269032 DOI: 10.1016/j.acap.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Casey N Hester
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Jessica W Tsai
- Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Boston Medical Center, Boston, Mass
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Hartford W, Nimmon L, Stenfors T. Frontline learning of medical teaching: "you pick up as you go through work and practice". BMC MEDICAL EDUCATION 2017; 17:171. [PMID: 28927385 PMCID: PMC5606032 DOI: 10.1186/s12909-017-1011-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/13/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Few medical teachers have received formal teaching education. Along with individual and organizational barriers to participation in teacher training programs, increasing numbers and altered distribution of physicians away from major teaching centers have increased the difficulty of attendance. Furthermore, it is not known if traditional faculty development formats are the optimal learning options given findings from existing studies document both positive and negative outcomes. There is a gap in research that explores how medical teachers learn to teach and also limited research regarding how medical teachers actually teach. The purpose of this study was to provide insight into how physicians describe their teaching of trainees, and the nature of their teaching development and improvement to inform faculty development programs. METHODS Semi-structured interviews were conducted with 36 physicians, with a broad range of teaching experience, purposefully selected from five disciplines: Internal Medicine, Pediatrics, Psychiatry, Surgery, and Family Medicine. A qualitative, inductive approach was used to analyse the data. RESULTS Teaching was described as being centered on the needs of individual trainees, but was dependent on patient presentation and environmental context. For this group of physicians learning to teach was perceived as a dynamic and evolving process influenced by multiple life experiences. The physicians had not learnt to teach through formal education and then put that learning into practice, but had learnt to teach and improve their teaching through their trial and errors teaching. Life experiences unconnected with the medical environment contributed to their knowledge of teaching along with limited formal learning to teach experiences. Teaching practice was influenced by peers and trainees, feedback, and observation. The findings suggest these medical teachers learn to teach along a continuum largely through their teaching practice. CONCLUSION The findings suggested that the participants' major resource for learning how to teach was informal experiential learning, both in and out of the workplace. This may have implications for faculty development strategies for medical teaching education.
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Affiliation(s)
- W. Hartford
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, V6T 1Z4 Canada
| | - L. Nimmon
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, V6T 1Z4 Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - T. Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Vicini A, Shaughnessy AF, Duggan A. On the Inner Life of Physicians: Analysis of Family Medicine Residents' Written Reflections. JOURNAL OF RELIGION AND HEALTH 2017; 56:1191-1200. [PMID: 28425004 DOI: 10.1007/s10943-017-0394-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This qualitative study introduces the broad and inclusive concept of the "inner life of physicians" and analyzes the written reflections (N = 756) of family medicine residents (N = 33) during their residency as indicative of the physicians' inner lives. Residents completed reflective entries without specific prompts. Researchers describe unsolicited emergent categorical themes indicative of a robust inner life of the physician. Nurturing physicians' inner life through reflection allows physicians to recognize, identify, and respond to daily emotional events. Reflections about the state of physicians' inner lives can formulate and express fundamental human questions that concern: (a) troubling human experiences (e.g., suffering, death, luck, destiny, and death); (b) questions that surface in practicing their profession; (c) spiritually explicit questions on their beliefs and practices. Physicians' inner lives can become a "place" where physicians look for answers and explore options for dealing with their human and professional challenges, thus enhancing the humanistic aspects of medical practice.
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Affiliation(s)
- Andrea Vicini
- School of Theology and Ministry, Boston College, Simboli Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Allen F Shaughnessy
- Tufts University School of Medicine, Boston, MA, USA
- Tufts University Family Medicine Residency at Cambridge Health Alliance, 195 Canal Street, Malden, MA, 02148, USA
| | - Ashley Duggan
- Communication Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
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Wear D, Zarconi J, Aultman JM, Chyatte MR, Kumagai AK. Remembering Freddie Gray: Medical Education for Social Justice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:312-317. [PMID: 27580436 DOI: 10.1097/acm.0000000000001355] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Recent attention to racial disparities in law enforcement, highlighted by the death of Freddie Gray, raises questions about whether medical education adequately prepares physicians to care for persons particularly affected by societal inequities and injustice who present to clinics, hospitals, and emergency rooms. In this Perspective, the authors propose that medical school curricula should address such concerns through an explicit pedagogical orientation. The authors detail two specific approaches-antiracist pedagogy and the concept of structural competency-to construct a curriculum oriented toward appropriate care for patients who are victimized by extremely challenging social and economic disadvantages and who present with health concerns that arise from these disadvantages. In memory of Freddie Gray, the authors describe a curriculum, outlining specific strategies for engaging learners and naming specific resources that can be brought to bear on these strategies. The fundamental aim of such a curriculum is to help trainees and faculty understand how equitable access to skilled and respectful health care is often denied; how we and the institutions where we learn, teach, and work can be complicit in this reality; and how we can work toward eliminating the societal injustices that interfere with the delivery of appropriate health care.
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Affiliation(s)
- Delese Wear
- D. Wear is professor, Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. J. Zarconi is professor and chair, Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio. J.M. Aultman is professor, Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. M.R. Chyatte is assistant professor, Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. A.K. Kumagai is professor of medicine and vice chair for education, University of Toronto Department of Medicine, Toronto, Ontario, Canada
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Byars LA, Stephens MB, Durning SJ, Denton GD. A curricular addition using art to enhance reflection on professional values. Mil Med 2016; 180:88-91. [PMID: 25850133 DOI: 10.7205/milmed-d-14-00571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Art and humanities can enhance undergraduate medical education curricular objectives. Most commonly, art is used to help students learn observational skills, such as medical interviewing and physical diagnosis. Educators concurrently struggle to find ways to meaningfully teach professional values within crowded curricula. AIM This curriculum aimed to combine art and reflection to actively convey tenets of medical professionalism. SETTING Internal medicine clerkship at a single institution. PARTICIPANTS Third-year students. PROGRAM DESCRIPTION Students reviewed an online module describing attributes of medical professionalism before completing a 4-step written exercise stimulated by viewing a work of art and based on a critical incident from their own experiences. A faculty member reviewed the essays and facilitated small group discussion to normalize the students' emotional responses and generalize their observations to others. PROGRAM EVALUATION The curriculum was acceptable to students and enthusiastically received by faculty. Efforts to assess the effects and durability of the exercise on student behavior are ongoing. DISCUSSION Artwork can enhance student reflection on professional values. This model efficiently and creatively meets curricular professionalism objectives.
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Affiliation(s)
- Lynn A Byars
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Mark B Stephens
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Steven J Durning
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Gerald D Denton
- University of Queensland/Ochsner Clinical School, 1514 Jefferson Highway, New Orleans, LA 70121
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Gutierrez KJ, DasGupta S. The Space That Difference Makes: On Marginality, Social Justice and the Future of the Health Humanities. THE JOURNAL OF MEDICAL HUMANITIES 2016; 37:435-448. [PMID: 26152805 DOI: 10.1007/s10912-015-9347-3] [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] [Indexed: 05/24/2023]
Abstract
Feminist theorist and educator, bell hooks, asserts that to seek true liberation one must choose marginality. One must choose to occupy the space outside the binary between colonizer-colonized, hegemonic center-periphery, and us-them in order to create a location of possibility. This essay will reveal the practice of social justice as the navigation of the space that difference makes and argue that choosing marginality provides a framework for health humanities work towards social justice in health care. The space of the launderette that is depicted in Hanif Kureishi's 1986 film, My Beautiful Laundrette, provides an example of choosing marginality and illustrates how difference structures both real and imagined spaces, which influences how individuals ultimately perceive one another. We will draw from the work of bell hooks; political geographer, Edward Soja; and Marxist philosopher, Henri Lefebvre, to demonstrate the importance of the health humanities' position at the margin to traditional health care education.
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Affiliation(s)
- Kevin J Gutierrez
- Program in Narrative Medicine, Columbia University in the City of New York, 630 W. 168th Street, PH9E-105, New York, NY, 10032, USA
| | - Sayantani DasGupta
- Program in Narrative Medicine, Columbia University in the City of New York, 630 W. 168th Street, PH9E-105, New York, NY, 10032, USA.
- Sarah Lawrence College, Yonkers, NY, USA.
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Ottenberg AL, Pasalic D, Bui GT, Pawlina W. An analysis of reflective writing early in the medical curriculum: The relationship between reflective capacity and academic achievement. MEDICAL TEACHER 2016; 38:724-729. [PMID: 26609870 DOI: 10.3109/0142159x.2015.1112890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the relationship between reflection, gender, residency choice, word count, and academic achievement among medical students. METHODS A modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) was developed and used for this study (Cronbach's alpha of 0.86 with an intraclass correlation coefficient [ICC] of 0.68). This was applied to writing samples about professionalism in gross anatomy from first-year medical students between 2005 and 2011. Four analysts reviewed and scored written reflections independently. Composite reflection scores were compared with gender, residency choice, length of written reflection, NBME® Gross Anatomy and Embryology Subject Examination scores, and final gross anatomy course. RESULTS Total of 319 written reflections were evaluated. Female students who pursued medicine specialties had the highest composite reflection scores (87 [27.2%]). Word count frequently correlated with reflection score (p < 0.0001). Students who performed well on the NBME® Gross Anatomy and Embryology Subject Examination tended to achieve high anatomy course grades (p < 0.0001). There was no statistically significant relationship between composite reflection scores and NBME® Gross Anatomy and Embryology Subject Examination scores (p = 0.16) or anatomy course grades (p = 0.90). CONCLUSIONS This study suggests there are likely no correlations between reflective capacity and academic performance on tests of medical knowledge administered early in the medical curriculum.
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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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Charon R, Hermann N, Devlin MJ. Close Reading and Creative Writing in Clinical Education: Teaching Attention, Representation, and Affiliation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91. [PMID: 26200577 PMCID: PMC4721945 DOI: 10.1097/acm.0000000000000827] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Medical educators increasingly have embraced literary and narrative means of pedagogy, such as the use of learning portfolios, reading works of literature, reflective writing, and creative writing, to teach interpersonal and reflective aspects of medicine. Outcomes studies of such pedagogies support the hypotheses that narrative training can deepen the clinician's attention to a patient and can help to establish the clinician's affiliation with patients, colleagues, teachers, and the self. In this article, the authors propose that creative writing in particular is useful in the making of the physician. Of the conceptual frameworks that explain why narrative training is helpful for clinicians, the authors focus on aesthetic theories to articulate the mechanisms through which creative and reflective writing may have dividends in medical training. These theories propose that accurate perception requires representation and that representation requires reception, providing a rationale for teaching clinicians and trainees how to represent what they perceive in their clinical work and how to read one another's writings. The authors then describe the narrative pedagogy used at the College of Physicians and Surgeons of Columbia University. Because faculty must read what their students write, they receive robust training in close reading. From this training emerged the Reading Guide for Reflective Writing, which has been useful to clinicians as they develop their skills as close readers. This institution-wide effort to teach close reading and creative writing aims to equip students and faculty with the prerequisites to provide attentive, empathic clinical care.
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Affiliation(s)
- Rita Charon
- R. Charon is professor, Department of Medicine, and executive director, Program in Narrative Medicine, College of Physicians and Surgeons of Columbia University, New York, New York. N. Hermann is creative director, Program in Narrative Medicine, College of Physicians and Surgeons of Columbia University, and adjunct faculty, Master of Science in Narrative Medicine Program, Columbia University School of Continuing Education, New York, New York. M.J. Devlin is professor, Department of Psychiatry, and codirector, Foundations of Clinical Medicine, College of Physicians and Surgeons of Columbia University, New York, New York
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Devlin MJ, Richards BF, Cunningham H, Desai U, Lewis O, Mutnick A, Nidiry MAJ, Saha P, Charon R. "Where Does the Circle End?": Representation as a Critical Aspect of Reflection in Teaching Social and Behavioral Sciences in Medicine. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:669-77. [PMID: 25272952 PMCID: PMC4383731 DOI: 10.1007/s40596-014-0222-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 09/10/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This paper describes a reflective learning program within a larger curriculum on behavioral and social science that makes use of close reading, written representation of experience, discussion, and textual response. This response may in turn lead to further reflection, representation, and response in a circular pattern. A unique feature of this program is that it pays attention to the representation itself as the pivotal activity within reflective learning. Using the narrative methods that are the hallmark of this program, faculty writings were analyzed to characterize the essential benefits that derive from these practices. METHODS In the context of a faculty development seminar on the teaching of behavioral and social sciences in medical curricula, a group of 15 faculty members wrote brief narratives of reflective learning experiences in which they had made use of the methods described above. Their responses were submitted to iterative close reading and discussion, and potential themes were identified. RESULTS Four themes emerged: writing as attention to self, writing as attention to other, writing as reader/writer contract, and writing as discovery. In each instance, writing provides a new or deepened perspective, and in each case, the dividends for the writer are amplified by the narrative skills of those who read, listen, and respond. CONCLUSIONS The narrative pedagogy described and modeled herein provides a potentially promising approach to teaching the social, cultural, behavioral, and interpersonal aspects of medical education and practice. Future research will deepen our understanding of the benefits and limitations of this pedagogy and expand our appreciation of its applications.
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Affiliation(s)
- Michael J Devlin
- Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Boyd F Richards
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Hetty Cunningham
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Urmi Desai
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Owen Lewis
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Andrew Mutnick
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mary Anne J Nidiry
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Prantik Saha
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Rita Charon
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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Blackie M, Wear D. Three Things to Do With Stories: Using Literature in Medical, Health Professions, and Interprofessional Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1309-1313. [PMID: 27002884 DOI: 10.1097/acm.0000000000000761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It would be unusual to find a current medical school administrator or faculty member who has not heard the phrase "literature and medicine" or who does not know that literature is taught in various forms-short stories, novels, poems, essays-at many points in the curriculum at U.S. medical schools. Yet the phrase is used in slippery if not elusive ways, with no clear referent common to all who use it. This article focuses on three theoretical and pedagogical uses for literature in medical, health professions, and interprofessional education: close reading, ethical or moral inquiry, and drawing illustrations. Summaries of these approaches are provided, followed by demonstrations of how they might work in the classroom by using the story "Blankets," by Native American writer Sherman Alexie.Close reading requires reading slowly and carefully to enrich an initial encounter with a text. Ethical or moral inquiry turns to literary representations to challenge readers' assumptions and prejudices. Literature offers rich, provoking, and unusual depictions of common phenomena, so it can be used to draw illustrations. Although each approach can be used on its own, the authors argue that reading closely makes the other two approaches possible and meaningful because it shares with the diagnostic process many practices critical to skilled interprofessional caregiving: paying attention to details, gathering and reevaluating evidence, weighing competing interpretations. By modeling a close reading of a text, faculty can demonstrate how this skill, which courts rather than resists ambiguity, can assist students in making ethical and compassionate judgments.
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Affiliation(s)
- Michael Blackie
- M. Blackie is associate professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio.D. Wear is professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio
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Duggan AP, Vicini A, Allen L, Shaughnessy AF. Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents' Reflections About Communication. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1441-1448. [PMID: 26147857 DOI: 10.1080/10810730.2015.1018647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients' illness experiences. This project examines physicians' written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients' lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.
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Affiliation(s)
- Ashley P Duggan
- a Communication Department , Boston College , Chestnut Hill , Massachusetts , USA
| | - Andrea Vicini
- b School of Theology and Ministry , Boston College , Chestnut Hill , Massachusetts , USA
| | - Lucas Allen
- b School of Theology and Ministry , Boston College , Chestnut Hill , Massachusetts , USA
| | - Allen F Shaughnessy
- c School of Medicine , Tufts University School of Medicine , Malden , Massachusetts , USA
- d Cambridge Health Alliance , Family Medicine , Malden , Massachusetts , USA
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Vergnes JN, Apelian N, Bedos C. What about narrative dentistry? J Am Dent Assoc 2015; 146:398-401. [DOI: 10.1016/j.adaj.2015.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/18/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
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Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. MEDICAL EDUCATION 2015; 49:461-75. [PMID: 25924122 DOI: 10.1111/medu.12680] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/13/2014] [Accepted: 12/19/2014] [Indexed: 05/12/2023]
Abstract
CONTEXT Reflection and reflective practice have become popular topics of scholarly dialogue in medical education. This popularity has given rise to checklists, portfolios and other tools to inspire and document reflection. We argue that some of the common ways in which reflection has been applied are influenced by broader discourses of assessment and evidence, and divorced from original theories of reflection and reflective practice. METHODS This paper was developed using a critical narrative approach. First we present two theoretical lenses provided by theories of reflection. Next we present a summary of relevant literature, indexed in PubMed from 2004 to 2014, relating to the application of reflection or reflective practice to undergraduate and postgraduate medical education. We categorise these articles broadly by trends and problematise the trends relative to the two theoretical lenses of reflection. RESULTS Two relevant theoretical orientations of reflection for medical education are: (i) reflection as epistemology of practice, and (ii) reflection as critical social inquiry. Three prevalent trends in the application of reflection to medical education are: (i) utilitarian applications of reflection; (ii) a focus on the self as the object of reflection, and (iii) reflection and assessment. These trends align with dominant epistemological positions in medicine, but not with those that underpin reflection. CONCLUSIONS We argue for continued theorising of and theoretically informed applications of reflection, drawing upon epistemologies of practice and critical reflection as critical social inquiry. These directions offer medical education research broad and deep potential in theories of reflection, particularly in relation to knowledge creation within uncertain and complex situations, and challenging of dominant discourses and structures. Future work could explore how dominant epistemological positions and discourses in medicine influence theories from other disciplines when these theories are deployed in medical education.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada; Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Wilson Centre for Research in Education, University Health Network, Toronto, Ontario, Canada
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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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Kumagai AK, Naidu T. Reflection, dialogue, and the possibilities of space. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:283-8. [PMID: 25426737 DOI: 10.1097/acm.0000000000000582] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
To educate physicians who are capable of delivering ethical, socially responsible, patient-centered care, there have been calls for identifying curricular space for reflection on the human and societal dimensions of medicine. These appeals, however, beg the question: What does it mean to devote space in an otherwise busy curriculum for these types of reflection? This Perspective is an attempt to understand the nature of this educational space in terms of its purpose, uses, dynamics, and limitations, and the underlying components that allow reflection and transformation to occur. Reflections on psychosocial themes often take the form of dialogues, which differ from the discussions commonly encountered in clinical settings because they require the engagement of the participants' whole selves--life experiences, backgrounds, personal values, beliefs, and perspectives--in the exchanges. Dialogues allow for the inclusion of affective and experiential dimensions in addition to intellectual/cognitive domains in learning, and for an emphasis on discovering new perspectives, insights, and questions instead of limiting participants solely to an instrumental search for solutions. Although these reflections may vary greatly in their form and settings, the reflective space requires three qualities: safety and confidentiality, an intentional designation of a time apart from the distractions of daily life for reflection and dialogue, and an awareness of the transitional nature--the liminality--of a critically important period of professional identity development. In this open space of reflection and dialogue, one's identity as a humanistic physician takes form.
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Affiliation(s)
- Arno K Kumagai
- Dr. Kumagai is professor of internal medicine and medical education and director, Family Centered Experience and Longitudinal Case Studies Programs, University of Michigan Medical School, Ann Arbor, Michigan. Dr. Naidu is lecturer, Department of Behavioral Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, and head of clinical psychology, King Dinuzulu Hospital, Durban, South Africa
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Wear D, Zarconi J, Kumagai A, Cole-Kelly K. Slow medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:289-93. [PMID: 25426738 DOI: 10.1097/acm.0000000000000581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Slow medical education borrows from other "slow" movements by offering a complementary orientation to medical education that emphasizes the value of slow and thoughtful reflection and interaction in medical education and clinical care. Such slow experiences, when systematically structured throughout the curriculum, offer ways for learners to engage in thoughtful reflection, dialogue, appreciation, and human understanding, with the hope that they will incorporate these practices throughout their lives as physicians. This Perspective offers several spaces in the medical curriculum where slowing down is possible: while reading and writing at various times in the curriculum and while providing clinical care, focusing particularly on conducting the physical exam and other dimensions of patient care. Time taken to slow down in these ways offers emerging physicians opportunities to more fully incorporate their experiences into a professional identity that embodies reflection, critical awareness, cultural humility, and empathy. The authors argue that these curricular spaces must be created in a very deliberate manner, even on busy ward services, throughout the education of physicians.
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Affiliation(s)
- Delese Wear
- Dr. Wear is professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio. Dr. Zarconi is system vice president for medical education and chief academic officer, Summa Health System, Akron, Ohio, and professor of medicine, Northeast Ohio Medical University, Rootstown, Ohio. Dr. Kumagai is professor of internal medicine and medical education and director, Family Centered Experience and Longitudinal Case Studies Programs, University of Michigan Medical School, Ann Arbor, Michigan. Ms. Cole-Kelly is professor of family medicine and director, Communication in Medicine and Foundations of Clinical Medicine Seminars, Case Western Reserve School of Medicine, Cleveland, Ohio
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Wen CC, Lin MJ, Lin CW, Chu SY. Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship. MEDICAL EDUCATION ONLINE 2015; 20:25965. [PMID: 25661500 PMCID: PMC4320997 DOI: 10.3402/meo.v20.25965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/29/2014] [Accepted: 01/06/2015] [Indexed: 05/26/2023]
Abstract
PURPOSE Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students' reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. METHODS Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. RESULTS Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. CONCLUSION Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new knowledge, deeper discussion, and exploring new ways of action planning for psychosocial issues was recommended to promote students' reflective capacity.
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Affiliation(s)
- Chin-Chen Wen
- Department of Human Development, Tzu Chi University, Hualien, Taiwan
| | - Meei-Ju Lin
- Department of Counseling & Clinical Psychology, Dong Hwa University, Hualien, Taiwan
| | - Chi-Wei Lin
- Department of Counseling & Clinical Psychology, Dong Hwa University, Hualien, Taiwan
| | - Shao-Yin Chu
- Department of Paediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan;
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Connecting Classroom, Clinic, and Context: Clinical Reasoning Strategies for Clinical Instructors and Academic Faculty. Pediatr Phys Ther 2015; 27:368-75. [PMID: 26397080 DOI: 10.1097/pep.0000000000000185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical reasoning is an essential skill in pediatric physical therapist (PT) practice. As such, explicit instruction in clinical reasoning should be emphasized in PT education. KEY POINTS This article provides academic faculty and clinical instructors with an overview of strategies to develop and expand the clinical reasoning capacity of PT students within the scope of pediatric PT practice. Achieving a balance between deductive reasoning strategies that provide a framework for thinking and inductive reasoning strategies that emphasize patient factors and the context of the clinical situation is an important variable in educational pedagogy. TEACHING IMPLICATIONS Consideration should be given to implementing various teaching and learning approaches across the curriculum that reflect the developmental level of the student(s). Deductive strategies may be helpful early in the curriculum, whereas inductive strategies are often advantageous after patient interactions; however, exposure to both is necessary to fully develop the learner's clinical reasoning abilities. VIDEO ABSTRACT For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A87.
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Examining ethics - developing a comprehensive exam for a bioethics master's program. Camb Q Healthc Ethics 2014; 23:461-71. [PMID: 25033030 DOI: 10.1017/s0963180114000139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Assessing mastery of bioethics in a graduate program requires careful attention not simply to the content knowledge and skill development of students but also to the principles of sound assessment processes. In this article, we describe the rationale, development process, and features of the comprehensive exam we created as a culminating experience of a master's program in bioethics. The exam became the students' opportunity to demonstrate the way they were able to integrate course, textual, and practical knowledge gained throughout the experience of the program. Additionally, the exam assessed students' proficiency in the field of bioethics and their ability to critically and constructively analyze bioethical issues. In this article, we offer tips to other exam creators regarding our experiences with question and answer development, scoring of the exam, and relationships between coursework and exam preparation and completion. We also include a sample rubric for others to see how we determined which student answers were satisfactory.
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Kumagai AK. From competencies to human interests: ways of knowing and understanding in medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:978-83. [PMID: 24662200 DOI: 10.1097/acm.0000000000000234] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
When considering the teaching and learning of topics of social relevance in medicine, such as professionalism, medical ethics, the doctor-patient relationship, and issues of diversity and social justice, one is tempted to ask, are the ways of knowing in these fields different from that in the biomedical and clinical sciences? Furthermore, given that the competency approach is dominant in medical education, one might also ask, is the competency model truly appropriate for all of the types of knowledge necessary to become a good physician? These questions are not merely academic, for they are at the core of how these subjects are taught, learned, and assessed.The goal of this article is threefold: first, to explore the nature of knowing and the educational goals in different areas of medicine and, in particular, those areas that have social relevance; second, to critically review the concept of competencies when applied to education in these areas; and third, to explore alternative strategies for teaching, learning, and assessment. This discussion reflects a view that the goal of education in areas of social relevance in medicine should be the enhancement of an understanding of-a deep and abiding connection with-the social responsibilities of the physician. Moving beyond competencies, this approach aspires toward the development of practical wisdom (phronesis) which, when embodied in the physician, links the knowledge and skills of the biomedical and clinical sciences with a moral orientation and call to action that addresses human interests in the practice of medicine.
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Affiliation(s)
- Arno K Kumagai
- Dr. Kumagai is professor of internal medicine and medical education and director, Family Centered Experience and Longitudinal Case Studies Programs, University of Michigan Medical School, Ann Arbor, Michigan
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Kind T, Goldman E, Fratantoni K, Wiedermann BL, Agrawal D, Coddington D. Learning to deliver care in a medical home: a qualitative analysis of residents' reflections on practice. Clin Pediatr (Phila) 2014; 53:658-65. [PMID: 24634427 DOI: 10.1177/0009922814526975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We used online structured reflection to improve residents' understanding of care delivery in the medical home. METHODS Third-year pediatric residents participated in an online curriculum on delivering effective, patient-centered primary care in the medical home to children with special health care needs. Residents were prompted to respond to questions designed to stimulate reflection. We qualitatively assessed their responses, graded their depth of reflection, and provided structured feedback. RESULTS Residents identified aspects of their practice consistent with medical home principles. Depth of reflection increased over time. Residents realized they needed to better understand families' financial, emotional, and social needs and increase families' involvement in care planning. Residents identified systems issues and practice changes to improve care delivery. CONCLUSIONS Online reflective writing with feedback is a powerful strategy to improve residents' learning. Residents identified and began to make practice changes to provide patient-centered care in a medical home.
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Affiliation(s)
- Terry Kind
- Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ellen Goldman
- George Washington University Graduate School of Education and Human Development, Washington, DC, USA
| | - Karen Fratantoni
- Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bernhard L Wiedermann
- Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Dewesh Agrawal
- Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Dale Coddington
- Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Miller E, Balmer D, Hermann N, Graham G, Charon R. Sounding narrative medicine: studying students' professional identity development at Columbia University College of Physicians and Surgeons. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:335-42. [PMID: 24362390 PMCID: PMC4002760 DOI: 10.1097/acm.0000000000000098] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To learn what medical students derive from training in humanities, social sciences, and the arts in a narrative medicine curriculum and to explore narrative medicine's framework as it relates to students' professional development. METHOD On completion of required intensive, half-semester narrative medicine seminars in 2010, 130 second-year medical students at Columbia University College of Physicians and Surgeons participated in focus group discussions of their experiences. Focus group transcriptions were submitted to close iterative reading by a team who performed a grounded-theory-guided content analysis, generating a list of codes into which statements were sorted to develop overarching themes. Provisional interpretations emerged from the close and repeated readings, suggesting a fresh conceptual understanding of how and through what avenues such education achieves its goals in clinical training. RESULTS Students' comments articulated the known features of narrative medicine--attention, representation, and affiliation--and endorsed all three as being valuable to professional identity development. They spoke of the salience of their work in narrative medicine to medicine and medical education and its dividends of critical thinking, reflection, and pleasure. Critiques constituted a small percentage of the statements in each category. CONCLUSIONS Students report that narrative medicine seminars support complex interior, interpersonal, perceptual, and expressive capacities. Students' lived experiences confirm some expectations of narrative medicine curricular planners while exposing fresh effects of such work to view.
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Affiliation(s)
- Eliza Miller
- Dr. Miller is a resident, Department of Neurology, Columbia University Medical Center, New York, New York. Dr. Balmer is associate professor, Department of Pediatrics, and associate director, Center for Research, Innovation and Scholarship in Medical Education, Baylor College of Medicine, Houston, Texas. Ms. Hermann is creative director, Program in Narrative Medicine, Columbia University College of Physicians and Surgeons, New York, New York. Ms. Graham is a student, Yale School of Nursing, New Haven, Connecticut. Dr. Charon is professor of clinical medicine and executive director of the Program in Narrative Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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Zink T, Solberg E. Development of a global health curriculum for family medicine based on ACGME competencies. TEACHING AND LEARNING IN MEDICINE 2014; 26:174-83. [PMID: 24702555 DOI: 10.1080/10401334.2014.883987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND With the popularity of global health among medical students and residents, family medicine (FM) residencies are developing pathways in global health. Curriculum based on Accreditation Council for Graduate Medical Education (ACGME) competencies adds rigor to the efforts. DESCRIPTION We describe the adaptation of a comprehensive pediatric global health curriculum based on ACGME competencies for family medicine. The curriculum maps out goals, objectives, curricular elements, and evaluation modalities for each of the six competencies (medical knowledge, patient care, practice-based learning, professionalism, communication, and systems-based practice). A literature review, followed by an iterative process, guided the expansion of the pediatric curriculum and the prioritization of domains for FM. Input was sought from FM global health faculty at our 8 residencies, affiliated community faculty, and international health experts from across the United States who attended our workshop at a national FM global health meeting. The final product includes comprehensive competency-based curriculum, open-source resources, and evaluation modalities. The goals and objectives pertinent to all FM residents, and those specific to global health pathway residents and fellows, are outlined. EVALUATION The limiting and enabling factors of the curriculum implementation are presented. CONCLUSIONS This global family medicine curriculum has added structure and rigor to our international electives in the department at the University of Minnesota. The competency-based curriculum is in the early stages of implementation and evaluation. It has already strengthened components of the residency learning experience for all residents. A robust evaluation is needed and requires monitoring pathway graduates and their career choices into the future. The curriculum is available for adoption by other FM residencies.
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Affiliation(s)
- Therese Zink
- a Department of Family and Community Health , University of Minnesota , Minneapolis , Minnesota , USA
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