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Edelist T, Friesen F, Ng S, Fernandez N, Bélisle M, Lechasseur K, Rochette A, Vachon B, Caty MÈ. Critical reflection in team-based practice: A narrative review. MEDICAL EDUCATION 2024. [PMID: 38973068 DOI: 10.1111/medu.15462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/08/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Research on critical reflection (a process of recognising and challenging assumptions that frame health care practice) has demonstrated strong potential for making health care more collaborative and equitable, yet its enactment within team-based health care remains underexplored. We conducted a narrative review to advance understanding of how critical reflection develops, occurs in and impacts team-based practice and care. METHODS We searched three databases (Medline, CINAHL and Scopus) for articles related to the concepts of critical reflection and/or critically reflective practice in the context of team-based health care and examined how teams engage with those theoretical concepts, to inform ideas for a new approach to support critically reflective practice. FINDINGS The search identified 974 citations of which nine articles showed elements of critical reflection in team-based practice. However, since only one of the nine included articles explicitly used the term 'critical reflection' in their research, critical reflection as a theoretical concept was found to be largely missing from the current team-based health care literature. Instead, aspects of critical reflection were evident in terms of challenging power hierarchies and questioning practice assumptions through dialogue, with a goal of collaborative practice. This sharing of knowledge and skills allowed teams to push boundaries and innovate together in practice. The included articles also emphasised the importance of creating a purposeful environment for open dialogue and practice change to occur. CONCLUSION To support equitable care through collaborative practices, we suggest dialogue as and for critical reflection should be explicitly developed and researched within team-based health care.
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Affiliation(s)
- Tracey Edelist
- Département d'Orthophonie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Farah Friesen
- Centre for Advancing Collaborative Healthcare and Education (CACHE), University Health Network, Toronto, Canada
| | - Stella Ng
- Centre for Advancing Collaborative Healthcare and Education (CACHE), University Health Network, Toronto, Canada
| | - Nicolas Fernandez
- Département de Médecine de Famille et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montreal, Canada
| | - Marilou Bélisle
- Faculté d'Éducation, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Annie Rochette
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation de Montréal (CRIR), Montreal, Canada
| | - Brigitte Vachon
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, Canada
| | - Marie-Ève Caty
- Département d'Orthophonie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Stephen C, Berezowski J. Reflective practice is a prerequisite for One Health development. ONE HEALTH OUTLOOK 2024; 6:13. [PMID: 38951887 PMCID: PMC11218157 DOI: 10.1186/s42522-024-00106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 07/03/2024]
Abstract
One Health is being promoted as a transformative approach in health, conservation, and environmental sustainability. The polycrisis of climate change, pandemics, food insecurity, biodiversity loss, pollution and inequity is creating an urgency to evolve the epistemology and methods of One Health. However, the amount of effort placed into critical and systematic reflection on One Health is outweighed by advocacy for its use, or for expanding its scope of practice. This paper advocates for reflective One Health practice to foster new ways of knowing and doing that are helpful in the face of a rapidly narrowing window of opportunity to preserve the social and environmental factors that secure health and resilience for all species and generations. We propose six areas for reflection; (1) how to moderate conformity so that One Health does not become its own silo; (2) finding the moral purpose of One Health to align actions with desired outcomes; (3) coping with the problem of too many interacting problems; (4) the strategic trajectory of growth to accelerate action on root causes and ensure One Health is future-ready; (5) how to identify priorities across a vast array of problems, values, and needs and (6) how to know if we are making the world healthier and safer and for whom. Reflective practice requires investment in ongoing conversation to guard against over-confidence that we have captured the "one right way" to meet changing expectations and circumstances in a fair and effective way. Our intention is to stimulate thinking and discussion within the One Health community to ensure that "doing is shaped by knowing". We hope One Health will continue to be an emergent and highly variable set of ever more effective practices that constantly changes in response to the complex, interconnected and changing problems facing the health of people, animals, and the environment.
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Affiliation(s)
- Craig Stephen
- McEachran Institute, 1859 Delanice Way, Nanoose Bay, Nanoose Bay, BC, Canada.
| | - John Berezowski
- McEachran Institute, 1859 Delanice Way, Nanoose Bay, Nanoose Bay, BC, Canada
- Scotland's Rural College, Inverness Campus, Inverness, IV2 5NA, UK
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van Oorschot F, Brouwers M, Muris J, Veen M, Timmerman A, Dulmen SV. How does guided group reflection work to support professional identity formation in postgraduate medical education: A scoping review. MEDICAL TEACHER 2024:1-11. [PMID: 38626746 DOI: 10.1080/0142159x.2024.2339409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/02/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In postgraduate medical education, guided group reflection is often applied to support professional identity formation. However, little is known about how guided group reflection is shaped and how it works. Our scoping review synthesizes existing evidence about various approaches for guided group reflection, their aims, components and potential working mechanisms. METHODS We conducted a scoping review using JBI (Joanna Briggs Institute) guidelines for conducting scoping reviews. We searched PubMed, PsycINFO, EMBASE and ERIC databases for all research articles published in English or Dutch in an iterative team approach. The articles were extracted and summarized quantitatively and qualitatively. RESULTS We included 71 papers (45 primary research papers and 26 non-empirical papers including program descriptions, theoretical concepts and personal experiences). We identified a diversity of approaches for guided group reflection (e.g. Balint groups, supervised collaborative reflection and exchange of experiences), applied in a variety of didactic formats and aims. We distilled potential working mechanisms relating to engagement in reflection, group learning and the supervisor's role. CONCLUSIONS There are significant knowledge gaps about the aims and underlying mechanisms of guided group reflection. Future systematic research on these topics is needed to understand the effectiveness of educational methods, that can help facilitate learning conditions to best shape professional identity formation (PIF) in educational curricula.
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Affiliation(s)
- Frederieke van Oorschot
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Marianne Brouwers
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Jean Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Mario Veen
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Ní Mhurchú M, Cantillon P. Reflective practice in medicine: The hidden curriculum challenge. CLINICAL TEACHER 2024; 21:e13682. [PMID: 37855062 DOI: 10.1111/tct.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Despite the known benefits of reflection in various health care professions, it is still not a thriving practice in medical education. The literature suggests that this may be due to tensions between epistemological tenets of reflection and biomedicine. Further research is needed into experiences of doctors as they implement reflection in medical education settings. We set out to explore how these experiences were influenced by hidden curricula to provide insights into personal and contextual features of medical settings influencing engagement in reflection. METHODS Using an interpretative phenomenological analysis (IPA) approach, four semi-structured qualitative interviews were conducted virtually. Participants were doctors who graduated from a postgraduate diploma in clinical education with core reflective practice components. Interviews were recorded, transcribed, coded and analysed using IPA. Opportunities to review and amend transcriptions were provided. FINDINGS Three superordinate themes were identified including epistemological divergence, fear of showing vulnerability and reflection volte-face. Challenges in engaging in practices epistemologically different to predominant discourses in medicine were compounded by fears of vulnerability and a common antipathy towards reflection. All developed more accommodating perspectives towards reflection with shared experiences of a programme incorporating reflective practice. CONCLUSION The hidden curriculum can have positive and negative impacts on doctors' engagement in reflection. In facilitating reflective practice for this group, we recommend assisting with awareness of ways of thinking and being in medicine, offering reassurance that reflection may initially feel like running contrary to predominant discourses and finally, role modelling openness to vulnerability to better integrate and promote meaningful engagement in reflection.
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Bilodeau K, Henriksen C, Aloisio Alves C, Piché L, Pepin J, Lee V, Vachon MF, Folch N, Pomey MP, Fernandez N. Learning to provide humanistic care and support in the context of chronic illness: Insights from the narratives of healthcare professionals in hemato-oncology. Eur J Oncol Nurs 2024; 69:102522. [PMID: 38382155 DOI: 10.1016/j.ejon.2024.102522] [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: 12/14/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To document the process by which healthcare professionals (HCPs) support people living with and beyond hematological cancer and detail how they learned from their personal and clinical experience. METHOD Using a narrative approach, we conducted nine semi-structured interviews with HCPs, including nurses, from a specialized care centre who support patients with hematological cancer. Interviews aimed to capture experiential learning gained from their practice. We performed a hybrid inductive/deductive content analysis on data using a framework based on sociological and educational models of experiential learning. RESULTS Among healthcare professionals, analysis revealed the need to provide care and support that is 'humane' and adapted to each patient. Learning to provide this type of care proved to be challenging. Over the course of their clinical experience, healthcare professionals learned to adapt the support they provided by straddling a boundary between sympathy and empathy. Learning outcomes were associated with personal-professional development among participants. CONCLUSION Our findings bring to light an overlooked facet of patient support in the context of cancer care, which is the acquisition of the soft skills required to deliver humanistic care and support. This learning process requires time and involves navigating between the realms of sympathy and empathy. Experiential learning is intertwined with the complexity of the often long-term patient-professional relationship that characterizes hemato-oncology. This unique relationship offers rewards for healthcare professionals on both personal and professional fronts.
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Affiliation(s)
- Karine Bilodeau
- Faculty of Nursing, University of Montreal, PO Box 6128, Station Centre-ville, Montreal, Quebec, H3C 3J7, Canada; Maisonneuve-Rosemont Hospital Research Center, 5415 Assomption Blvd, Montreal, Quebec, H1T 2M4, Canada.
| | - Cynthia Henriksen
- Maisonneuve-Rosemont Hospital Research Center, 5415 Assomption Blvd, Montreal, Quebec, H1T 2M4, Canada.
| | - Camila Aloisio Alves
- Petrópolis Medical College (FMP/UNIFASE), Av. Barão do Rio Branco, 1003 - Centro, Petrópolis, Rio de Janeiro, 25680-120, Brazil.
| | - Lynda Piché
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, Quebec, H2X 3E4, Canada.
| | - Jacinthe Pepin
- Faculty of Nursing, University of Montreal, PO Box 6128, Station Centre-ville, Montreal, Quebec, H3C 3J7, Canada.
| | - Virginia Lee
- McGill University Health Center (Glen site), 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.
| | - Marie-France Vachon
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, Quebec, H2X 3E4, Canada.
| | - Nathalie Folch
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, Quebec, H2X 3E4, Canada.
| | - Marie-Pascale Pomey
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, Quebec, H2X 3E4, Canada; Department of Management, Evaluation and Health Policy of the School of Public Health, University of Montreal, 7101 Av du Parc, Montréal, Quebec, H3N 1X9, Canada.
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada.
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Moniz T, Melro CM, Warren A, Watling C. Twelve tips for maximizing the potential of reflective writing in medical education. MEDICAL TEACHER 2024:1-6. [PMID: 38508199 DOI: 10.1080/0142159x.2024.2326093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
Reflective writing (RW) is a popular tool in medical education, but it is being used in ways that fail to maximize its potential. Literature in the field focuses on why RW is used - that is to develop, assess, and remediate learner competencies - but less so on how to use it effectively. The emerging literature on how to integrate RW in medical education is haphazard, scattered and, at times, reductionist. We need a synthesis to translate this literature into cohesive strategies for medical educators using RW in a variety of contexts. These 12 tips offer guidelines for the principles and practices of using RW in medical education. This synthesis aims to support more strategic and meaningful integration of RW in medical education.
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Affiliation(s)
- Tracy Moniz
- Department of Communication Studies, Mount Saint Vincent University, Halifax, Canada
| | - Carolyn M Melro
- Department of Communication Studies, Mount Saint Vincent University, Halifax, Canada
| | - Andrew Warren
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Chris Watling
- Department of Oncology, Clinical Neurological Sciences, and Family Medicine, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Edelist T, Zaman S, Katzman E, Jarus T. 'Patient' or 'professional'? Negotiating accommodations and identity in fieldwork education. MEDICAL EDUCATION 2024. [PMID: 38449338 DOI: 10.1111/medu.15365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice. METHODS Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations. FINDINGS Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures. DISCUSSION The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care.
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Affiliation(s)
- Tracey Edelist
- Department of Speech-Language Pathology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Shahbano Zaman
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Katzman
- Disability Studies, King's University College at Western University, London, Ontario, Canada
| | - Tal Jarus
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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Ginsburg S, Stroud L, Brydges R, Melvin L, Hatala R. Dual purposes by design: exploring alignment between residents' and academic advisors' documents in a longitudinal program. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10318-2. [PMID: 38438699 DOI: 10.1007/s10459-024-10318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
Longitudinal academic advising (AA) and coaching programs are increasingly implemented in competency based medical education (CBME) to help residents reflect and act on the voluminous assessment data they receive. Documents created by residents for purposes of reflection are often used for a second, summative purpose-to help competence committees make decisions-which may be problematic. Using inductive, thematic analysis we analyzed written comments generated by 21 resident-AA dyads in one large internal medicine program who met over a 2 year period to determine what residents write when asked to reflect, how this aligns with what the AAs report, and what changes occur over time (total 109 resident self-reflections and 105 AA reports). Residents commented more on their developing autonomy, progress and improvement than AAs, who commented far more on performance measures. Over time, residents' writing shifted away from intrinsic roles, patient care and improvement towards what AAs focused on, including getting EPAs (entrustable professional activities), studying and exams. For EPAs, the emphasis was on getting sufficient numbers rather than reflecting on what residents were learning. Our findings challenge the practice of dual-purposing documents, by questioning the blurring of formative and summative intent, the structure of forms and their multiple conflicting purposes, and assumptions about the advising relationship over time. Our study suggests a need to re-evaluate how reflective documents are used in CBME programs. Further research should explore whether and how documentation can best be used to support resident growth and development.
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Affiliation(s)
- Shiphra Ginsburg
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada.
| | - Lynfa Stroud
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lindsay Melvin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
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Schaepkens SPC, de la Croix A, Veen M. 'Oh yes, that is also reflection'-Using discursive psychology to describe how GP registrars construct reflection. MEDICAL EDUCATION 2024; 58:318-326. [PMID: 37555285 DOI: 10.1111/medu.15183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/22/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Learners in medical education generally perceive that reflection is important, but they also find that reflection is not always valuable or practically applicable. We address the gap between the potential benefits of reflection and its practical implementation in medical education. We examined the perspective of Dutch GP registrars who (must) reflect for their GP specialty training to understand their participant perspective on reflection. Our aim is stimulating alignment between reflective activities that occur in a medical curriculum and the ideals of reflection as a valuable educational activity. METHODS We conducted, video-recorded and transcribed seven focus group sessions with GP registrars in 2021 across two Dutch GP educational programmes. We used discursive psychology to analyse the focus group data by focusing on 'assessments of reflection'. We analysed their discursive features (how something was said) and content features (what was said) and related these to each other to understand how GP registrars construct reflection. RESULTS Participants constructed reflection with nuance; they combined negative and positive assessments that displayed varied orientations to reflection. First, their combined assessments showed complex orientations to norms and experiences with reflecting in practice and that these are not simply negative or positive. Second, GP registrars constructed reflection as a negotiable topic and showed how reflection and its value can be variably understood. Third, through combined assessments, they displayed an orientation to the integration of reflection with other educational tasks, which impacts its value. CONCLUSIONS Generally, GP registrars speak positively about reflection, but the value of reflection partly depends on its proper integration with other educational tasks. When meaningful integration fails, activities to stimulate reflection can overshoot their own goal and hamper learner motivation to reflect. Developing a healthy 'reflection culture' could mitigate some challenges. Therein, reflection is treated as important while learners also have adequate autonomy.
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Affiliation(s)
- Sven P C Schaepkens
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anne de la Croix
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mario Veen
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Moniz T, Ng SL. Towards a culture and pedagogy of reflection. MEDICAL EDUCATION 2024; 58:280-283. [PMID: 38225534 DOI: 10.1111/medu.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/17/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
What does it mean to cultivate a "healthy reflection culture" in HPE? For @moniztracy1 and @StellaHPE, it means acceptance and management of “not knowing” and an explicit framing of the essence of being a professional practitioner; to get there, writing can help.
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Affiliation(s)
- Tracy Moniz
- Department of Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Stella L Ng
- Centre for Advancing Collaborative Healthcare & Education, Toronto, Ontario, Canada
- Speech-Language Pathology & Institute of Health Policy, Management & Evaluation, Toronto, Ontario, Canada
- The Wilson Centre & The Institute for Education Research, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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Kalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, Johnson A, McNaughton N, Rodak T, McCullough K, Soklaridis S. Power to the people? A co-produced critical review of service user involvement in mental health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:273-300. [PMID: 37247126 DOI: 10.1007/s10459-023-10240-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
Meaningful service user involvement in health professions education requires integrating knowledge held by "lay" people affected by health challenges into professional theories and practices. Involving service users redefines whose knowledge "counts" and implies a shift in power. Such a shift is especially significant in the mental health field, where power imbalances between health professionals and service users are magnified. However, reviews of the literature on service user involvement in mental health professional education do little to explore how power manifests in this work. Meanwhile critical and Mad studies scholars have highlighted that without real shifts in power, inclusion practices can lead to harmful consequences. We conducted a critical review to explore how power is addressed in the literature that describes service user involvement in mental health professions education. Our team used a co-produced approach and critical theories to identify how power implicitly and explicitly operates in this work to unearth the inequities and power structures that service user involvement may inadvertently perpetuate. We demonstrate that power permeates service user involvement in mental health professional education but is rarely made visible. We also argue that by missing the opportunity to locate power, the literature contributes to a series of epistemic injustices that reveal the contours of legitimate knowledge in mental health professions education and its neoliberal underpinnings. Ultimately, we call for a critical turn that foregrounds power relations to unlock the social justice-oriented transformative potential of service user involvement in mental health professions education and health professions education more broadly.
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Affiliation(s)
- Csilla Kalocsai
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sacha Agrawal
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lee de Bie
- Centre for Clinical Ethics, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- Independent service user educator researcher, Toronto, ON, Canada
| | - Suze Berkhout
- University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nancy McNaughton
- Wilson Centre for Research in Education at University Health Network and University of Toronto, Toronto, ON, Canada
- Michener Institute of Education at University Health Network, Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kim McCullough
- Department of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Ray S, Mudokwenyu-Rawdon C, Bonduelle M, Iliff G, Maposhere C, Mataure P, Jacobs C, Van Schalkwyk SC. Hearing the voices of midwives through reflective writing journals: Qualitative research on an educational intervention for Respectful Maternity Care in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002008. [PMID: 38134000 PMCID: PMC10745140 DOI: 10.1371/journal.pgph.0002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
Women attending public and private sector health facilities in Africa have reported abuse and neglect during childbirth, which carries a risk of poor health outcomes. We explored from the midwives' perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, using transformative learning theory as the conceptual framework. The twelve-week educational intervention motivating for Respectful Maternity Care consisted of a two-day workshop and five follow-up sessions every two weeks. Thematic analysis was conducted on eighteen reflective journals written by the midwives with member-checking during follow-up discussions and a further one-day participative workshop a year later. The midwives reported being more women-centred, with involvement of birth companions and use of different labour positions, stronger professional pride and agency, collaborative decision-making and less hierarchical relationships which persisted over the year. Their journal narratives included examples of treating birthing women with more compassion. Some categories aligned with the phases of transformative learning theory (self-examination of prior experience, building of competence and self-confidence into new roles and relationships). Others related to improving communications and effective teamwork, providing role-models of good behaviour, use of scientific knowledge to inform practice and demonstrating competence in management of complex cases. This study shows that innovative educational initiatives have the potential to change the way midwives work together, even in challenging physical environments, leading to a shared vision for the quality of service they want to provide, to improve health outcomes and to develop life-long learning skills.
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Affiliation(s)
- Sunanda Ray
- Department of Community Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Myriam Bonduelle
- Swansea Bay University Health Board, Swansea, Wales, United Kingdom
| | - Ginny Iliff
- Private obstetric practice, Harare, Zimbabwe
| | | | - Priscilla Mataure
- Department of Family and Health Sciences, Women’s University in Africa, Harare, Zimbabwe
| | - Cecilia Jacobs
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
| | - Susan C. Van Schalkwyk
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
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Kleiner MJ, Kinsella EA, Miciak M, Teachman G, Walton DM. From reflection to phronesis in 'good' physiotherapy practice. Physiother Theory Pract 2023:1-17. [PMID: 38108310 DOI: 10.1080/09593985.2023.2285419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Reflection is promoted in health professional education as a way to learn in and on practice. 'Being reflective' is considered important to 'good' and 'expert' physiotherapy practice, yet there is limited research on reflective practices of experienced physiotherapists. For Aristotle, a good person reasons and acts in ways to promote human flourishing. Physiotherapists' perspectives on the place of reflection in good practice has the potential to advance professional understandings of how it may be enacted. Such knowledge may inform health professions education, regulatory guidelines, professional practices, and patient interactions. PURPOSE The purpose of this research was to examine experienced musculoskeletal (MSK) practitioners' perceptions of reflection in the practice of a 'good' physiotherapist. METHODS A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of the qualities and practices that constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on ways of 'being reflective', which emerged as a major theme in the original study. FINDINGS Six themes were identified related to 'being reflective' in a 'good' physiotherapist: 1) learning from experience; 2) integrating multiple perspectives; 3) navigating indeterminate zones; 4) developing embodied knowledge; 5) questioning assumptions; and 6) cultivating wisdom. CONCLUSIONS Findings support the notion that 'good' physiotherapy involves a disposition toward making wise judgments through reflection. This practice-based knowledge can inform educational initiatives that nurture practices that foster attention to reflective processes that inform phronesis in professional life. Through reflexivity on what the profession takes for granted, physiotherapists may be better prepared when navigating the indeterminate zones of practice.
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Affiliation(s)
- Michelle J Kleiner
- QuinnRehab, Barrie, Ontario, Canada
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Elizabeth Anne Kinsella
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gail Teachman
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - David M Walton
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, Elborn College, London, Ontario, Canada
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14
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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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15
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Hansen A, Engel-Hills P, Jacobs C, Blitz J, Cooke R, Hess-April L, Leisegang K, Naidoo N, Volschenk M, van Schalkwyk S. Understandings and practices: Towards socially responsive curricula for the health professions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1131-1149. [PMID: 36732399 PMCID: PMC9894667 DOI: 10.1007/s10459-023-10207-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 05/21/2023]
Abstract
Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.
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Affiliation(s)
- Anthea Hansen
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Cecilia Jacobs
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Hess-April
- Department of Occupational Therapy, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariette Volschenk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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16
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Diaz BA, Rieker J, Ng S. Teaching critical reflection in health professions education with transformative-vygotskian praxis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1191-1204. [PMID: 36890283 DOI: 10.1007/s10459-023-10209-y] [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: 11/17/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Reflective practice is a complex concept to adequately describe, communicate about and, ultimately, teach. Unrelieved tensions about the concept persist within the health professions education (HPE) literature owing to reflection's diverse theoretical history. Tensions extend from the most basic, e.g., what is reflection and what are its contents, to the complex, e.g., how is reflection performed and whether it should be evaluated. Nonetheless, reflection is generally seen as vital to HPE, because it imparts crucial strategies and awareness to learners in their professional practices. In this article, we explore both conceptual and pedagogical dimensions of teaching for reflection. We address the concept of reflection, its application to practice, and how to remain faithful to transformative, critical pedagogy when teaching for it. We present (a) an analysis of two theories of education in HPE: Transformative Learning and Vygotskian Cultural Historical Theory. We (b) outline a pedagogical approach that applies Piotr Gal'perin's SCOBA: schema for the complete orienting basis of an action. We then employ (a) and (b) to provide affordances for developing materials for educational interventions across HPE contexts.
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Affiliation(s)
- Brett A Diaz
- Centre for Faculty Development, Li Ka Shing International Healthcare, Education Centre, St. Michael's Hospital, 209 Victoria Street, 4th floor, Toronto, ON, Canada.
- The Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada.
| | - Jacob Rieker
- Department of Applied Linguistics, The Pennsylvania State University, University Park, USA
| | - Stella Ng
- The Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for Advancing Collaborative Healthcare & Education at University Health Network, Toronto Western Hospital, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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17
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Blum RH, Mai CL, Mitchell JD, Saddawi-Konefka D, Cooper JB, Shorten G, DunnGalvin A. Measuring deliberate reflection in residents: validation and psychometric properties of a measurement tool. BMC MEDICAL EDUCATION 2023; 23:606. [PMID: 37626350 PMCID: PMC10463616 DOI: 10.1186/s12909-023-04536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE Reflective capacity is "the ability to understand critical analysis of knowledge and experience to achieve deeper meaning." In medicine, there is little provision for post-graduate medical education to teach deliberate reflection. The feasibility, scoring characteristics, reliability, validation, and adaptability of a modified previously validated instrument was examined for its usefulness assessing reflective capacity in residents as a step toward developing interventions for improvement. METHODS Third-year residents and fellows from four anesthesia training programs were administered a slightly modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) in a prospective, observational study at the end of the 2019 academic year. Six written vignettes of imperfect anesthesia situations were created. Subjects recorded their perspectives on two randomly assigned vignettes. Responses were scored using a 5-element rubric; average scores were analyzed for psychometric properties. An independent self-report assessment method, the Cognitive Behavior Survey: Residency Level (rCBS) was used to examine construct validity. Internal consistency (ICR, Cronbach's alpha) and interrater reliability (weighted kappa) were examined. Pearson correlations were used between the two measures of reflective capacity. RESULTS 46/136 invited subjects completed 2/6 randomly assigned vignettes. Interrater agreement was high (k = 0.85). The overall average REFLECT score was 1.8 (1-4 scale) with good distribution across the range of scores. ICR for both the REFLECT score (mean 1.8, sd 0.5; α = 0.92) and the reflection scale of the rCBS (mean 4.5, sd 1.1; α = 0.94) were excellent. There was a significant correlation between REFLECT score and the rCBS reflection scale (r = .44, p < 0.01). CONCLUSIONS This study demonstrates feasibility, reliability, and sufficiently robust psychometric properties of a modified REFLECT rubric to assess graduate medical trainees' reflective capacity and established construct/convergent validity to an independent measure. The instrument has the potential to assess the effectiveness of interventions intended to improve reflective capacity.
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Affiliation(s)
- Richard H Blum
- Department of Anaesthesia, Harvard Medical School, MA, Boston, USA.
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, MA, 02115, Boston, USA.
- The Center For Medical Simulation, Charleston, MA, USA.
| | - Christine L Mai
- Department of Anaesthesia, Harvard Medical School, MA, Boston, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John D Mitchell
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health Systems, Detroit, MI, USA
| | - Daniel Saddawi-Konefka
- Department of Anaesthesia, Harvard Medical School, MA, Boston, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeffrey B Cooper
- Department of Anaesthesia, Harvard Medical School, MA, Boston, USA
- The Center For Medical Simulation, Charleston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - George Shorten
- Anesthesia and Intensive Care Medicine, School of Medicine, University College Cork, Cork, Ireland
- Insight II SFI Research Centre, Cork, Ireland
- Department of Anesthesia and Intensive Care, Cork University Hospital, Cork, Ireland
| | - Audrey DunnGalvin
- Early Years and Childhood Studies in the School of Applied Psychology, Cork University Hospital, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Bashir A, Wilkins K, Pallett R. An Innovative Workshop Embedding Pathology Service Users into the Undergraduate Biomedical Science Curriculum. Br J Biomed Sci 2023; 80:11584. [PMID: 37614721 PMCID: PMC10442479 DOI: 10.3389/bjbs.2023.11584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
The integration of pathology service users into the biomedical science curriculum has been driven by the refinement of the Health and Care Professions Council (HCPC) Standards of Proficiency. This study aimed to design and implement a novel and innovative service user event with a reflective assessment to enhance students' knowledge and understanding of the impact of pathology laboratory results on the patient pathway. The 4-h workshop consisted of a series of service users. Patients discussed how pathology services had contributed to their diagnosis and treatment, while service providers-a Microbiology Consultant, a director of primary care, and the patient referral optimisation officer-discussed their roles and their interactions with pathology services. Post-event, students completed a 750-word reflective assessment, highlighting challenges experienced by service users and providing suggestions for improving the delivery of pathology services. In total, 57.5% of respondents (57/99) completed a post-reflection survey, which included open- and closed-ended questions. Quantitative analysis of the survey data revealed that over 87.7% of respondents had increased knowledge and understanding of the revised HCPC standards. Following the assessment, students reported a significant increase in their confidence with respect to reflective writing (p < 0.001), with over 90% of respondents agreeing that the reflective assessment had increased their knowledge and understanding of the limitations that may negatively impact service users and patient care. Moreover, respondents highlighted how advancements in point-of-care testing (POCT) and improvements in communication can improve patient experiences. Thematic analysis revealed that respondents agreed that embedding patients into the curriculum reinforced the importance of there being a patient behind every sample. Respondents reported that reflecting upon service user experiences enabled them to identify improvements to the delivery of pathology services while recognising the essential role that Biomedical Scientists play in the patient pathway. This successful workshop has created a platform encompassing a range of pathology service users in the undergraduate curriculum. We recommend that other accredited biomedical science programmes adopt and embed this innovative workshop and reflective assessment into their programmes to help them meet these standards relating to service users while fostering important transferable skills in their students.
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19
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Lucas B. Using reflection in nursing practice to enhance patient care. Nurs Stand 2023; 38:44-49. [PMID: 37005865 DOI: 10.7748/ns.2023.e11598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 06/01/2023]
Abstract
The ability to reflect on, and learn from, practice experiences is essential for nurses when seeking to provide effective person-centred care. This article outlines the various types of reflection that nurses can use, such as reflection-in-action and reflection-on-action. It also details some of the main models of reflection and explains how nurses might develop their skills in reflection to enhance the quality of patient care. The article provides examples of cases and reflective activities to demonstrate how nurses can use reflection in their practice.
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20
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Naraynassamy C. The Central Role of Ethics in Medical Affairs Practice. Pharmaceut Med 2023:10.1007/s40290-023-00477-9. [PMID: 37227690 DOI: 10.1007/s40290-023-00477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 05/26/2023]
Abstract
The author argues that notwithstanding available guidelines and established practices, the elaboration of a formal ethics framework specific to medical affairs could improve good practice internationally. He further argues that further and better insights into the theory behind the practice of medical affairs are an essential precondition for elaborating any such framework.
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Affiliation(s)
- Carl Naraynassamy
- Centre for Pharmaceutical Medicine Research, King's College London, London, SE1 9NH, UK.
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21
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Linsenmeyer M, Long G. Goal-Oriented and Habit-Oriented Reflective Models to Support Professional Identity Formation and Metacognitive Thinking. MEDICAL SCIENCE EDUCATOR 2023; 33:569-575. [PMID: 37261017 PMCID: PMC10226929 DOI: 10.1007/s40670-023-01752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 06/02/2023]
Abstract
Professional identity formation (PIF) is a multi-year, complex, social, and intellectual process that culminates in trainees "thinking, acting, and feeling like a doctor." Some of the processes of PIF, particularly the Hidden Curriculum, may result in suboptimal outcomes in student's cognition, including implicit bias and poor clinical decision-making. Many have recognized the importance of reflective writing, particularly metacognition, in undergraduate medical education. However, there are few concrete examples and explanations for fully integrating reflective writing exercises across multiple situations, experiences, and levels of growth. The authors provide conceptual frameworks, concrete curricular structures, and reflective tools used at two medical schools. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01752-9.
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Affiliation(s)
- Machelle Linsenmeyer
- Office of Assessment and Educational Development, West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901 USA
| | - Goldberry Long
- Department of Creative Writing, University of California Riverside School of Medicine, Riverside, CA 92521 USA
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22
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Brown MEL, George RE. Supporting critically conscious integrated care: A toolbox for the health professions. CLINICAL TEACHER 2023:e13569. [PMID: 36883581 DOI: 10.1111/tct.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Riya E George
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London, UK
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23
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Kuhn J, Mamede S, van den Berg P, Zwaan L, van Peet P, Bindels P, van Gog T. Learning deliberate reflection in medical diagnosis: does learning-by-teaching help? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:13-26. [PMID: 35913665 PMCID: PMC9992049 DOI: 10.1007/s10459-022-10138-2] [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: 09/24/2020] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice residents would learn the deliberate reflection procedure through 'learning-by-teaching' and apply it to diagnose new cases. The study was a two-phase experiment. In the learning phase, 56 general-practice residents were randomly assigned to one of two conditions. They either (1) studied examples of deliberate reflection and then explained the procedure to a fictitious peer on video; or (2) solved cases without reflection (control). In the test phase, one to three weeks later, all participants diagnosed new cases while thinking aloud. The analysis of the test phase showed no significant differences between the conditions on any of the outcome measures (diagnostic accuracy, p = .263; time to diagnose, p = .598; mental effort ratings, p = .544; confidence ratings, p = .710; proportion of contradiction units (i.e. measure of deliberate reflection), p = .544). In contrast to findings on learning-by-teaching from other domains, teaching deliberate reflection to a fictitious peer, did not increase reflective reasoning when diagnosing future cases. Potential explanations that future research might address are that either residents in the experimental condition did not apply the learned deliberate reflection procedure in the test phase, or residents in the control condition also engaged in reflection.
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Affiliation(s)
- Josepha Kuhn
- Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Silvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Pieter van den Berg
- Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrick Bindels
- Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tamara van Gog
- Department of Education, Utrecht University, Utrecht, The Netherlands
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Archibald D, Grant R, Tuot DS, Liddy C, Sewell JL, Price DW, Grad R, Shipman SA, Campbell C, Guglani S, Wood TJ, Keely E. Development of eConsult reflective learning tools for healthcare providers: a pragmatic mixed methods approach. BMC PRIMARY CARE 2023; 24:15. [PMID: 36647016 PMCID: PMC9841624 DOI: 10.1186/s12875-022-01948-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Electronic consultation (eConsult) programs are crucial components of modern healthcare that facilitate communication between primary care providers (PCPs) and specialists. eConsults between PCPs and specialists. They also provide a unique opportunity to use real-world patient scenarios for reflective learning as part of professional development. However, tools that guide and document learning from eConsults are limited. The purpose of this study was to develop and pilot two eConsult reflective learning tools (RLTs), one for PCPs and one for specialists, for those participating in eConsults. METHODS We performed a four-phase pragmatic mixed methods study recruiting PCPs and specialists from two public health systems located in two countries: eConsult BASE in Canada and San Francisco Health Network eConsult in the United States. In phase 1, subject matter experts developed preliminary RLTs for PCPs and specialists. During phase 2, a Delphi survey among 20 PCPs and 16 specialists led to consensus on items for each RLT. In phase 3, we conducted cognitive interviews with three PCPs and five specialists as they applied the RLTs on previously completed consults. In phase 4, we piloted the RLTs with eConsult users. RESULTS The RLTs were perceived to elicit critical reflection among participants regarding their knowledge and practice habits and could be used for quality improvement and continuing professional development. CONCLUSION PCPs and specialists alike perceived that eConsult systems provided opportunities for self-directed learning wherein they were motivated to investigate topics further through the course of eConsult exchanges. We recommend the RLTs be subject to further evaluation through implementation studies at other sites.
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Affiliation(s)
- Douglas Archibald
- grid.28046.380000 0001 2182 2255Department of Family Medicine, C.T. Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, Canada ,grid.28046.380000 0001 2182 2255Faculty of Education, University of Ottawa, Ottawa, Canada
| | - Rachel Grant
- grid.28046.380000 0001 2182 2255Faculty of Education, University of Ottawa, Ottawa, Canada
| | - Delphine S. Tuot
- grid.266102.10000 0001 2297 6811Department of Medicine, Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
| | - Clare Liddy
- grid.28046.380000 0001 2182 2255Department of Family Medicine, C.T. Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, Canada ,grid.412687.e0000 0000 9606 5108Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Justin L. Sewell
- grid.266102.10000 0001 2297 6811Department of Medicine, Division of Gastroenterology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
| | - David W. Price
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO USA ,The American Board of Family Medicine, Lexington, KY USA
| | - Roland Grad
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, Montreal, Canada
| | - Scott A. Shipman
- grid.414000.10000 0000 8652 9597Association of American Medical Colleges, Washington, DC USA ,grid.254748.80000 0004 1936 8876Creighton University, Omaha, NE USA
| | - Craig Campbell
- grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Sheena Guglani
- grid.418792.10000 0000 9064 3333Bruyère Research Institute, Ottawa, Canada ,grid.412687.e0000 0000 9606 5108Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Timothy J. Wood
- grid.28046.380000 0001 2182 2255Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
| | - Erin Keely
- grid.412687.e0000 0000 9606 5108Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada ,grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, Canada
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Mamede S, Schmidt HG. Deliberate reflection and clinical reasoning: Founding ideas and empirical findings. MEDICAL EDUCATION 2023; 57:76-85. [PMID: 35771936 PMCID: PMC10083910 DOI: 10.1111/medu.14863] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/15/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT The idea that reflection improves reasoning and learning, since long present in other fields, emerged in the 90s in the medical education literature. Since then, the number of publications on reflection as a means to improve diagnostic learning and clinical problem-solving has increased steeply. Recently, concerns with diagnostic errors have raised further interest in reflection. Several approaches based on reflection have been proposed to reduce clinicians' errors during diagnostic reasoning. What reflection entails varies substantially, and most approaches still require empirical examination. PURPOSE The present essay aims to help clarify the role of deliberate reflection in diagnostic reasoning. Deliberate reflection is an approach whose effects on diagnostic reasoning and learning have been empirically studied over the past 15 years. The philosophical roots of the approach will be briefly examined, and the theory and practice of deliberate reflection, particularly its effectiveness, will be reviewed. Lessons learned and unresolved issues will be discussed. DISCUSSION The deliberate reflection approach originated from a conceptualization of the nature of reflection practice in medicine informed by Dewey's and Schön's work. The approach guides physicians through systematically reviewing the grounds of their initial diagnosis and considering alternatives. Experimental evidence has supported the effectiveness of deliberate reflection in increasing physicians' diagnostic performance, particularly in nonstraightforward diagnostic tasks. Deliberate reflection has also proved helpful to improve students' diagnostic learning and to facilitate learning of new information. The mechanisms behind the effects of deliberate reflection remain unclear. Tentative explanations focus on the activation/reorganisation of prior knowledge induced by deliberate reflection. Its usefulness depends therefore on the difficulty of the problem relative to the clinician's knowledge. Further research should examine variations in instructions on how to reflect upon a case, the value of further guidance while learning from deliberate reflection, and its benefits in real practice.
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Affiliation(s)
- Sílvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus MC; Department of Psychology, Education and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
| | - Henk G. Schmidt
- Institute of Medical Education Research Rotterdam, Erasmus MC; Department of Psychology, Education and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
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Schaepkens SPC, Lijster T. Mind The Gap: A Philosophical Analysis of Reflection's Many Benefits. TEACHING AND LEARNING IN MEDICINE 2022:1-10. [PMID: 36475951 DOI: 10.1080/10401334.2022.2142794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/16/2022] [Indexed: 06/17/2023]
Abstract
Issue: Expectations of reflection run high in medical practice and medical education; it is claimed as a means to many ends. In this article, the authors do not reject the value of reflection for medical education and medical practitioners, but they still ask why reflection can (potentially) yield so many different benefits, and what that implies for the status of reflection in medical education practice. Evidence: Based on a conceptual analysis of debates about reflection in the philosophical tradition, the authors argue that there are two quintessential gaps that play a role in the proliferation of (potential) benefits. First, reflection deals with bridging the gap between theory and practice; second, it deals with bridging the gap between the individual sense and communal sense. These gaps prevent the systematization of reflection, and they are fundamental to human thinking and experience in any situated environment, which led contemporary research on reflection to list a wide variety of benefits. Implications: The authors argue that if reflection resists systematization, it cannot be learned by following rules or protocols, but only practiced. Then, reflection should no longer be taught and researched as an individual skill one learns, nor as a means to some particular, beneficial end. Rather, one should practice reflection, and experience what it means to be part of a community wherein professionals jump the theory-practice gap constantly in a myriad of situations. Based on their analysis, the authors provide three concrete recommendations for reflection in medical education. First, to give precedence to reflective activities that encompass both gaps wherein situated examples can flourish; second, to use reflective guidelines as sources of inspiration; third, to show reserve about assessing reflection.
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Affiliation(s)
| | - Thijs Lijster
- Faculty of Arts, University of Groningen, Groningen, The Netherlands
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Ng SL, Forsey J, Boyd VA, Friesen F, Langlois S, Ladonna K, Mylopoulos M, Steenhof N. Combining adaptive expertise and (critically) reflective practice to support the development of knowledge, skill, and society. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1265-1281. [PMID: 36350488 PMCID: PMC9645329 DOI: 10.1007/s10459-022-10178-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Adaptive expertise (AE) and reflective practice (RP), two influential and resonant theories of professional expertise and practice in their own right, may further benefit health professions education if carefully combined. The current societal and systemic context is primed for both AE and RP. Both bodies of work position practitioners as agentive, learning continually and thoughtfully throughout their careers, particularly in order to manage unprecedented situations well. Similar on the surface, the roots and practices of AE and RP diverge at key junctures and we will focus on RP's movement toward critically reflective practice. The roots of AE and RP, and how they relate to or diverge from present-day applications matter because in health professions education, as in all education, paradigmatic mixing should be undertaken purposefully. This paper will explore the need for AE and RP, their shared commitments, distinctive histories, pedagogical possibilities both individually and combined, and next steps for maximizing their potential to positively impact the field. We argue that this exploration is urgently needed because both AE and RP hold much promise for improving health care and yet employing them optimally-whether alone or together-requires understanding and intent. We build an interprofessional education case situated in long-term care, throughout the paper, to demonstrate the potential that AE and RP might offer to health professions education individually and combined. This exploration comes just in time. Within the realities of uncertain practice emphasized by the pandemic, practitioners were also called to act in response to complex and urgent social movements. A combined AE and RP approach, with focus on critically reflective practice in particular, would potentially prepare professionals to respond effectively, compassionately, and equitably to future health and social crises and challenges.
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Affiliation(s)
- Stella L Ng
- Centre for Advancing Collaborative Healthcare and Education, University of Toronto, Toronto, Canada.
| | - Jacquelin Forsey
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Victoria A Boyd
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Farah Friesen
- Centre for Advancing Collaborative Healthcare and Education, University of Toronto, Toronto, Canada
| | | | - Kori Ladonna
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
| | - Maria Mylopoulos
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Naomi Steenhof
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Boyd VA, Woods NN, Kumagai AK, Kawamura AA, Orsino A, Ng SL. Examining the Impact of Dialogic Learning on Critically Reflective Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S71-S79. [PMID: 35950763 DOI: 10.1097/acm.0000000000004916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE While research is beginning to reveal the potential of dialogue in sparking critical reflection (critically reflective ways of seeing), additional research is needed to guide the teaching of critical reflection toward enabling critically reflective practice (critically reflective ways of seeing and doing). An experimental study was conducted to investigate the impact of dialogic learning on critically reflective practice, compared to discussion-based learning. The dialogic intervention integrated the theory of Mikhail Bakhtin with the theory of critical reflection and critical disability studies. METHOD In interprofessional groups of 4, medical, occupational therapy, and speech-language pathology students were randomly assigned to a learning condition that used a reflective discussion or critically reflective dialogue about a pediatric patient case. All participants were then randomly assigned a clinical report for a novel pediatric patient and asked to write a hypothetical clinical letter to the child's school. Hierarchical logistic regression models were constructed to estimate the probabilities of sentences and letters being critically reflective. RESULTS The probability of sentences being critically reflective was significantly higher for the dialogue condition (0.26, 95% CI [0.2, 0.33]), compared to the discussion condition (0.11, 95% CI [0.07, 0.15]). Likewise, the probability of letters being critically reflective was significantly higher for the dialogue condition (0.26, 95% CI [0.15, 0.4]), compared to the discussion condition (0.04, 95% CI [0.01, 0.16]). In both conditions, the probability of a letter being critically reflective was positively associated with the proportion of critically reflective sentences. CONCLUSIONS The results demonstrate dialogic learning prepared students to enact critically reflective practice when writing mock clinical letters. Students who participated in a dialogue engaged in a collaborative process of critical reflection and subsequently applied that way of seeing in the individual act of writing a letter. This study highlights how Bakhtin's theory of dialogue can advance critical pedagogy.
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Affiliation(s)
- Victoria A Boyd
- V.A. Boyd is a PhD candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, and fellow, The Wilson Centre, University Health Network, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-3602-8964
| | - Nikki N Woods
- N.N. Woods is director, Institute for Education Research, and scientist, The Wilson Centre, University Health Network, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2976-1108
| | - Arno K Kumagai
- A.K. Kumagai is vice chair for education, Department of Medicine, and F.M. Hill Chair in Humanism Education, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-7088-0208
| | - Anne A Kawamura
- A.A. Kawamura is associate professor, Department of Pediatrics, University of Toronto, and developmental pediatrician, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-5088-3011
| | - Angela Orsino
- A. Orsino is assistant professor, Department of Pediatrics, University of Toronto, and developmental pediatrician, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Stella L Ng
- S.L. Ng is director, Centre for Interprofessional Education, University of Toronto, and scientist, The Wilson Centre, University Health Network, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1433-6851
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Armitage-Chan E, Reissner S, Jackson E, Kedrowicz A, Schoenfeld-Tacher R. How Do Veterinary Students Engage When Using Creative Methods to Critically Reflect on Experience? A Qualitative Analysis of Assessed Reflective Work. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:632-640. [PMID: 34499593 DOI: 10.3138/jvme-2021-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Critical reflection-the exploration and questioning of one's experience, beliefs, assumptions, and actions-supports resilience, empathy, the management of uncertainty, and professional identity formation. Yet for many students and educators, the techniques to engage in critical reflection are elusive. Creative methods that foster engagement with emotional and uncertain aspects of experience reportedly help some students to reflect at a more critical level than when they use reflective writing, and this study explores more deeply the experiences of such students, who used creative methods to critically reflect on challenging or troubling past events. A narrative methodology was utilized, in which researchers collaboratively co-constructed an understanding of students' experiences of reflection to identify the activities and steps they used. Creative methods did not inherently lead to critical reflection, but when this was achieved, the creative approaches seemed to facilitate a staging of reflection, which incorporated five sequential stages: preplanning creative depiction, experimenting with different ideas, deliberately completing the reflective piece, reflecting on creative work, and reflecting again on learning and development. This cyclic, repeated revisit to experience, as students engaged in each stage of their work, appeared to facilitate both a deep connection with the emotional elements of experience and a more distanced analysis. This ultimately led to a deepening of understanding of events, including the construction of students' own beliefs and empathy with others' views.
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Stasiuk S, Hubinette M, Nimmon L. The ways social networks shape reflection on early significant clinical experiences in medical school. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:28-38. [PMID: 36310907 PMCID: PMC9588180 DOI: 10.36834/cmej.73422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical curricula are increasingly providing opportunities to guide reflection for medical students. However, educational approaches are often limited to formalized classroom initiatives where reflection is prescriptive and measurable. There is paucity of literature that explores the personal ways students may experience authentic reflection outside of curricular time. The purpose of this study was to understand how social networks might shape dimensions of reflection. METHODS This study employed a qualitative social network analysis approach with a core sample of seven first year undergraduate medical students who described their relationships with 61 individuals in their networks. Data consisted of participant generated sociograms and individual semi-structured interviews. RESULTS Many learners struggled to find significant ways to involve their social networks outside of medicine in their new educational experiences. It appeared that some medical students began in-grouping, becoming more socially exclusive. Interestingly, participants emphasized how curricular opportunities such as reflective portfolio sessions were useful for capturing a diversity of perspectives. CONCLUSIONS Our study is one of the first to characterize the social networks inside and outside of medical school that students utilize to discuss and reflect on early significant clinical experiences. Recent commentary in the literature has suggested reflection is diverse and personal in nature and our study offers empirical evidence to demonstrate this. Our insights emphasize the importance of moving from an instrumental approach to an authentic socially situated approach if we wish to cultivate reflective lifelong learning.
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Affiliation(s)
- Samantha Stasiuk
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Maria Hubinette
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
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Chow CJ, Hirshfield LE, Wyatt TR. Sharpening Our Tools: Conducting Medical Education Research Using Critical Theory. TEACHING AND LEARNING IN MEDICINE 2022; 34:285-294. [PMID: 34282701 DOI: 10.1080/10401334.2021.1946401] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Issue: As medical education continues to grapple with issues of systemic racism and oppression within its institutions, educational researchers will undoubtedly turn to critical theory to help illuminate these issues. Critical theory refers both to a "school of thought" and a process of critique that reveals the dynamic forces impacting minoritized groups and individuals. Critical theory can be helpful when researchers want to examine or expose social structures for their asymmetrical power differentials, and subsequently act upon them to create change. Evidence: However, despite the repeated calls for more critical work in medical education, merely describing critical theory's school of thought has not forwarded researchers' engagement with these theories. Presently, critical analyses remain rare in medical education. One potential reason for the lack of critical analyses is that there is little guidance for how researchers might engage with their data and approach their findings. Implications: In this paper, we go beyond merely describing critical theory and demonstrate how critical theory can be used as an analytic approach to interrogate the experiences of minoritized individuals in medical education. Using three critical theories: critical race theory, feminist theory, and postcolonial theory, we provide an illustration of how researchers might approach their data using one of three critical theories. In doing so, we hope to assist researchers in better understanding the utility of critical analyses to illuminate sociohistorical forces at work within medical education.
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Affiliation(s)
- Candace J Chow
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Laura E Hirshfield
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Hughes K, Hudson N, Bell C, Tomlin N, Handel I, Chinnery S, Rhind S. Exploring Student Experiences of an Undergraduate Certificate in Veterinary Medical Education. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 50:e20210098. [PMID: 35588307 DOI: 10.3138/jvme-2021-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ability to teach is recognized as a core skill for many professionals, including veterinarians, but undergraduate opportunities to develop this skill are not always available. A complementary teaching certificate offered during the clinical years of an undergraduate veterinary program was evaluated to investigate student experiences of the program and the perceived benefits and challenges of participating. The study used a mixed methods approach with questionnaires to provide an overview of the participant experience and semi-structured interviews to gain a deeper insight into students' experiences of the program. Two cohorts completed questionnaires comprising Likert-style and open-ended questions on the 3-year teaching certificate, the first cohort after 1 year of the program and the second cohort at completion. Interviews with participants from both cohorts were thematically analyzed to identify recurring themes. An average of 27% of students per academic year enrolled in the certificate program, most of whom completed it. Additionally, four to six students per cohort applied for Associate Fellow of the Higher Education Academy (AFHEA), and 19 students have achieved this recognition. Key themes from the data included that students felt the certificate built their confidence, increased their veterinary knowledge, and helped them become better teachers, with time management and reflection the biggest challenges. The Undergraduate Certificate of Veterinary Medical Education was seen as a good teaching foundation, while working toward the AFHEA provided some insight into higher education and academic careers. A structured teaching program offers students the opportunity to develop their learning and reflection both as students and future educators.
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Schaepkens SPC, Veen M, de la Croix A. Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:537-551. [PMID: 34767115 PMCID: PMC9117338 DOI: 10.1007/s10459-021-10082-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/31/2021] [Indexed: 05/21/2023]
Abstract
Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, 'how can research approach the conceptual indeterminacy of reflection to produce knowledge?'. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.
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Affiliation(s)
- Sven P C Schaepkens
- Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - M Veen
- Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - A de la Croix
- Faculty of Medicine, Vrije Universiteit Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
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Ng SL, Crukley J, Brydges R, Boyd V, Gavarkovs A, Kangasjarvi E, Wright S, Kulasegaram K, Friesen F, Woods NN. Toward 'seeing' critically: a Bayesian analysis of the impacts of a critical pedagogy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:323-354. [PMID: 34973100 PMCID: PMC9117363 DOI: 10.1007/s10459-021-10087-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/14/2021] [Indexed: 05/30/2023]
Abstract
Critical reflection supports enactment of the social roles of care, like collaboration and advocacy. We require evidence that links critical teaching approaches to future critically reflective practice. We thus asked: does a theory-informed approach to teaching critical reflection influence what learners talk about (i.e. topics of discussion) and how they talk (i.e. whether they talk in critically reflective ways) during subsequent learning experiences? Pre-clinical students (n = 75) were randomized into control and intervention conditions (8 groups each, of up to 5 interprofessional students). Participants completed an online Social Determinants of Health (SDoH) module, followed by either: a SDoH discussion (control) or critically reflective dialogue (intervention). Participants then experienced a common learning session (homecare curriculum and debrief) as outcome assessment, and another similar session one-week later. Blinded coders coded transcripts for what (topics) was said and how (critically reflective or not). We constructed Bayesian regression models for the probability of meaning units (unique utterances) being coded as particular what codes and as critically reflective or not (how). Groups exposed to the intervention were more likely, in a subsequent learning experience, to talk in a critically reflective manner (how) (0.096 [0.04, 0.15]) about similar content (no meaningful differences in what was said). This difference waned at one-week follow up. We showed experimentally that a particular critical pedagogical approach can make learners' subsequent talk, ways of seeing, more critically reflective even when talking about similar topics. This study offers the field important new options for studying historically challenging-to-evaluate impacts and supports theoretical assertions about the potential of critical pedagogies.
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Affiliation(s)
- Stella L Ng
- University of Toronto Centre for Interprofessional Education at University Health Network, Toronto Western Hospital, 399 Bathurst St., Nassau Annex (Entrance), Toronto, ON, M5T 2S8, Canada.
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
- Wilson Centre, University of Toronto, Toronto, ON, Canada.
| | - Jeff Crukley
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Data Science and Statistics, Toronto, ON, Canada
| | - Ryan Brydges
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Education, Unity Health Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Victoria Boyd
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Adam Gavarkovs
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | | | - Sarah Wright
- Department of Family and Community Medicine and Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Kulamakan Kulasegaram
- Department of Family and Community Medicine and Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Farah Friesen
- University of Toronto Centre for Interprofessional Education at University Health Network, Toronto Western Hospital, 399 Bathurst St., Nassau Annex (Entrance), Toronto, ON, M5T 2S8, Canada
| | - Nicole N Woods
- Department of Family and Community Medicine and Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
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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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36
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Fabry G. Wie lassen sich professionelle Kompetenzen im Medizinstudium vermitteln? Ethik Med 2022. [DOI: 10.1007/s00481-022-00695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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Moniz T, Melro CM, Warren A, Watling C. Dual and duelling purposes: An exploration of educators' perspectives on the use of reflective writing to remediate professionalism in residency. MEDICAL EDUCATION 2022; 56:176-185. [PMID: 34437727 PMCID: PMC9297876 DOI: 10.1111/medu.14625] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging-and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism. METHOD In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comparison to identify themes and to understand the relationships among them. RESULTS Medical educators reported using reflective writing as a learning tool to develop insight and as an assessment tool to unearth evidence of insight. The goal of learning may compete with the goal of assessment, creating tension that leads to uncertainty about the sincerity, quality and effectiveness of reflective writing as well as concerns about learner safety. Educators reported uncertainty about whether learners write to pass or to introspect and about how to judge the effectiveness of reflective writing as a learning tool. They expressed concern about creating a safe environment for learners-one that enables the genuine reflection required for insight development-while meeting requirements of remediation. CONCLUSIONS Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism.
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Affiliation(s)
- Tracy Moniz
- Department of Communication StudiesMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | | | - Andrew Warren
- Department of Pediatrics, Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Chris Watling
- Departments of Oncology and Clinical Neurological Sciences, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
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Ziada HM, Ditmyer MM, Abubakr NH. Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:157-165. [PMID: 33730391 DOI: 10.1111/eje.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development. MATERIALS AND METHODS Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes. RESULTS Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate. CONCLUSIONS The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.
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Affiliation(s)
- Hassan M Ziada
- Department of Clinical Sciences, University of Nevada, Las Vegas, Nevada, USA
| | - Marcia M Ditmyer
- School of Dental Medicine, University of Nevada, Las Vegas, Nevada, USA
| | - Neamat H Abubakr
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, Nevada, USA
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Gathu C. Facilitators and Barriers of Reflective Learning in Postgraduate Medical Education: A Narrative Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221096106. [PMID: 35529178 PMCID: PMC9069595 DOI: 10.1177/23821205221096106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Reflection in postgraduate medical education has been found to aid in the development of professional skills, improve clinical expertise, and problem solving with the aim of advancing lifelong learning skills and self-awareness, leading to good medical practice among postgraduate residents. Despite the evidenced benefits, reflection remains underused as a tool for teaching and learning, and few trainee physicians regularly engage in the process. Factors that affect the uptake of reflective learning in residency training have not yet been adequately explored. OBJECTIVE The purpose of this review is to demonstrate the factors that influence the adoption of reflective learning for postgraduate students and their centrality to good clinical practice. METHODS A review of the literature was performed using defined databases and the following search terms: 'reflection', 'reflective learning', 'postgraduate medical education', 'barriers' and 'facilitators'. The search was limited to peer-reviewed published material in English between 2011 and 2020 and included research papers, reviews, and expert opinion pieces. RESULTS Eleven relevant articles were included, which identified three main categories as facilitators and barriers to the adoption of reflective learning in postgraduate medical education. These included structure, assessment and relational factors. The structure of reflective practice is important, but it should not be too rigid. Assessments are paramount, but they should be multidimensional to accommodate the multicomponent nature of reflections. Relational factors such as motivation, coaching, and role modeling facilitate sustainable reflective practice. CONCLUSIONS This review suggests that the same factors that facilitate reflection can be a barrier if not used within the right epistemic. Educators should consider these factors to increase the acceptance and integration of reflective learning in curriculums by both teachers and learners.
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Affiliation(s)
- C Gathu
- C Gathu, Family Medicine, The Aga Khan University, Nairobi, Kenya.
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Herzog LS, Wright SR, Pennington JJ, Richardson L. The KAIROS Blanket Exercise: Engaging Indigenous ways of knowing to foster critical consciousness in medical education. MEDICAL TEACHER 2021; 43:1437-1443. [PMID: 34369238 DOI: 10.1080/0142159x.2021.1956679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Indigenous Peoples across Turtle Island (North America) experience ongoing health disparities tied to the effects of colonization and persistent racism toward Indigenous Peoples. Educating future clinicians to develop a critical consciousness is an important way to work toward cultural safety and improve the health care experiences of Indigenous patients. The present study evaluated the ability of the KAIROS Blanket Exercise (KBE) to foster critical consciousness. METHODS Two hundred thirteen medical students at the University of Toronto participated in the KBE. Subsequently, 174 students completed a paper evaluation, designed to capture concepts of cultural safety and critical consciousness. Data were analyzed using quantitative and qualitative methods to identify shifts in perspectives. RESULTS The majority of students reported the exercise altered the way they viewed those from backgrounds different from their own, and comments regarding bias, power and privilege were highlighted throughout the responses. Engaging in critical reflection through dialogue and revealing the complex sociopolitical context of Indigenous Peoples' history were emphasized as central to this transformation. CONCLUSIONS Following participation in the KBE, medical students demonstrated a shift in their perspectives. This suggests that creating curricular space for critical pedagogy may be effective in fostering critical consciousness, ultimately encouraging reflexive practice and social action.
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Affiliation(s)
- Lindsay S Herzog
- Mount Sinai Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Sarah R Wright
- Michael Garron Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Canada
| | | | - Lisa Richardson
- Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Molinaro ML, Cheng A, Cristancho S, LaDonna K. Drawing on experience: exploring the pedagogical possibilities of using rich pictures in health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1519-1535. [PMID: 34152494 DOI: 10.1007/s10459-021-10056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
In both clinical and health professions education research, rich pictures, or participant-generated drawings of complex phenomena, are gaining recognition as a useful method for exploring multifaceted and emotional topics in medicine. For instance, two recent studies used rich pictures to augment semi-structured interviews exploring trainees', health care professionals' (HCPs), and parents' experiences of difficult conversations in the Neonatal Intensive Care Unit (NICU)-an environment in which communication is often challenging, anxiety-provoking, and emotionally distressing. In both studies, participants were invited to draw a picture depicting how they experienced a difficult conversation in this setting. As part of the interview process, participants were asked to both describe how they engaged with rich pictures, and to share their perceptions about the affordances and limitations of this research method. Here, their perspectives are reported and the possibilities of using rich pictures to inform pedagogical innovations in health professions education and research are considered.
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Affiliation(s)
- Monica L Molinaro
- Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.
| | - Anita Cheng
- Department of Neonatal and Perinatal Medicine, London Health Sciences Centre, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Sayra Cristancho
- Department of Surgery, Faculty of Education, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Kori LaDonna
- Department of Innovation in Medical Education and Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Goldman J, Smeraglio A, Lo L, Kuper A, Wong BM. Theory in quality improvement and patient safety education: A scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:319-326. [PMID: 34609733 PMCID: PMC8633332 DOI: 10.1007/s40037-021-00686-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Theory plays an important role in education programming and research. However, its use in quality improvement and patient safety education has yet to be fully characterized. The authors undertook a scoping review to examine the use of theory in quality improvement and patient safety education. METHODS Eligible articles used theory to inform the design or study of a quality improvement or patient safety curriculum. The authors followed scoping review methodology and searched articles referenced in 20 systematic reviews of quality improvement and patient safety education, or articles citing one of these reviews, and hand searched eligible article references. Data analysis involved descriptive and interpretive summaries of theories used and the perspectives the theories offered. RESULTS Eligibility criteria were met by 28 articles, and 102 articles made superficial mention of theory. Eligible articles varied in professional group, learning stage and journal type. Theories fell into two broad categories: learning theories (n = 20) and social science theories (n = 11). Theory was used in the design (n = 12) or study (n = 17) of quality improvement and patient safety education. The range of theories shows the opportunity afforded by using more than one type of theory. DISCUSSION Theory can guide decisions regarding quality improvement and patient safety education practices or play a role in selecting a methodology or lens through which to study educational processes and outcomes. Educators and researchers should make deliberate choices around the use of theory that relates to aspects of an educational program that they seek to illuminate.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- The Wilson Centre, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Andrea Smeraglio
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Division of Hospital & Specialty Medicine, Portland Veterans Administration Medical Center, Portland, OR, USA
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- The Wilson Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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McCarthy B, Bessell N, Murphy S, Hartigan I. "Nursing and speech and language students' perspectives of reflection as a clinical learning strategy in undergraduate healthcare education: A qualitative study". Nurse Educ Pract 2021; 57:103251. [PMID: 34775226 DOI: 10.1016/j.nepr.2021.103251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/19/2021] [Accepted: 10/29/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to explore nursing and speech and language students' perspectives of reflection as a clinical learning strategy during years three and four of their undergraduate education programmes. BACKGROUND Reflection is recognised as a core student learning activity which is widely used in undergraduate healthcare education for clinical practice. Studies indicate that structured models and frameworks do help novice students to develop the process of reflection-on-practice particularly in years one and two. However, there is limited research on healthcare students' perspectives of reflection as a clinical learning strategy in the latter years of their undergraduate healthcare education (years 3 and 4). DESIGN A qualitative descriptive design was used. METHODS Using a self-reporting method whereby students respond to a series of questions posed by the researchers, data were collected from nursing (n = 20) and speech and language students (n = 26) in one university in Ireland and analysed using thematic analysis. RESULTS The findings from both nursing and speech and language students were similar. Three themes identified included: description of reflection, undertaking reflection and contribution to clinical learning. Most students expressed beneficial effects of reflection for personal and professional clinical learning. Some students reported negativities to the written reflections, expressing a preference for more diverse and less structured strategies and more face-to-face reflective discussions with clinical educators. CONCLUSIONS Whilst the benefits of reflection for clinical practice are well versed in this study, the authors suggest that academic and clinical educators employ more diverse and innovative reflective tools for healthcare students who are at a more competent level of their undergraduate education programme. Further interprofessional research in relation to different clinical reflective strategies for healthcare students in years three and four of their undergraduate education programmes is warranted.
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Affiliation(s)
- Bridie McCarthy
- School of Nursing & Midwifery, University College Cork, Cork, Ireland.
| | - Nicola Bessell
- School of Clinical Therapies, University College Cork, Cork, Ireland.
| | - Siobhan Murphy
- School of Nursing and Midwifery, University College Cork, Ireland.
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Ireland.
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Forsey J, Ng S, Rowland P, Freeman R, Li C, Woods NN. The Basic Science of Patient-Physician Communication: A Critical Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S109-S118. [PMID: 34348382 DOI: 10.1097/acm.0000000000004323] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Strong verbal communication skills are essential for physicians. Despite a wealth of medical education research exploring communication skills training, learners struggle to become strong communicators. Integrating basic science into the curriculum provides students with conceptual knowledge that improves learning outcomes and facilitates the development of adaptive expertise, but the conceptual knowledge, or "basic science," of patient-provider communication is currently unknown. This review sought to address that gap and identify conceptual knowledge that would support improved communication skills training for medical trainees. METHOD Combining the search methodology of Arksey and O'Malley with a critical analytical lens, the authors conducted a critical scoping review of literature in linguistics, cognitive psychology, and communications to determine: what is known about verbal communication at the level of word choice in physician-patient interactions? Studies were independently screened by 3 researchers during 2 rounds of review. Data extraction focused on theoretical contributions associated with language use and variation. Analysis linked patterns of language use to broader theoretical constructs across disciplines. RESULTS The initial search returned 15,851 unique studies, and 271 studies were included in the review. The dominant conceptual groupings reflected in the results were: (1) clear and explicit language, (2) patient participation and activation, (3) negotiating epistemic knowledge, (4) affiliative language and emotional bonds, (5) role and identity, and (6) managing transactional and relational goals. CONCLUSIONS This in-depth exploration supports and contextualizes theory-driven research of physician-patient communication. The findings may be used to support future communications research in this field and educational innovations based on a solid theoretical foundation.
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Affiliation(s)
- Jacquelin Forsey
- J. Forsey is a PhD candidate, Rehabilitation Sciences Institute, University of Toronto, and a fellow, Wilson Centre, Toronto, Ontario, Canada
| | - Stella Ng
- S. Ng is associate professor, Faculty of Medicine, University of Toronto, and director of research, Centre for Faculty Development, St. Michael's Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1433-6851
| | - Paula Rowland
- P. Rowland is assistant professor, Department of Occupational Therapy, University of Toronto, and scientist, Wilson Centre, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8054-7142
| | - Risa Freeman
- R. Freeman is vice chair of education and scholarship, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connie Li
- C. Li is a medical student, McMaster University, Hamilton, Ontario, Canada
| | - Nicole N Woods
- N.N. Woods is associate professor, Department of Family and Community Medicine, University of Toronto, and director, Institute for Education Research, UHN, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2976-1108
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Bindels E, van den Goor M, Scherpbier A, Lombarts K, Heeneman S. Sharing Reflections on Multisource Feedback in a Peer Group Setting: Stimulating Physicians' Professional Performance and Development. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1449-1456. [PMID: 33951680 DOI: 10.1097/acm.0000000000004142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Reflecting on and using feedback are important for physicians' continuous professional development (CPD). A common format is the discussion of multisource feedback (MSF) in a one-on-one session with a trusted peer or coach. A new approach is to discuss MSF during a peer group session moderated by a professional facilitator. This qualitative study explored how physicians experience participation in these peer group sessions in the context of their CPD. METHOD Between March and July 2018, 26 physicians were interviewed about their experiences in a peer group session. These physicians represented 13 monospecialty physician groups from 5 general hospitals in the Netherlands. Interviews were transcribed verbatim and analyzed iteratively, following the interpretative phenomenological approach. RESULTS Participation was experienced as a process of disclosing and sharing personal reflections with peers while striking a balance between interpersonal proximity to and distance from peers. Sharing reflections with peers rendered the feedback more meaningful, deepened collegial relationships, and created a sense of urgency for improvement. Improvement goals were mostly related to relational fine-tuning in collaboration; goals related to individual career management remained in the background. Influential factors for the perceived effectiveness of the group sessions were related to the facilitator's expertise, group size, continuity and quality of collegial relationships, personal vulnerabilities, and the context of CPD policy. CONCLUSIONS Peer group sessions offered interactivity and established a clear link between individual physicians and their work environments. Sharing reflections on MSF in a peer group setting provided physicians with nuanced insight into their professional performance and fostered a community spirit that supported the implementation of intended changes. Future research should focus on the role of group dynamics and communication strategies and the application of coaching principles, such as drawing up a detailed plan of action and monitoring the follow-up process.
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Affiliation(s)
- Elisa Bindels
- E. Bindels was a PhD candidate, Amsterdam Center for Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands, and Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, at the time of the study. The author is now a lecturer, Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0001-6096-4950
| | - Myra van den Goor
- M. van den Goor is CEO, Q3 Company for Physician Development, Den Bosch, the Netherlands; ORCID: https://orcid.org/0000-0002-6361-0178
| | - Albert Scherpbier
- A. Scherpbier is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-9652-0163
| | - Kiki Lombarts
- K. Lombarts is professor, Amsterdam Center for Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0001-6167-0620
| | - Sylvia Heeneman
- S. Heeneman is professor, Department of Pathology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-6103-8075
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Baker LR, Phelan S, Woods NN, Boyd VA, Rowland P, Ng SL. Re-envisioning paradigms of education: towards awareness, alignment, and pluralism. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1045-1058. [PMID: 33742339 PMCID: PMC8338841 DOI: 10.1007/s10459-021-10036-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
In this article we introduce a synthesis of education "paradigms," adapted from a multi-disciplinary body of literature and tailored to health professions education (HPE). Each paradigm involves a particular perspective on the purpose of education, the nature of knowledge, what knowledge is valued and included in the curriculum, what it means to learn and how learning is assessed, and the roles of teachers and learners in the learning process. We aim to foster awareness of how these different paradigms look in practice and to illustrate the importance of alignment between teaching, learning and assessment practices with paradigmatic values and assumptions. Finally, we advocate for a pluralistic approach that purposefully and meaningfully integrates paradigms of education, enhancing our ability to drive quality in HPE.
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Affiliation(s)
- Lindsay R Baker
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Centre for Faculty Development, Faculty of Medicine, University of Toronto At St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 2W8, Canada.
| | - Shanon Phelan
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Nicole N Woods
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
| | - Victoria A Boyd
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Paula Rowland
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, Toronto, Canada
| | - Stella L Ng
- Centre for Faculty Development, Faculty of Medicine, University of Toronto At St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 2W8, Canada
- The Wilson Centre, Unviersity of Toronto At University Health Network, Toronto, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Artioli G, Deiana L, De Vincenzo F, Raucci M, Amaducci G, Bassi MC, Di Leo S, Hayter M, Ghirotto L. Health professionals and students' experiences of reflective writing in learning: A qualitative meta-synthesis. BMC MEDICAL EDUCATION 2021; 21:394. [PMID: 34294058 PMCID: PMC8299581 DOI: 10.1186/s12909-021-02831-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/14/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: "What are the experiences of health professionals and students in applying reflective writing during their education and training?" METHODS We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals' and students' experience using reflective writing during their academic and in-service training by performing a meta-synthesis. RESULTS We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users' experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one's own and others' emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified. CONCLUSIONS The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.
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Affiliation(s)
- Giovanna Artioli
- Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy.
| | - Laura Deiana
- Medical and Surgical Department, University of Parma, Parma, Italy
| | | | - Margherita Raucci
- Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giovanna Amaducci
- Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Silvia Di Leo
- Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Mark Hayter
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Luca Ghirotto
- Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
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Jones CT, Tornwall J, Plahovinsak J, Fritter JS, Neidecker MV. Key ePortfolio features and strategies for student success in a competency-based clinical research program. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:826-834. [PMID: 34074514 DOI: 10.1016/j.cptl.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 12/17/2020] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Student ePortfolios provide an interactive space for faculty, student peers, and potential employers to view skillsets and reflective expressions of students. EDUCATIONAL ACTIVITY The adoption of ePortfolios in an interdisciplinary, competency-based, master's degree program in clinical research at a university in the Midwestern United States is described. Students submitted their ePortfolios as their culminating assessment. A survey was used to collect objective and open-ended responses from 104 students between 2015 and 2019 followed by a voluntary post-survey interview. Two ePortfolio platforms and instructional methods were compared. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY A user-friendly platform enhanced student engagement and reduced student and faculty frustration with the ePortfolio requirement. Thirty-seven students and alumni responded to an ePortfolio survey, and five students shared their experiences in a post-survey interview. Students described positive experiences related to their academic program and job search as a result of completing the ePortfolio. However, alumni were not strongly motivated to maintain their ePortfolio post-graduation. ePortfolios provide evidence of student acquisition of core competencies in a professional graduate degree. Facilitating the process of ePortfolio creation with instruction guides, exemplar ePortfolios, and an evaluation rubric support student success. A user-friendly ePortfolio platform with social media linking features will enhance exposure of the student's work to key stakeholders during and after their academic program. If the ePortfolio is to have an impact on a student's professional trajectory after graduation, it should contain meaningful examples of academic work that can be shared publicly and allow updating of ePortfolio content.
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Affiliation(s)
- Carolynn Thomas Jones
- The Ohio State University, Center for Clinical and Translational Science, College of Nursing, Columbus, OH, United States.
| | - Joni Tornwall
- The Ohio State University, College of Nursing, Columbus, OH, United States
| | | | - Jessica S Fritter
- The Ohio State University, College of Nursing, Nationwide Children's Hospital, Columbus, OH, United States
| | - Marjorie V Neidecker
- The Ohio State University, College of Nursing, The Ohio State University, College of Pharmacy, Columbus, OH, United States
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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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Emery L, Jackson B, Herrick T. Trainee engagement with reflection in online portfolios: A qualitative study highlighting the impact of the Bawa-Garba case on professional development. MEDICAL TEACHER 2021; 43:656-662. [PMID: 33600732 DOI: 10.1080/0142159x.2021.1887833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Reflection is an essential tool for postgraduate medical training, yet fear of exposing incompetence is a known barrier for engagement with reflection. In the UK, this fear may have been amplified by the case of Dr Bawa-Garba, whose reflective e-portfolio entries informed a General Medical Council investigation resulting in the loss of her licence to practice. AIM To identify themes GP trainees commonly explore in e-portfolio entries, and whether their reflective e-portfolio entries have changed following the Bawa-Garba case. METHOD A phenomenological approach was applied. Semi-structured interviews continued to data saturation in a purposive sample of trainees (7) and trainers (4) recruited from a South Yorkshire GP training scheme. Transcript data were assigned to a coding framework with iterative thematic analysis. RESULTS Dominant emergent themes were 'difficulty' and 'challenge'. All trainees described reluctance to submit significant event analyses (SEAs) on mistakes and near misses for fear of jeopardising their careers. International medical graduates were disproportionately affected by the challenges reflection posed. CONCLUSION Following the Bawa-Garba case, trainees are disengaging with SEAs to reduce the risk of self-incrimination. Further guidance with which trainees can navigate their reflective e-portfolios is required to retain the value of reflection as a tool for professional development.
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Affiliation(s)
- Laura Emery
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Ben Jackson
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Tim Herrick
- SFHEA School of Education, The University of Sheffield, Sheffield, UK
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