1
|
Cook KJ, Messick C, Baylor C, McAuliffe MJ. A qualitative study of reflective practice in the workplace. Speech-language pathologists have their say. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:637-651. [PMID: 38058000 DOI: 10.1080/17549507.2023.2267193] [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: 12/08/2023]
Abstract
PURPOSE Engaging in reflective practice (RP) and demonstrating reflective abilities is an essential graduate skill for speech-language pathologists (SLPs), yet limited studies have examined the perspectives of practicing SLPs and how and why they engage in RP. This qualitative study aimed to examine SLPs' experiences and perspectives of RP in diverse workplaces. METHOD Individual semi-structured interviews were conducted with 30 SLPs working in health, education, or private practice sectors. Interviews were analysed using thematic analysis. RESULT Three themes were developed from the data, describing what SLPs use RP for, what SLPs perceive as important in order to engage in RP in the workplace, as well as the barriers they have identified, and how SLPs have observed a change in engaging in RP as they have progressed in their careers. CONCLUSION SLPs described that RP is valued in the workplace for supporting client focused care, problem-solving, and lifelong learning. SLPs wanted time to be protected for RP at all stages of their career and valued the relationships with others as contributing positively to RP. Perceptions of and engagement in RP changed in relation to SLPs' clinical experience. Implications for clinical practice are discussed.
Collapse
Affiliation(s)
- Kate J Cook
- School of Psychology Speech & Hearing, Te Kura Mahi ā-Hirikapo, University of Canterbury, Aotearoa, New Zealand
| | - Cheryl Messick
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, DC, USA
| | - Megan J McAuliffe
- School of Psychology Speech & Hearing, Te Kura Mahi ā-Hirikapo, University of Canterbury, Aotearoa, New Zealand
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, Aotearoa, New Zealand
| |
Collapse
|
2
|
Lucas B. How to reflect on clinical practice. Nurs Stand 2024; 39:35-39. [PMID: 38910434 DOI: 10.7748/ns.2024.e12365] [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] [Accepted: 05/08/2024] [Indexed: 06/25/2024]
Abstract
RATIONALE AND KEY POINTS This 'How to' article explains how to reflect on clinical practice using reflection-on-action and a reflective model to help ensure the nurse gains comprehensive learning from an experience or incident to enhance their professional development and patient care. • Reflection is a vital element of nursing practice and has a wide-ranging purpose including, for example, self-inquiry into experiences to find meaning, gain insight and prompt action, recognition of emotional responses to care situations and exploring wider issues, such as healthcare culture. • Reflection-on-action involves a retrospective critical exploration of an experience or incident to identify learning points and may be engaged in alone, with one other person, for example during clinical supervision, or in a group activity. • There are a range of reflective models that can be used to structure a reflection, the main components of which generally include a description of the event, reflection on its meaning and identification of learning. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when using reflective techniques. • How you could use this information to educate nursing students or your colleagues on the appropriate methods for reflecting on clinical practice.
Collapse
|
3
|
Edelist T, Zaman S, Katzman E, Jarus T. 'Patient' or 'professional'? Negotiating accommodations and identity in fieldwork education. MEDICAL EDUCATION 2024; 58:1107-1116. [PMID: 38449338 DOI: 10.1111/medu.15365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Rueb M, Rehfuess EA, Siebeck M, Pfadenhauer LM. Cinemeducation: A mixed methods study on learning through reflective thinking, perspective taking and emotional narratives. MEDICAL EDUCATION 2024; 58:63-92. [PMID: 37525520 DOI: 10.1111/medu.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/29/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Cinemeducation describes the use of film in medical education. The M23 Cinema (M23C) comprises a film screening and subsequent discussion with experts, affected persons and the audience. Previous research suggests that participating in cinemeducation may affect emotions and attitudes. This study aimed to establish a conceptual framework and explore when learning takes place, how learning occurs and what participants learn during the M23C. METHODS Informed by focused literature searches, discussions of the authors and the research results, a conceptual framework of the M23C was developed, comprising three dimensions (five distinct phases, learning methodology and potential impact). A mixed method study was undertaken, employing an exploratory sequential design. Initially, the qualitative component was conducted by interviewing everyone involved, comprising focus groups, expert interviews, a group interview and one narrative interview. All qualitative data were analysed using qualitative content analysis. The qualitative findings were used to inform the development of a survey among the participants of M23C evenings. The survey results were analysed descriptively. The findings generated by both data sets were integrated using the "following a thread" protocol and visualised by joint displays. RESULTS In total, 15 participants in M23C courses, six members of the current and two of the former organising committee, two experts, two affected persons and the initiator of the M23C were included in the qualitative component (n = 28). A total of 503 participants responded to the survey. The qualitative data confirmed the relevance of the five phases and participants described reflective thinking, perspective taking and emotional narratives as the three dimensions of how they learned during the M23C. Participants reported a change in attitudes, enriching their knowledge, experiencing empathy and learning about other health professions. DISCUSSION Our findings suggest that the M23C as a cinemeducation course provides a unique learning environment in the training of health professionals.
Collapse
Affiliation(s)
- Mike Rueb
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva A Rehfuess
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| |
Collapse
|
7
|
Smyth Zahra F, Pearson J, Piper K. The ' Clinical Humanities & Wellbeing programme'- sustainable healthcare education for an era of uncertainty. Int Rev Psychiatry 2023; 35:636-644. [PMID: 38461386 DOI: 10.1080/09540261.2023.2262026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 03/11/2024]
Abstract
This article presents a case study where integration of arts and humanities into a clinical programme is being implemented at scale, as core mandatory learning for all students within a UK dental, undergraduate context. The cross-disciplinary programme described, that integrates the Humanities with Clinical Sciences, is a longitudinal professional identity formation curriculum for sustainable oral healthcare which aligns with the UK dental regulator's proposals for a 'safe practitioner' framework for new graduates. The Clinical Humanities & Wellbeing modules embrace the emotional and attitudinal aspects of learning and educate clinical students for the practical wisdom (phronesis) required to deliver 21st century oral healthcare in an era of uncertainty. The overarching aim of the curriculum and its accompanying assessment is to promote critical reflection, student insight and development of integrity, reflexivity, and responsibility. Enabling the subjectification of professional identity formation in this cross-disciplinary way aims to develop students as 'safe practitioners', with increased professional autonomy, responsible for their own actions, and who are better equipped for the uncertainties and phronesis of clinical practice. At present, the programme is being evaluated, employing illuminative evaluation methodology and we present some tentative initial findings. The authors believe that this unique approach and signature pedagogy is, with careful curation, transferrable to other health professions' contexts.
Collapse
Affiliation(s)
- Flora Smyth Zahra
- Centre for Dental Education, Faculty of Dentistry Oral & Craniofacial Sciences, King's College London, London
| | | | - Kim Piper
- Centre for Dental Education, Faculty of Dentistry Oral & Craniofacial Sciences, King's College London, London
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Wondimagegn D, Pain C, Seifu N, Cartmill C, Alemu AA, Whitehead CR. Reimagining global mental health in Africa. BMJ Glob Health 2023; 8:e013232. [PMID: 37666576 PMCID: PMC10481728 DOI: 10.1136/bmjgh-2023-013232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/20/2023] [Indexed: 09/06/2023] Open
Abstract
In 2001, the WHO launched The World Health Report most specifically addressing low-income and middle-income countries (LAMICs). It highlighted the importance of mental health (MH), identifying the severe public health impacts of mental ill health and made 10 recommendations. In 2022, the WHO launched another world MH report and reaffirmed the 10 recommendations, while concluding that 'business as usual for MH will simply not do' without higher infusions of money. This paper suggests the reason for so little change over the last 20 years is due to the importation and imposition of Western MH models and frameworks of training, service development and research on the assumption they are relevant and acceptable to Africans in LAMICs. This ignores the fact that most mental and physical primary care occurs within local non-Western traditions of healthcare that are dismissed and assumed irrelevant by Western frameworks. These trusted local institutions of healthcare that operate in homes and spiritual spaces are in tune with the lives and culture of local people. We propose that Western foundations of MH knowledge are not universal nor are their assumptions of society globally applicable. Real change in the MH of LAMICs requires reimagining. Local idioms of distress and healing, and explanatory models of suffering within particular populations, are needed to guide the development of training curricula, research and services. An integration of Western frameworks into these more successful approaches are more likely to contribute to the betterment of MH for peoples in LAMICs.
Collapse
Affiliation(s)
- Dawit Wondimagegn
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clare Pain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nardos Seifu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Carrie Cartmill
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Bélanger-Dibblee M, Pham Thi-Desmarteau S, Jacques MC, Tremblay H, Roy-Desruisseaux J. The Experiences, Needs, and Solutions of Caregivers of Patients With Behavioral and Psychological Symptoms of Dementia Living in Residential and Long-Term Care Centers. QUALITATIVE HEALTH RESEARCH 2023; 33:871-883. [PMID: 37271946 PMCID: PMC10426249 DOI: 10.1177/10497323231173854] [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: 06/06/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) pose great challenges for the caregivers during the evolution of the disease with impacts on patients, caregivers, and healthcare providers. Caregivers often remain very present and involved once the difficult decision has been made to relocate the person to a residential and long-term care center (centre d'hébergement de soins de longue durée [CHSLD] in Quebec). The experience of caregivers about BPSD management in CHSLDs remains poorly understood. The aim of this study is to explore the needs and experience of caregivers of patients with BPSD living in CHSLDs, as well as the solutions they suggest to better manage BPSD in CHSLDs. We carried out this qualitative interpretive descriptive study with six focus groups, including 32 caregivers, in Quebec, Canada. Data analysis identified six themes: (1) the transition period between home and the CHSLD; (2) the lack of knowledge about BPSD; (3) the approach to BPSD by healthcare professionals; (4) the lack of communication; (5) defining the caregiver's role in the healthcare team; and (6) the caregiver's need for respite. These results offer relevant avenues to improve collaborative practices with caregivers in CHSLDs involved in the care of people with BPSD.
Collapse
Affiliation(s)
| | | | | | - Hubert Tremblay
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | | |
Collapse
|
11
|
Pool N, Hebdon M, de Groot E, Yee R, Herrera-Theut K, Yee E, Allen LA, Hasan A, Lindenfeld J, Calhoun E, Carnes M, Sweitzer NK, Breathett K. A novel approach for assessing bias during team-based clinical decision-making. Front Public Health 2023; 11:1014773. [PMID: 37228737 PMCID: PMC10203455 DOI: 10.3389/fpubh.2023.1014773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/20/2023] [Indexed: 05/27/2023] Open
Abstract
Many clinical processes include multidisciplinary group decision-making, yet few methods exist to evaluate the presence of implicit bias during this collective process. Implicit bias negatively impacts the equitable delivery of evidence-based interventions and ultimately patient outcomes. Since implicit bias can be difficult to assess, novel approaches are required to detect and analyze this elusive phenomenon. In this paper, we describe how the de Groot Critically Reflective Diagnoses Protocol (DCRDP) can be used as a data analysis tool to evaluate group dynamics as an essential foundation for exploring how interactions can bias collective clinical decision-making. The DCRDP includes 6 distinct criteria: challenging groupthink, critical opinion sharing, research utilization, openness to mistakes, asking and giving feedback, and experimentation. Based on the strength and frequency of codes in the form of exemplar quotes, each criterion was given a numerical score of 1-4 with 1 representing teams that are interactive, reflective, higher functioning, and more equitable. When applied as a coding scheme to transcripts of recorded decision-making meetings, the DCRDP was revealed as a practical tool for examining group decision-making bias. It can be adapted to a variety of clinical, educational, and other professional settings as an impetus for recognizing the presence of team-based bias, engaging in reflexivity, informing the design and testing of implementation strategies, and monitoring long-term outcomes to promote more equitable decision-making processes in healthcare.
Collapse
Affiliation(s)
- Natalie Pool
- School of Nursing, University of Northern Colorado, Greeley, CO, United States
| | - Megan Hebdon
- School of Nursing, University of Texas-Austin, Austin, TX, United States
| | - Esther de Groot
- Department of General Practice, University of Utrecht, Utrecht, Netherlands
| | - Ryan Yee
- Division of Cardiovascular Medicine Research Department, Indiana University, Indianapolis, IN, United States
| | - Kathryn Herrera-Theut
- College of Medicine, Department of Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Erika Yee
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Larry A. Allen
- Division of Cardiovascular Medicine, University of Colorado, Denver, CO, United States
| | - Ayesha Hasan
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, United States
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, United States
| | - Elizabeth Calhoun
- Department of Population Health, University of Kansas, Kansas City, KS, United States
| | - Molly Carnes
- Department of Medicine, University of Wisconsin, Madison, WI, United States
| | - Nancy K. Sweitzer
- Division of Cardiovascular Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, IN, United States
| |
Collapse
|
12
|
Calhoun AJ, Martin A, Adigun A, Alleyne SD, Aneni K, Thompson-Felix T, Asnes A, de Carvalho-Filho MA, Benoit L, Genao I. Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice. MEDEDPUBLISH 2023; 13:4. [PMID: 37123251 PMCID: PMC10140654 DOI: 10.12688/mep.19487.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/02/2023] Open
Abstract
Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.
Collapse
Affiliation(s)
- Amanda J. Calhoun
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Ayodola Adigun
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Shirley D. Alleyne
- Division of Child Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, 33805, USA
| | - Kammarauche Aneni
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | | | - Andrea Asnes
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06520, USA
| | | | - Laelia Benoit
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Inginia Genao
- Office of Equity, Inclusion and Belonging, Penn State College of Medicine, State College, PA, 17033, USA
| |
Collapse
|
13
|
Peterson K, Ryan A, Antonelli M. Critical Reflection Practice in Nursing Health Care Policy Education. J Nurs Educ 2023; 62:312-315. [PMID: 36701131 DOI: 10.3928/01484834-20230105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A call to action is in effect for nurses to be change agents and bridge the gaps between the delivery of health care and the social needs of individuals, families, and communities. Response to this charge requires nurses to address long-standing inequity in health care policy and practice realms. METHOD This article describes the creative teaching-learning approach of critical reflection practice as a first step in developing skills and attitude for nurses to do this work. RESULTS Early observations of the effect of critical reflection practice on learners show improved appreciation for the intersection of social, economic, and political dimensions operating in health care policy and practice that influence health inequities. CONCLUSION When nurses engage in a practice of critical reflection, they are more likely to identify offensive social determinants, act to ameliorate disparities, and advance the agenda for health equity. [J Nurs Educ. 2023;62(X):XXX-XXX.].
Collapse
|
14
|
Zhan TT, Wang LL, Yan Wang, Sun CJ. Master of nursing specialist experiences of an internship through the use of written reflections: A qualitative research study. Heliyon 2023; 9:e13299. [PMID: 36814604 PMCID: PMC9939592 DOI: 10.1016/j.heliyon.2023.e13299] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Abstract
Background Reflective practice is an educational strategy and an essential part of the professional development of nurses. However, there are few reflective journals in the master of nursing specialist program or clinical nursing education. Objectives Based on Gibbs' reflective cycle theory, masters of nursing specialists (MNS) will use a diary to record their reflections on a particular clinical event. The purpose of this study was to identify reflective practice as tool to help MNS improve their professional and personal development. Design A descriptive qualitative study. Methods The purposive sampling method was used in the qualitative study. The data were derived from the master of nursing specialist who interned at the hospital from June to December 2021. After completing the job rotation and relevant course training within 6 months, a clinical experience was selected as a reflection. The traditional qualitative content analysis method was applied to analyze the collected data in the research. Results A total of 10 reflective diaries completed by ten students were analyzed. This qualitative study demonstrated that the Gibbs' reflective cycle is valuable and helpful in the clinical practice of master of nursing specialists. This program helps master of nursing specialists reflect on their clinical practice and translate real-life experiences into valuable learning experiences for developing their professional development and personal skills. Conclusions By writing reflection diaries, master of nursing specialists can reflect on the problems encountered during clinical rotations and take action following that reflection, which can assist them in improving their professional development and personal skills to handle clinical nursing aspects in the future, as well as improve their full participation in clinical practice.
Collapse
Affiliation(s)
- Ting-ting Zhan
- Department of Brain Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 117 Meishan Street, Hefei, 230031, Anhui, China
| | - Li-li Wang
- School of Nursing, Anhui University of Chinese Medicine, No. 103 Meishan Street, Hefei, 230031, Anhui, China,Corresponding author.
| | - Yan Wang
- School of Nursing, Anhui University of Chinese Medicine, No. 103 Meishan Street, Hefei, 230031, Anhui, China
| | - Cai-jie Sun
- School of Nursing, Anhui University of Chinese Medicine, No. 103 Meishan Street, Hefei, 230031, Anhui, China
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Bunch M, Johnson M, Moro SS, Adams MS, Sergio L. Virtual reality hope machines in a curative imaginary: recommendations for neurorehabilitation research from a critical disability studies perspective. Disabil Rehabil 2022; 44:7655-7663. [PMID: 34672894 DOI: 10.1080/09638288.2021.1982024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This paper provides recommendations for neurorehabilitative research informed by insights from critical disability studies (CDS) and a research study that tested an augmented neurorehabilitative technology prototype. METHODS The methodology combines critical reflection, feminist science studies and CDS to analyze how neurorehabilitation and disability studies conceptualize notions of disability and cure. It offers recommendations for reconciling the conflicting ideologies of cure that operate within neurorehabilitative research. RESULTS The prototype acted as a kind of virtual reality hope machine that tapped into different emotions and language games regarding disability and cure. The result is five recommendations about the ways that a CDS perspective might inform neurorehabilitation research: (I) ensure clarity in recruitment materials to account for dominant social views on disability and the possibility of cure; (II) build "strong objectivity" into research methods through attention to social context and multiple meanings of terms; (III) engage in critical reflection about research processes and findings; (IV) incorporate principles of crip technoscience; and (V) include CDS perspectives in neurorehabilitation education. CONCLUSIONS Bridging a conversation between neurorehabilitative research and CDS can address the discrepancies between ideologies of cure, and situate rehabilitation within the wider concerns of social determinants of health and disability justice.Implications for rehabilitationBridging connections between rehabilitation studies and critical disability studies can generate productive insights that open up conversations with disabled people and a commitment to disability justice.Disability and cure are social constructs and may have different meanings for patients and rehabilitation professionals.Clinicians should be mindful of the conflicting ideological constructs and socio-political dimensions of disability and cure that are operating below the surface in the rehabilitation profession and in interactions between clinicians and patients.As technology continues to transform clinical rehabilitation care through virtual reality and other innovative paradigms, rehabilitation clinicians should recognize the potential for these technologies to become "hope machines," generating patient expectations that are idealized constructions of hoped-for outcomes of returning to a previous state or level of functionality rather than predictive expectations of likely results.
Collapse
Affiliation(s)
- Mary Bunch
- Department of Cinema & Media Arts, York University, Toronto, Canada
| | - Megan Johnson
- Department of Theatre & Performance Studies, York University, Toronto, Canada
| | - Stefania S Moro
- School of Kinesiology & Health Science, York University, Toronto, Canada
| | - Meaghan S Adams
- School of Kinesiology & Health Science, York University, Toronto, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Lauren Sergio
- School of Kinesiology & Health Science, York University, Toronto, Canada
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Fernandez N, Cyr J, Perreault I, Brault I. Revealing tacit knowledge used by experienced health professionals for interprofessional collaboration. J Interprof Care 2020; 34:537-544. [PMID: 32067527 DOI: 10.1080/13561820.2020.1724901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With the current interest in interprofessional collaboration in health care as a response to ever-increasing complexity of health issues and scarcity of resources, many higher education institutions are developing interprofessional education (IPE) programs. However, there has been little empirical work on what. With the current interest for interprofessional collaboration in health care ever-increasing knowledge and skills are required to work collaboratively between health professions. We have undertaken to describe interprofessional collaboration as a practice largely underpinned by tacit knowledge acquired by experienced clinicians. Clinicians from all health professions in a large francophone university in Eastern Canada were invited to participate in explicitation interviews. Explicitation interviews require participants to freely recall an interprofessional collaboration event (e.g., team meeting or joint care delivery) and describe specific actions they personally enacted. An experienced health professional encounters many interprofessional situations over time; the actions they describe reflect their personal theories about the practice. Hence, it is highly probable that they use them frequently when working with colleagues in clinical settings. Unveiled tacit knowledge was divided into four themes: the importance of a sense of belonging to a team, the imperative to meet face-to-face, the practice of soliciting the working hypotheses of colleagues, and the art of summarizing meeting discussions.
Collapse
Affiliation(s)
- Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université De Montréal , Montréal, Quebec, Canada
| | - Jessica Cyr
- Faculty of Medicine, Université De Montréal , Montréal, Québec, Canada
| | - Isabelle Perreault
- Faculty of Educational Sciences, Université De Montréal , Montréal, Quebec, Canada
| | - Isabelle Brault
- Faculty of Nursing, Université De Montréal , Montreal, Quebec, Canada
| |
Collapse
|