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Berri M, Beydoun N, Johnson M. Curriculum guide for teaching house officers and faculty: applying procedure codes effectively using chemical denervation as a model. Front Med (Lausanne) 2024; 11:1359230. [PMID: 39359926 PMCID: PMC11444958 DOI: 10.3389/fmed.2024.1359230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/27/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction The healthcare system in the United States relies heavily on physician-and house officer-driven initiation of billing and coding for collection of hospital payments and professional fees. Under the umbrella of practice management is the ever-changing and suboptimally taught concept of procedural billing and coding to house officers and faculty. Clinical providers and practitioners initiate billing and coding for performed services based on the procedural visit encounter, supported by the appropriate documentation. Correct charge capture is dependent on accurately linking CPT codes and J codes, including waste documentation, modifiers, and charge collection. We discuss a perspective regarding a new curricular methodology that teaches learners to apply an algorithmic approach for coding CPT codes, J codes, and modifiers for chemical denervation procedures involving high-cost botulinum toxin. We further recommend the use of visuals with algorithm development for other pertinent procedures that are specific to a department. Methods We developed a curriculum that includes algorithmic visuals, pre-and post-test questions, and reflections. It was implemented across various learner types. Results This chemical denervation curriculum was well-received and impactful in meeting the objectives of the course. It further expanded a learner's vision of practice management that can be applied to other procedural examples. Discussion The results demonstrate a clear gap in practice management education, with pre-education knowledge on applying appropriate codes being particularly low among resident physicians. Learners found the algorithm we developed especially valuable, as it serves as a practical tool for accurately accounting for all aspects of CPT codes, modifiers, and J-codes. The methodology of the algorithmic approach proved to be innovative for avoiding billing write-offs and loopbacks that were beneficial for the training process. Learners indicated that this approach can be applied to other procedural billing.
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Affiliation(s)
- Maryam Berri
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Noha Beydoun
- Comprehensive Studies Program, University of Michigan, Ann Arbor, MI, United States
| | - Martha Johnson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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King SM, Anas S, Carnicer Hijazo R, Jordaan J, Potter JDF, Low-Beer N. Twelve tips for designing and implementing an academic coaching program. MEDICAL TEACHER 2024; 46:1140-1146. [PMID: 38295433 DOI: 10.1080/0142159x.2024.2308058] [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: 07/24/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
Coaching has become increasingly popular as a mechanism to support learning across the health professions education (HPE) continuum. While there is a growing body of literature in this area, there is minimal guidance related to the design and implementation of academic coaching in health professional courses. This paper seeks to contribute to this literature by presenting guidance for academic developers who are considering introducing academic coaching into a health professional course. The 12 tips are based on the authors' collective experiences of designing and implementing academic coaching in university medical courses in Australia and the UK. Although focused on medical education, this paper is intended to have applicability across the health professions, and potentially across university and postgraduate training contexts. Together, the tips offer a strategic and operational framework to guide the design and implementation of academic coaching initiatives in health professions education.
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Affiliation(s)
- Svetlana M King
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | | | - Johanna Jordaan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jean D F Potter
- Brunel Medical School, Brunel University London, UK
- The Hillingdon Hospital Pield Heath Road, Uxbridge Middlesex, UK
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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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Schumann Scheel L, Kjaer NK, Marnie C, Peters MDJ. Reflection in the training of general practitioners in clinical practice settings: a scoping review protocol. JBI Evid Synth 2023:02174543-990000000-00130. [PMID: 36727248 DOI: 10.11124/jbies-22-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this scoping review is to explore formalized methods of reflection that are used in clinical settings in general practice when training medical students, postgraduate trainees, general practitioners, and family physicians. INTRODUCTION Medical professionals are increasingly required to demonstrate competency in their ability to reflect on clinical practice. To accommodate this, the teaching of reflection is common in medical programs; however, there is a lack of clarity in the literature on how reflection is taught. INCLUSION CRITERIA This review will seek evidence describing the tools and approaches to reflection used by medical students, postgraduate trainees, and other registered medical professionals in general practice. The review will also include any evidence from those who teach reflection in a general practice setting. Evidence regarding reflection in training programs for other medical specialties will not be considered for inclusion. METHODS This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the JBI methodology for scoping reviews. Databases to be searched will include MEDLINE (Ovid), Emcare (Ovid), Embase (Ovid), Web of Science, Scopus, and the Cochrane Database of Systematic Reviews. Extracted evidence will be presented using figurative, tabular, and accompanying narrative synthesis in line with the review questions. SCOPING REVIEW DETAILS Open Science Framework https://osf.io/uxw7d.
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Affiliation(s)
- Linda Schumann Scheel
- Danish Centre of Systematic Reviews: A JBI Centre of Excellence, University of Aalborg, Denmark
| | - Niels Kristian Kjaer
- The Faculty of Health Sciences, Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Casey Marnie
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, South Australia, Australia
| | - Micah D J Peters
- UniSA Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, South Australia, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A Joanna Briggs Institute Centre of Excellence
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Ulfsdottir H, Johnson K, Rubertsson C, Ekelin M, Edqvist M. A complex and demanding situation - Midwifery preceptors and midwifery students' experiences of teaching and learning prevention of severe perineal trauma. Women Birth 2023; 36:e118-e124. [PMID: 35568665 DOI: 10.1016/j.wombi.2022.05.003] [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: 01/20/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described. AIM To describe midwifery preceptors and midwifery students' experiences' of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma. METHODS A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis. RESULTS "A complex and demanding situation with mutual need for feedback, reflection and safety" was the overall theme describing the conditions. Three sub-themes were identified. "Adapting to a unique situation" refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. "Hindering and limiting circumstances" describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. "A trustful and communicative relationship" describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part. CONCLUSION An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors' confidence in teaching.
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Affiliation(s)
- H Ulfsdottir
- Department of Women's Health and Health professions Karolinska University Hospital, Stockholm, Sweden
| | - K Johnson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - C Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Ekelin
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Edqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Lim JY, Ong SYK, Ng CYH, Chan KLE, Wu SYEA, So WZ, Tey GJC, Lam YX, Gao NLX, Lim YX, Tay RYK, Leong ITY, Rahman NDA, Chiam M, Lim C, Phua GLG, Murugam V, Ong EK, Krishna LKR. A systematic scoping review of reflective writing in medical education. BMC MEDICAL EDUCATION 2023; 23:12. [PMID: 36624494 PMCID: PMC9830881 DOI: 10.1186/s12909-022-03924-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Reflective writing (RW) allows physicians to step back, review their thoughts, goals and actions and recognise how their perspectives, motives and emotions impact their conduct. RW also helps physicians consolidate their learning and boosts their professional and personal development. In the absence of a consistent approach and amidst growing threats to RW's place in medical training, a review of theories of RW in medical education and a review to map regnant practices, programs and assessment methods are proposed. METHODS A Systematic Evidence-Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure the two concurrent reviews. Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2022 in PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus, Google Scholar, OpenGrey, GreyLit and ProQuest. The Split Approach saw the included articles analysed separately using thematic and content analysis. Like pieces of a jigsaw puzzle, the Jigsaw Perspective combined the themes and categories identified from both reviews. The Funnelling Process saw the themes/categories created compared with the tabulated summaries. The final domains which emerged structured the discussion that followed. RESULTS A total of 33,076 abstracts were reviewed, 1826 full-text articles were appraised and 199 articles were included and analysed. The domains identified were theories and models, current methods, benefits and shortcomings, and recommendations. CONCLUSIONS This SSR in SEBA suggests that a structured approach to RW shapes the physician's belief system, guides their practice and nurtures their professional identity formation. In advancing a theoretical concept of RW, this SSR in SEBA proffers new insight into the process of RW, and the need for longitudinal, personalised feedback and support.
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Affiliation(s)
- Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Simon Yew Kuang Ong
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Chester Yan Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Karis Li En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Song Yi Elizabeth Anne Wu
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Glenn Jin Chong Tey
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Yun Xiu Lam
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Nicholas Lu Xin Gao
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Ian Tze Yong Leong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Nur Diana Abdul Rahman
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Vengadasalam Murugam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, 574627, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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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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Nash C, MacPherson AC, Collins D. Reflections on Reflection: Clarifying and Promoting Use in Experienced Coaches. Front Psychol 2022; 13:867720. [PMID: 35602681 PMCID: PMC9114759 DOI: 10.3389/fpsyg.2022.867720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background We draw on the work of established scholars in the field of reflective practice who highlight its importance as a key cognitive skill for professionals to hold. While the substantive effect of engaging in reflective practice is emphasised in the literature, apparently coaches only spend a limited time learning about and engaging with it. Objectives This study was conducted in two parts: Part 1 examined coaches' knowledge of reflective practice and ascertained their perceived lack of value and use of reflective practice within their coaching. In response to the unexpected findings in Part 1, in Part 2, we instituted an educational intervention to further these participant coaches' knowledge of Reflective Practice (RP) and facilitate its integration into their coaching practice. Design The present study utilised a mixed method design with semi-structured interviews being conducted in Part 1. A coach development reflective programme inspired by Stimulated Recall approach was implemented in Part 2. Participants Twelve high level coaches were interviewed about their reflective practices in Part 1. In Part 2, the same coaches agreed to participate in the educational intervention for the duration of the project. Results Findings from Part 1 revealed an interesting paradox: coaches demonstrated a lack of appreciation for reflective practice yet recounted the positive influence that specific events and individuals had on their practice. In Part 2, to fully develop RP with the present cohort, an educational intervention was conducted. While watching videos of their own practice, coaches initially required lots of prompts from the lead interviewer to facilitate a deep and meaningful discussion of their practice. During the latter stages of the intervention, however, participants were less dependent on questions and prompts. Conclusion In part 1, the coaches in this study did employ reflection, although they did not label it as such. The qualitative evidence we have gathered enables us to suggest that it is the combination of how to reflect, and against what criteria that makes RP a powerful tool to develop expertise which it has the potential to be. Importantly, however, additional coach education input is necessary for these benefits to be fully realised.
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Affiliation(s)
- Christine Nash
- Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan C MacPherson
- Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Dave Collins
- Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Grey Matters Performance Ltd., Stratford-upon-Avon, United Kingdom
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Ohta R, Sano C. Reflection in Rural Family Medicine Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095137. [PMID: 35564531 PMCID: PMC9100794 DOI: 10.3390/ijerph19095137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 12/30/2022]
Abstract
Reflection in medical education is vital for students' development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents' learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents' desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during "doorknob" times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents' learning and sustainability of rural medical care.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Abstract
Educational change in higher education is challenging and complex, requiring engagement with a multitude of perspectives and contextual factors. In this paper, we present a case study based on our experiences of enacting a fundamental educational change in a medical program; namely, the steps taken in the transition to programmatic assessment. Specifically, we reflect on the successes and failures in embedding a coaching culture into programmatic assessment. To do this, we refer to the principles of programmatic assessment as they apply to this case and conclude with some key lessons that we have learnt from engaging in this change process. Fostering a culture of programmatic assessment that supports learners to thrive through coaching has required compromise and adaptability, particularly in light of the changes to teaching and learning necessitated by the global pandemic. We continue to inculcate this culture and enact the principles of programmatic assessment with a focus on continuous quality improvement.
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Rainusso N, Lemke D, Frugé E. A Simulation Workshop for Pediatric Residents Using Team-Based Reflective Practice to Communicate Life-Altering News. Cureus 2022; 14:e22695. [PMID: 35386176 PMCID: PMC8966956 DOI: 10.7759/cureus.22695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Guiding patients and their families through threat and tragedy is an essential skill for physicians. Educational opportunities to acquire this crucial expertise during medical training are limited. We describe a workshop design employing simulation and team-based reflection to enhance pediatric residents' confidence in delivering life-altering news. Methods Three hundred and seventy-six pediatric residents participated in an annual 2.75-hour workshop from 2011 to 2018. For each session, 24 to 28 residents were randomly assigned to learning teams of 6-7 trainees and two faculty. Each team had four different simulated parent encounters to convey life-altering news. Briefing and debriefing of encounters utilized team-based reflection. The impact of this educational intervention was evaluated using retrospective pre-post self-report questionnaires. Results Participants indicated that the learning experience was realistic, useful, and was provided in a safe learning environment. Residents reported increased confidence in their ability to communicate various types of life-altering news. A one-year follow-up survey indicated most respondents found the experience useful in actual practice subsequent to the workshop. The design also appears to be an efficient use of resources. Conclusion A workshop combining team-based reflection and simulation improves the confidence of pediatric residents in communicating life-altering news.
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Zaccagnini M, Miller PA. Portfolios with Evidence of Reflective Practice Required by Regulatory Bodies: An Integrative Review. Physiother Can 2021. [DOI: 10.3138/ptc-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Regulatory bodies impose continuing professional development (CPD) requirements on health care professionals (HCPs) as a condition for license revalidation. Many regulatory bodies require annual evidence of CPD activities that are informed by reflective practices, guided by learning plans, and compiled into a portfolio. The purpose of this integrative review is to summarize the literature discussing how regulatory bodies use portfolios with evidence of reflection for licensure renewal. Method: We reviewed English-language articles published until May 2020 discussing evidence of CPD and reflective practice in portfolios in the context of licensure renewal. Results: We located 17 articles for the review. None reported or measured outcomes beyond submission of reflective evidence. Sixteen articles (93%) included information about passive learning resources that regulatory bodies provided to help guide HCPs’ reflective learning activities. HCPs’ feedback about using reflective learning activities indicated mixed opinions about their utility. Conclusions: Few publications reported how jurisdictions expected HCPs to provide evidence of reflective practices for licensure renewal. None of the regulatory bodies required evidence regarding the impact of reflective practice on patient or organizational outcomes. HCPs reported both benefits and challenges of a mandated reflective process.
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Affiliation(s)
- Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
| | - Patricia A. Miller
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Heeneman S, de Jong LH, Dawson LJ, Wilkinson TJ, Ryan A, Tait GR, Rice N, Torre D, Freeman A, van der Vleuten CPM. Ottawa 2020 consensus statement for programmatic assessment - 1. Agreement on the principles. MEDICAL TEACHER 2021; 43:1139-1148. [PMID: 34344274 DOI: 10.1080/0142159x.2021.1957088] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In the Ottawa 2018 Consensus framework for good assessment, a set of criteria was presented for systems of assessment. Currently, programmatic assessment is being established in an increasing number of programmes. In this Ottawa 2020 consensus statement for programmatic assessment insights from practice and research are used to define the principles of programmatic assessment. METHODS For fifteen programmes in health professions education affiliated with members of an expert group (n = 20), an inventory was completed for the perceived components, rationale, and importance of a programmatic assessment design. Input from attendees of a programmatic assessment workshop and symposium at the 2020 Ottawa conference was included. The outcome is discussed in concurrence with current theory and research. RESULTS AND DISCUSSION Twelve principles are presented that are considered as important and recognisable facets of programmatic assessment. Overall these principles were used in the curriculum and assessment design, albeit with a range of approaches and rigor, suggesting that programmatic assessment is an achievable education and assessment model, embedded both in practice and research. Knowledge on and sharing how programmatic assessment is being operationalized may help support educators charting their own implementation journey of programmatic assessment in their respective programmes.
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Affiliation(s)
- Sylvia Heeneman
- Department of Pathology, School of Health Profession Education, Maastricht University, Maastricht, The Netherlands
| | - Lubberta H de Jong
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Luke J Dawson
- School of Dentistry, University of Liverpool, Liverpool, UK
| | - Tim J Wilkinson
- Education Unit, University of Otago, Christchurch, New Zealand
| | - Anna Ryan
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Glendon R Tait
- MD Program, Department of Psychiatry, and The Wilson Centre, University of Toronto, Toronto, Canada
| | - Neil Rice
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Dario Torre
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Adrian Freeman
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, School of Health Profession Education, Maastricht University, Maastricht, The Netherlands
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Rainusso N, Frugé E. Comment on: Parents' responses to prognostic disclosure at diagnosis of a child with a high-risk brain tumor: Analysis of clinician-parent interactions and implications for clinical practice. The role of reflection in dealing with uncertainty. Pediatr Blood Cancer 2021; 68:e29057. [PMID: 33844434 DOI: 10.1002/pbc.29057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Nino Rainusso
- Department of Pediatrics, Hematology-Oncology Section, Baylor College of Medicine, Texas Children's Cancer & Hematology Centers, Houston, TX, 77030, USA
| | - Ernest Frugé
- Department of Pediatrics, Hematology-Oncology Section, Baylor College of Medicine, Texas Children's Cancer & Hematology Centers, Houston, TX, 77030, USA
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van Braak M, Giroldi E, Huiskes M, Diemers AD, Veen M, van den Berg P. A participant perspective on collaborative reflection: video-stimulated interviews show what residents value and why. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:865-879. [PMID: 33590384 PMCID: PMC8338865 DOI: 10.1007/s10459-020-10026-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/23/2020] [Indexed: 05/28/2023]
Abstract
The potential of reflection for learning and development is broadly accepted across the medical curriculum. Our understanding of how exactly reflection yields its educational promise, however, is limited to broad hints at the relation between reflection and learning. Yet, such understanding is essential to the (re)design of reflection education for learning and development. In this qualitative study, we used participants' video-stimulated comments on actual practice to identify features that do or do not make collaborative reflection valuable to participants. In doing so, we focus on aspects of the interactional process that constitute the educational activity of reflection. To identify valuable and less valuable features of collaborative reflection, we conducted one-on-one video-stimulated interviews with Dutch general practice residents about collaborative reflection sessions in their training program. Residents were invited to comment on any aspect of the session that they did or did not value. We synthesized all positively and negatively valued features and associated explanations put forward in residents' narratives into shared normative orientations about collaborative reflection: what are the shared norms that residents display in telling about positive and negative experiences with collaborative reflection? These normative orientations display residents' views on the aim of collaborative reflection (educational value for all) and the norms that allegedly contribute to realizing this aim (inclusivity and diversity, safety, and efficiency). These norms are also reflected in specific educational activities that ostensibly contribute to educational value. As such, the current synthesis of normative orientations displayed in residents' narratives about valuable and less valuable elements of collaborative reflection deepen our understanding of reflection and its supposed connection with educational outcomes. Moreover, the current empirical endeavor illustrates the value of video-stimulated interviews as a tool to value features of educational processes for future educational enhancements.
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Affiliation(s)
- Marije van Braak
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands.
| | | | - Mike Huiskes
- Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- University Medical Center Groningen, Groningen, The Netherlands
| | - Mario Veen
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
| | - Pieter van den Berg
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
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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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Maejima S, Ohta R, Sano C. The Implementation of a Clinical Ladder in Rural Japanese Nursing Education: Effectiveness and Challenges. Healthcare (Basel) 2021; 9:healthcare9040469. [PMID: 33920946 PMCID: PMC8071243 DOI: 10.3390/healthcare9040469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
The clinical ladder is an essential tool for nursing education, enabling nurses to ascend from novice to expert. The learning content for nurses can depend on their clinical situations. The aging of societies has changed the demand for nurses at community hospitals because of the multimorbidity of older patients. At the same time, the gap in nursing education between urban and rural hospitals is wide, as rural hospitals often lack the application of the clinical ladder. This study investigates the effectiveness of using the clinical ladder in a rural Japanese community hospital using the clinical ladder scale and interviews. Through its application, we found that both novice nurses and nursing educators came to recognize the effectiveness and importance of the ladder. However, unfamiliarity with assessments, working conditions, and Japanese culture inhibited the smooth application of the ladder. For the effective application of the clinical ladder, continual training on assessments and the ladder’s effectiveness in clinical situations, along with consideration of educational background, should be enhanced through the monitoring of the clinical ladder.
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Affiliation(s)
- Satoko Maejima
- Department of Nursing, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan City 699-1221, Japan;
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan City 699-1221, Japan
- Correspondence:
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Ament Giuliani Franco C, Franco RS, Cecilio-Fernandes D, Severo M, Ferreira MA, de Carvalho-Filho MA. Added value of assessing medical students' reflective writings in communication skills training: a longitudinal study in four academic centres. BMJ Open 2020; 10:e038898. [PMID: 33158823 PMCID: PMC7651724 DOI: 10.1136/bmjopen-2020-038898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/13/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study describes the development and implementation of a model to assess students' communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students' reflections in the assessment of communication skills. DESIGN Third-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods. SETTING AND PARTICIPANTS The communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students. OUTCOME MEASURES The students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach's alpha, dimensionality and the person's correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections' depth, and the Thematic Score (TS) to map and grade reflections' themes. RESULTS The Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE. CONCLUSIONS Assessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods-possibly a metacognitive domain.
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Affiliation(s)
| | - Renato Soleiman Franco
- Medicine School and Post-Graduate Program in Bioethics, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health and Public Health and Forensic Sciences, and Medical Education Department, University of Porto Medical School, Porto, Portugal
| | - Maria Amélia Ferreira
- Public Health and Forensic Sciences, and Medical Education Department, University of Porto Faculty of Medicine, Porto, Portugal
| | - Marco Antonio de Carvalho-Filho
- Internal Medicine, University of Minho School of Medicine, Braga, Portugal
- CEDAR - Center for Educational Development and Research in Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
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Radl-Karimi C, Nicolaisen A, Sodemann M, Batalden P, von Plessen C. Under what circumstances can immigrant patients and healthcare professionals co-produce health? - an interpretive scoping review. Int J Qual Stud Health Well-being 2020; 15:1838052. [PMID: 33112713 PMCID: PMC7599002 DOI: 10.1080/17482631.2020.1838052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Christina Radl-Karimi
- OPEN Odense Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense C, Denmark
| | - Anne Nicolaisen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Morten Sodemann
- Migrant Health Clinic, Odense Universitetshospital, Odense C, Denmark
- Center for Global Health, University of Southern Denmark, Odense C, Denmark
| | - Paul Batalden
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Christian von Plessen
- Direction générale de la santé, Unisanté, Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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20
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Lillevang G, Ibsen H, Prins SH, Kjaer NK. How to enhance and assess reflection in specialist training: a mixed method validation study of a new tool for global assessment of reflection ability. BMC MEDICAL EDUCATION 2020; 20:352. [PMID: 33032573 PMCID: PMC7545892 DOI: 10.1186/s12909-020-02256-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In Danish GP training we had the ambition to enhance and assess global reflection ability, but since we found no appropriate validated method in the literature, we decided to develop a new assessment tool. This tool is based on individual trainee developed mind maps and structured trainer-trainee discussions related to specific complex competencies. We named the tool Global Assessment of Reflection ability (GAR) and conducted a mixed method validation study. Our goal was to investigate whether it is possible to enhance and assess reflection ability using the tool. METHODS In order to investigate acceptability, feasibility, face validity, and construct validity of the tool we conducted a mixed method validation study that combined 1) qualitative data obtained from 750 GP trainers participating in train-the-trainer courses, 2) a questionnaire survey sent to 349 GP trainers and 214 GP trainees and 3) a thorough analysis of eight trainer-trainee discussions. RESULTS Our study showed an immediate high acceptance of the GAR tool. Both trainers and trainees found the tool feasible, useful, and relevant with acceptable face validity. Rating of eight audio recordings showed that the tool can demonstrate reflection during assessment of complex competencies. CONCLUSIONS We have developed an assessment tool (GAR) to enhance and assess reflection. GAR was found to be acceptable, feasible, relevant and with good face- and construct validity. GAR seems to be able to enhance the trainees' ability to reflect and provide a good basis for assessment in relation to complex competencies.
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Affiliation(s)
- Gunver Lillevang
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Helle Ibsen
- The Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Søren Hast Prins
- Centre for Health Sciences Education, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Niels Kristian Kjaer
- The Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Jones J, Bion J, Brown C, Willars J, Brookes O, Tarrant C. Reflection in practice: How can patient experience feedback trigger staff reflection in hospital acute care settings? Health Expect 2019; 23:396-404. [PMID: 31858677 PMCID: PMC7104653 DOI: 10.1111/hex.13010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/08/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022] Open
Abstract
Background Patient and staff experiences provide important insights into care quality, but health systems have difficulty using these data to improve care. Little attention has been paid to understanding how patient experience feedback can act as a prompt to reflection in practice in the clinical setting. Objective We aimed to identify the ways in which different types of patient experience feedback act as a trigger or prompt for engagement in reflection in clinical practice in acute hospital settings and identify important considerations for enhancing the value of patient experience data for reflective learning. Methods We conducted an ethnographic study in eight acute care units in three NHS hospital trusts in England, including 140 hours of observations and 45 semi‐structured interviews with nursing, medical and managerial staff working in acute medical units and intensive care units. The data were analysed thematically. Findings We distinguished between formal patient experience data sources: data purposively collected and collated to capture the patient experience of care, generally at organizational level, including surveys, complaints and comments; and informal sources of feedback on the patient experience recognized by staff alongside the formal data. We also identified patient narratives as an ‘in between’ source of data. The impact of different types of patient feedback in triggering reflection primarily depended on the extent to which the feedback was experienced as personally relevant, meaningful and emotionally salient. Discussion Patient experience feedback is multi‐faceted, but our study suggests that all types of feedback could be harnessed more effectively to prompt reflection.
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Affiliation(s)
- Jennifer Jones
- Health Sciences department, University of Leicester, Leicester, UK
| | - Julian Bion
- Intensive Care Medicine, University of Birmingham, Birmingham, UK
| | - Celia Brown
- Warwick Medical School, The University of Warwick, Warwick, UK
| | - Janet Willars
- Health Sciences department, University of Leicester, Leicester, UK
| | - Olivia Brookes
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Carolyn Tarrant
- Health Sciences department, University of Leicester, Leicester, UK
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22
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Warman SM. Experiences of recent graduates: reframing reflection as purposeful, social activity. Vet Rec 2019; 186:347. [PMID: 31826933 DOI: 10.1136/vr.105573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND During the Royal College of Veterinary Surgeons' (RCVS) Professional Development Phase, graduates are required to reflect on their progress. Reflection is often conceptualised as a solitary activity, which may contrast with day-to-day reflective activities in the workplace. This study drew on cultural-historical activity theory to understand how recently graduated veterinary surgeons engage in reflective activity. METHODS Data comprised RCVS documentation and semistructured interviews with 15 recent graduates from one veterinary school. Thematic analysis was used to describe a collective system of reflective activity and to identify contradictions in the system with the potential to limit outcomes of reflective activity. RESULTS Two overarching themes of contradictions were identified: 'social reflection' and 'formalising the informal'. Graduates need opportunities for talking and/or writing to progress worries into purposeful reflection, underpinned by a shared understanding of reflective activity with colleagues, and by working practices which prioritise and normalise reflective interaction. CONCLUSION These findings identify potential avenues to better support veterinary graduates as they negotiate the transition to working life, and suggest that reconsideration of the formal expectations of new veterinary graduates and their employers is timely.
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Affiliation(s)
- Sheena M Warman
- Bristol Veterinary School, University of Bristol, Bristol, UK
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Jordan J, Watcha D, Cassella C, Kaji AH, Trivedi S. Impact of a Mentorship Program on Medical Student Burnout. AEM EDUCATION AND TRAINING 2019; 3:218-225. [PMID: 31360814 PMCID: PMC6637010 DOI: 10.1002/aet2.10354] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Burnout can have negative consequences for providers' health and patient care. Mentorship has positive effects including stress mitigation. We sought to evaluate the impact of a mentorship program on burnout in fourth-year medical students during their 4-week emergency medicine subinternship. METHODS This was a prospective, quasi-experimental, mixed-methods study at two institutions. We assessed burnout using the Maslach Burnout Inventory, comprising three subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). We compared changes in burnout scores before and after implementation of a resident-student mentorship program. We compared categorical variables using risk ratios and continuous variables using Wilcoxon rank-sum test. To account for potential confounders, we performed multivariable analysis. Students and mentors completed an evaluative survey. We reported descriptive statistics and performed thematic qualitative analysis on free-response data. RESULTS A total of 135 students (intervention = 51; control = 84) and 59 mentors participated. Intervention students demonstrated decreased EE and DP and increased PA scores, medians of -2 (-4 to 4), -1 (-3 to 2), and 1 (-1 to 4), respectively, compared to controls, median difference of 0 for all subscales. After adjusting for potential confounders, there was no significant difference in EE (mean difference = -0.2 [-0.5 to 0.2], p = 0.4) or DP scores (mean difference = -0.2 [-1.8 to 1.5], p = 0.9). There was a significant difference in PA scores (mean difference = 2.2 [0.1 to 4.3], p = 0.04). Most students felt the program positively impacted their rotation (39/48) and decreased stress (28/48). Students felt that the program provided career guidance and positively impacted their personal and professional development. The majority (34/37) of mentors enjoyed participating. Qualitative analysis revealed five major themes: relationship building, different perspective, knowledge sharing, personal fulfillment, and self-reflection. CONCLUSION We found an increased sense of personal accomplishment after implementation of a mentorship program. Both mentors and mentees viewed the program positively and perceived multiple benefits.
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Affiliation(s)
- Jaime Jordan
- Department of Emergency MedicineRonald Reagan UCLA Medical CenterLos AngelesCA
- David Geffen School of Medicine at UCLALos AngelesCA
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
| | - Daena Watcha
- Department of Emergency MedicineRegional Medical CenterSan JoseCA
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
| | - Courtney Cassella
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
- Mount Sinai HospitalIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Amy H. Kaji
- David Geffen School of Medicine at UCLALos AngelesCA
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
| | - Shefali Trivedi
- Mount Sinai HospitalIcahn School of Medicine at Mount SinaiNew YorkNY
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Heeneman S, Driessen E, Durning SJ, Torre D. Use of an e‑portfolio mapping tool: connecting experiences, analysis and action by learners. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:197-200. [PMID: 31098981 PMCID: PMC6565639 DOI: 10.1007/s40037-019-0514-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Reflective practice is an important characteristic of a knowledgeable health professional. Reflection is needed to maintain professional competence, practice-based learning, and an improvement focused attitude. Yet, learners struggle with reflective practice activities as they are perceived as challenging and time consuming. We used the idea of concept mapping to design an e‑portfolio tool that supports learners with their reflective practice activities. The purpose of this article is to demonstrate the design and rationale of e‑portfolio mapping and how this tool could be used to support reflective practice activities.Following the stepwise approach typical for the reflective cycle, two types of maps were designed, a trigger map and a competency map. In a trigger map, the learner reflects on a concrete learning or feedback experience. In a competency map the learner interprets and synthesizes several previous trigger maps which ultimately leads to the formulation of new learning objectives. The e‑portfolio mapping tool can be a useful and supportive tool to foster learners' reflective skills and provide mentors with in-depth insight into the students' learning and reflection processes.
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Affiliation(s)
- Sylvia Heeneman
- Department of Pathology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Erik Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Steven J Durning
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Dario Torre
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Van Schalkwyk SC, Hafler J, Brewer TF, Maley MA, Margolis C, McNamee L, Meyer I, Peluso MJ, Schmutz AM, Spak JM, Davies D. Transformative learning as pedagogy for the health professions: a scoping review. MEDICAL EDUCATION 2019; 53:547-558. [PMID: 30761602 DOI: 10.1111/medu.13804] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/16/2018] [Accepted: 12/13/2018] [Indexed: 05/13/2023]
Abstract
CONTEXT Transformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field. METHODS Arksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis. RESULTS A mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists. CONCLUSIONS The training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.
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Affiliation(s)
- Susan C Van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janet Hafler
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Timothy F Brewer
- Departments of Medicine and Epidemiology, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Moira A Maley
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Carmi Margolis
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Lakshini McNamee
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilse Meyer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael J Peluso
- Division of Infectious Diseases, University of California-San Francisco Medical Center, San Francisco, California, USA
| | - Ana Ms Schmutz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judy M Spak
- Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Davies
- Warwick Medical School, University of Warwick, Coventry, UK
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Uygur J, Stuart E, De Paor M, Wallace E, Duffy S, O'Shea M, Smith S, Pawlikowska T. A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51. MEDICAL TEACHER 2019; 41:3-16. [PMID: 30634872 DOI: 10.1080/0142159x.2018.1505037] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Reflection is thought to be an essential skill for physicians. Although much has been written about it, there is little concurrence about how to best teach reflection in medical education. The aim of this review was to determine: (i) which educational interventions are being used to develop reflection, (ii) how is reflection being assessed, and (iii) what are the most effective interventions. METHODS Inclusion criteria comprised: (i) undergraduate medical students, (ii) a teaching intervention to develop reflection, and (iii) assessment of the intervention. A review protocol was developed and nine databases were searched. Screening, data extraction, and analysis procedures were performed in duplicate. Due to the heterogeneity of studies, a narrative synthesis approach was performed for the study analysis. RESULTS Twenty-eight studies met the inclusion criteria. The interventions in these studies had at least of two of the following components related to reflection: (i) introduction, (ii) trigger, (iii) writing, (iv) guidelines, (v) small group discussion, (vi) tutor and (vii) feedback. Three validated rubrics were used to assess reflective writing in these studies. CONCLUSIONS The strongest evidence from studies in this review indicates that guidelines for, and feedback on, reflective writing improve student reflection.
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Affiliation(s)
- Jane Uygur
- a Department of General Practice , RCSI , Dublin , Ireland
| | - Ellen Stuart
- a Department of General Practice , RCSI , Dublin , Ireland
| | | | - Emma Wallace
- a Department of General Practice , RCSI , Dublin , Ireland
| | - Seamus Duffy
- a Department of General Practice , RCSI , Dublin , Ireland
| | - Marie O'Shea
- b Health Professions Education Centre, RCSI , Dublin , Ireland
| | - Susan Smith
- a Department of General Practice , RCSI , Dublin , Ireland
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Wakeling J, Holmes S, Boyd A, Tredinnick-Rowe J, Cameron N, Marshall M, Bryce M, Archer J. Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:13-20. [PMID: 30730475 DOI: 10.1097/ceh.0000000000000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Reflective practice has become the cornerstone of continuing professional development for doctors, with the expectation that it helps to develop and sustain the workforce for patient benefit. Annual appraisal is mandatory for all practicing doctors in the United Kingdom as part of medical revalidation. Doctors submit a portfolio of supporting information forming the basis of their appraisal discussion where reflection on the information is mandated and evaluated by a colleague, acting as an appraiser. METHODS Using an in-depth case study approach, 18 online portfolios in Scotland were examined with a template developed to record the types of supporting information submitted and how far these showed reflection and/or changes to practice. Data from semistructured interviews with the doctors (n = 17) and their appraisers (n = 9) were used to contextualize and broaden our understanding of the portfolios. RESULTS Portfolios generally showed little written reflection, and most doctors were unenthusiastic about documenting reflective practice. Appraisals provided a forum for verbal reflection, which was often detailed in the appraisal summary. Portfolio examples showed that reflecting on continued professional development, audits, significant events, and colleague multisource feedback were sometimes considered to be useful. Reflecting on patient feedback was seen as less valuable because feedback tended to be uncritical. DISCUSSION The written reflection element of educational portfolios needs to be carefully considered because it is clear that many doctors do not find it a helpful exercise. Instead, using the portfolio to record topics covered by a reflective discussion with a facilitator would not only prove more amenable to many doctors but would also allay fears of documentary evidence being used in litigation.
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Affiliation(s)
- Judy Wakeling
- Dr. Wakeling: Research Lead-Medical, NHS Education for Scotland, Edinburgh, Scotland. Mrs. Holmes: Specialty Training Manager, Revalidation Support Unit, Wales Deanery, Cardiff, Wales. Mr. Boyd: Research Fellow in Healthcare and Public Sector Management, Alliance Manchester Business School, The University of Manchester, Manchester, England. Dr. Tredinnick-Rowe: Research Assistant, University of Plymouth, Plymouth, England. Mr. Cameron: National Appraisal Advisor for Medical Appraisal NHS Education for Scotland, Edinburgh, Scotland. Dr. Marshall: Professor of Healthcare Improvement at UCL, and Vice Chair (External Affairs) RCGP, and Program Director at UCLPartners, London, England. Dr. Bryce: Senior Research Fellow, Collaboration for the Advancement of Medical Education Research & Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, England. Dr. Archer: Honorary Professor in Medical Education Research, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, England
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Vachon B, Foucault ML, Giguère CÉ, Rochette A, Thomas A, Morel M. Factors Influencing Acceptability and Perceived Impacts of a Mandatory ePortfolio Implemented by an Occupational Therapy Regulatory Organization. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:25-31. [PMID: 29261571 DOI: 10.1097/ceh.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The use of ePortfolios has been implemented in several regulatory organizations to encourage clinicians' engagement in continuing professional development (CPD). However, their use has achieved mixed success, and multiple personal and contextual factors can influence their impacts on practice change. The aim of this study was to identify which factors influence the acceptability and perceived impacts of an ePortfolio implemented by an occupational therapy regulatory organization in one Canadian province. METHOD A cross-sectional online survey design was used. The survey was sent to registered occupational therapists in Quebec. Multiple regression analyses were conducted to identify factors influencing acceptability and outcomes: ease of use, satisfaction, impact on implementation of the CPD plan, and competence improvement. RESULTS The survey was fully completed by 546 participants. Factors significantly influencing the ePortfolio acceptability and perceived impacts were attitude toward and familiarity with the portfolio, confidence in reflective skills, engagement in the CPD plan, and desire for feedback. Time spent completing the ePortfolio and the fact of completing it in teams were negatively associated with the outcomes. DISCUSSION Shaping more favorable user attitudes, helping users recognize and experience the tool's benefits for their practice, and fostering confidence in their reflective skills are important factors that can be addressed to improve ePortfolio acceptability and outcomes. Contextual factors, such as time spent completing the ePortfolio and completing it in teams, seem to reflect greater difficulty with using the tool. Study findings can contribute to improving ePortfolio implementation in the CPD context.
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Affiliation(s)
- Brigitte Vachon
- Dr. Vachon: Associate Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Canada. Mrs. Foucault: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada. Mr. Giguère: Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Canada. Dr. Rochette: Full Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of the Greater Montreal, Montreal, Canada. Dr. Thomas: Assistant Professor, School of Physical and Occupational Therapy, Centre for Medical Education, McGill University; Centre for Interdisciplinary Research in Rehabilitation of the Greater Montreal, Montreal, Canada. Ms. Morel: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
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Macdougall C, Epstein M, Highet L. Continuing professional development: putting the learner back at the centre. Arch Dis Child Educ Pract Ed 2017; 102:249-253. [PMID: 28302733 DOI: 10.1136/archdischild-2016-310864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/03/2022]
Abstract
Continuing professional development (CPD) is changing. Once seen as flexible on the basis of personal choice and mainly consisting of conferences and lecture style meetings, it is now much more likely to be specified, mandatory and linked to specific regulatory or quality improvement activities. This may not be well aligned with how adult professionals learn best and the evidence of resulting change in practice is limited. Also there is a danger of losing out on serendipity in learning by pushing experienced professionals into focusing excessively on mandatory activities that seem to be increasingly 'ticking the box'. However, the previous impression of flexibility may have hidden poor education practice. This paper defines CPD and asks whether there are problems with CPD. It looks at how adults are thought to learn and places this in the context of current practice. It considers practical models of how to deal with a series of common challenges met by those who provide and undertake CPD.
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Affiliation(s)
| | - Melanie Epstein
- Community Paediatrics, St James's University Hospital, Leeds, UK
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Butani L, Bannister SL, Rubin A, Forbes KL. How Educators Conceptualize and Teach Reflective Practice: A Survey of North American Pediatric Medical Educators. Acad Pediatr 2017; 17:303-309. [PMID: 27993644 DOI: 10.1016/j.acap.2016.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objectives of this study were to explore pediatric undergraduate medical educators' understanding of reflective practice, the barriers they face in teaching this, the curricular activities they use, and the value they assign to reflective practice. METHODS Nine survey questions were sent to members of the Council on Medical Student Education in Pediatrics, an international pediatric undergraduate medical educator group. Quantitative data were analyzed using descriptive statistics. Open-ended responses were analyzed qualitatively through an iterative process to establish themes representing understanding of reflective practice and barriers in teaching this. RESULTS Respondents representing 56% of all North American schools answered at least 1 survey question. Qualitative analysis of understanding of reflection revealed 11 themes spanning all components of reflective practice, albeit with a narrow view on triggers for reflection and a lower emphasis on understanding the why of things and on perspective-taking. The most frequent barriers in teaching this were the lack of skilled educators and limited time. Most respondents valued reflective skills but few reported confidence in their ability to teach reflection. Several curricular activities were used to teach reflection, the most common being narrative writing. CONCLUSIONS Pediatric undergraduate medical educators value reflection and endorse its teaching. However, many do not have a complete understanding of the construct and few report confidence in teaching this. Implementing longitudinal curricula in reflective practice may require a culture change; opportunities exist for faculty development about the meaning and value of reflective practice and how best to teach this.
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Affiliation(s)
- Lavjay Butani
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento.
| | - Susan L Bannister
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Allison Rubin
- University of California Davis School of Medicine, Sacramento
| | - Karen L Forbes
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Foucault ML, Vachon B, Thomas A, Rochette A, Giguère CÉ. Utilisation of an electronic portfolio to engage rehabilitation professionals in continuing professional development: results of a provincial survey. Disabil Rehabil 2017; 40:1591-1599. [PMID: 28291951 DOI: 10.1080/09638288.2017.1300335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION ePortfolios are frequently used to support continuing professional development (CPD) of rehabilitation professionals. Though this tool is now widely implemented in many professions by regulatory organisations, very few studies have investigated the use and impact among rehabilitation professionals. Implementation of comprehensive ePortfolios that are centred on the needs of rehabilitation professionals requires documenting their level of use and perceived outcomes. OBJECTIVES The objectives were to describe how occupational therapists use a mandatory ePortfolio that has been recently implemented by a regulatory organisation in Quebec (Canada) and the perceived outcomes of this requirement on continuing professional development and practice change. METHODS An online survey was sent to all registered occupational therapists in Quebec using the ePortfolio. The survey content was developed based on a literature review and expert consultation. Results were analysed using descriptive statistics. RESULTS A total of 546 respondents completed the survey. Results show relatively high levels of ease and satisfaction with the tool, but a limited perception of the tool's impacts on the improvement of professional competencies and change in practices. CONCLUSIONS Occupational therapists reported that use of the ePortfolio supports their engagement in CPD but has limited impact on practice. Promotion of work-based learning, team use and mentor support could increase its meaningfulness for professionals. Implications for Rehabilitation To improve attitudes and beliefs about benefits related to portfolio use, rehabilitation practitioners need a very clear understanding of the purpose and usefulness of a portfolio in clinical practice. Most of the respondents saw the ePortfolio as helping them develop and implement a continuing professional development plan and reflect on the changes needed in their practice. Portfolio use in teams and productive reflection should be promoted in order to target shared objectives for continuous practice improvement. Rehabilitation professionals trained in portfolio use during their entry-level studies have a slightly more positive attitude towards portfolio use and impact of this use compared with than clinicians who have not had this training.
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Affiliation(s)
- Marie-Lyse Foucault
- a School of rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Canada
| | - Brigitte Vachon
- a School of rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Canada.,b Centre de recherche de l'Institut universitaire en santé mentale de Montréal , Montreal , Canada
| | - Aliki Thomas
- c School of Physical and Occupational Therapy , Centre for Medical Education, McGill University , Montreal , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of the Greater Montreal , Montreal , Canada
| | - Annie Rochette
- a School of rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of the Greater Montreal , Montreal , Canada
| | - Charles-Édouard Giguère
- b Centre de recherche de l'Institut universitaire en santé mentale de Montréal , Montreal , Canada
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Keely EJ, Archibald D, Tuot DS, Lochnan H, Liddy C. Unique Educational Opportunities for PCPs and Specialists Arising From Electronic Consultation Services. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:45-51. [PMID: 28030423 DOI: 10.1097/acm.0000000000001472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health care reform should be driven by the goals of better patient experience, improved population health, lower per capita costs, and improved provider satisfaction. Electronic consultation (eConsult) services have been adopted by several jurisdictions in the United States, Canada, and Europe to improve access to specialists by primary care providers (PCPs) and are being heralded as a key component for delivery of coordinated care. The primary intent of an eConsult service is to provide PCPs with efficient, timely, direct access to specialist expertise to help guide the management of their patients, reduce the need for unnecessary face-to-face specialty consultations, and improve the quality of the initial face-to-face consultation when needed, through the preconsultative communication.In addition to improving access to care, eConsult services have been praised by PCPs and specialists for their educational value, in particular their ability to enrich practice-based learning. Less recognized, but equally important from the educational perspective, include the abilities of eConsult programs to promote reflection by PCPs and specialists, improve collegiality and professionalism between primary and specialist care, inform continuing professional development activities and maintenance of certification, and enhance training programs' teaching of effective communication and care coordination.As eConsult services become increasingly available, the medical community must leverage the educational opportunities inherent in eConsult programs to further improve the delivery of coordinated specialty care. The educational role of eConsults should be considered as a priority outcome in their evaluation and must be highlighted and optimized in next iterations of eConsult systems design.
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Affiliation(s)
- Erin J Keely
- E.J. Keely is full professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and chief, Division of Endocrinology and Metabolism, Ottawa Hospital, Ottawa, Ontario, Canada, and specialist lead, Champlain BASE eConsult Service.D. Archibald is assistant professor, Department of Family Medicine, Faculty of Medicine, University of Ottawa, and education researcher, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.D.S. Tuot is assistant professor, Department of Medicine, University of California, San Francisco; Division of Nephrology, San Francisco General Hospital; and director, San Francisco General Hospital eReferral program and University of California, San Francisco, Center for Innovation in Access and Quality, San Francisco, California.H. Lochnan is associate professor, Department of Medicine, and assistant dean, Continuing Professional Development and Education Programming, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.C. Liddy is associate professor, Department of Family Medicine, Faculty of Medicine, University of Ottawa, clinician investigator, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada, and primary care lead, Champlain BASE eConsult Service
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Furmedge DS, Griffin A, O'Keeffe C, Verma A, Smith LJ, Gill D. Paper trials: a qualitative study exploring the place of portfolios in making revalidation recommendations for Responsible Officers. BMC MEDICAL EDUCATION 2016; 16:66. [PMID: 26887892 PMCID: PMC4756457 DOI: 10.1186/s12909-016-0592-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/08/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND A portfolio of supporting information (SI) reflecting a doctor's entire medical practice is now a central aspect of UK appraisal for revalidation. Medical revalidation, introduced in 2012, is an assessment of a doctor's competence and passing results in a five yearly license to practice medicine. It assesses of a doctor's professional development, workplace performance and reflection and aims to provide assurance that doctors are up-to-date and fit to practice. The dominant assessment mechanism is a portfolio. The content of the revalidation portfolio has been increasingly prescribed and the assessment of the SI is a fundamental aspect of the appraisal process which ultimately allows Responsible Officers (ROs) to make recommendations on revalidation. ROs, themselves doctors, were the first to undergo UK revalidation. This qualitative study explored the perceptions of ROs and their appraisers about the use of this portfolio of evidence in a summative revalidation appraisal. METHODS 28 purposefully sampled London ROs were interviewed following their revalidation appraisal and 17 of their appraisers participated in focus groups and interviews. Thematic analysis was used to identify commonalities and differences of experience. RESULTS SI was mostly easy to provide but there were challenges in gathering certain aspects. ROs did not understand in what quantities they should supply SI or what it should look like. Appraisers were concerned about making robust judgements based on the evidence supplied. A lack of reflection from the process of collating SI and preparing for appraisal was noted and learning came more from the appraisal interview itself. CONCLUSIONS More explicit guidance must be available to both appraisee and appraiser about what SI is required, how much, how it should be used and, how it will be assessed. The role of SI in professional learning and revalidation must be clarified and further empirical research is required to examine how best to use this evidence to make judgments as part of this type of appraisal.
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Affiliation(s)
- Daniel S Furmedge
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Ann Griffin
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK.
| | | | - Anju Verma
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Laura-Jane Smith
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Deborah Gill
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK.
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Graduate midwives' perception of their preparation and support in using evidence to advocate for women's choice: A Western Australian study. Nurse Educ Pract 2016; 16:305-11. [DOI: 10.1016/j.nepr.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/27/2015] [Accepted: 06/11/2015] [Indexed: 11/20/2022]
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Ah-Kee EY, Khan AA. Foundation years: a time of reflection. PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:350-351. [PMID: 26481396 PMCID: PMC4673058 DOI: 10.1007/s40037-015-0223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Elliott Yann Ah-Kee
- Monklands Hospital, Monkscourt Ave, Airdrie, North Lanarkshire, ML6 0JS, UK.
| | - Aamir Asif Khan
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
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Sittikariyakul P, Jaturapatporn D, Kirshen AJ. Acting as standardized patients enhances family medicine residents' self-reported skills in palliative care. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:645-654. [PMID: 25256636 DOI: 10.1007/s10459-014-9552-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 09/19/2014] [Indexed: 06/03/2023]
Abstract
Recent publications have confirmed the use of standardized patients (SPs) in improving clinical skills and enhancing competency. Little research has studied the benefits residents may themselves gain in palliative care playing the role of SPs. Nineteen Family Medicine residents were recruited as standardized patients (FMR-SPs) for a mandatory palliative care workshop in communication for incoming, first-year trainees. Four months later, FMR-SPs reflected upon their own experiences. Two independent researchers performed thematic analysis of these interviews. Most of the residents were satisfied with their roles. Twelve reported improved understanding of self, their patients, the doctor-patient relationship, and the underlying philosophy of palliative care. They also described improved verbal and non-verbal communication skills. Eleven of 14 residents reflected upon behavioral changes in problem coping styles. All residents indicated an intention to apply the learning in their future work. Encouraging Thai Family Medicine residents, in years one through three, to portray SPs in palliative care appears to be a valuable learning experience for the resident. Future studies to validate whether this learning has been applied in subsequent practice are planned.
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Affiliation(s)
- Pat Sittikariyakul
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
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Hollaar G, Taylor R. Assessing personal contributions in global surgery: By whose yardstick? Can J Surg 2015. [PMID: 26204141 DOI: 10.1503/cjs.002015] [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: 11/01/2022] Open
Abstract
Over the past 2 decades, interest and involvement in global surgery as an evolving discipline have increased among practitioners and trainees. A demand for formal evaluation of global surgery projects has also increased with demands for outcomes and impact. However, there has been little or no encouragement or requirement for participants to formally assess their personal contribution either to a project or to the discipline itself owing to the volunteer-based nature of those involved. Though participant contribution cannot be easily measured, the experience can be used to foster professional development. We propose that this neglected opportunity be addressed and suggest a framework of intentional reflection and mentorship that can be applied as an integral part of the global surgery experience, from participants election through debriefing after the experience.
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Affiliation(s)
- Gwendolyn Hollaar
- From the Department of Surgery, University of Calgary, Calgary, Alta. (Hollaar); and the Department of Surgery, University of British Columbia, Vancouver, BC (Taylor)
| | - Robert Taylor
- From the Department of Surgery, University of Calgary, Calgary, Alta. (Hollaar); and the Department of Surgery, University of British Columbia, Vancouver, BC (Taylor)
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Bannister SL, Hanson JL, Maloney CG, Dudas RA. Practical Framework for Fostering a Positive Learning Environment. Pediatrics 2015; 136:6-9. [PMID: 26077478 DOI: 10.1542/peds.2015-1314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Susan L Bannister
- University of Calgary, Faculty of Medicine, Calgary, Alberta, Canada;
| | | | - Christopher G Maloney
- University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah; and
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Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. MEDICAL EDUCATION 2015; 49:461-75. [PMID: 25924122 DOI: 10.1111/medu.12680] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/13/2014] [Accepted: 12/19/2014] [Indexed: 05/12/2023]
Abstract
CONTEXT Reflection and reflective practice have become popular topics of scholarly dialogue in medical education. This popularity has given rise to checklists, portfolios and other tools to inspire and document reflection. We argue that some of the common ways in which reflection has been applied are influenced by broader discourses of assessment and evidence, and divorced from original theories of reflection and reflective practice. METHODS This paper was developed using a critical narrative approach. First we present two theoretical lenses provided by theories of reflection. Next we present a summary of relevant literature, indexed in PubMed from 2004 to 2014, relating to the application of reflection or reflective practice to undergraduate and postgraduate medical education. We categorise these articles broadly by trends and problematise the trends relative to the two theoretical lenses of reflection. RESULTS Two relevant theoretical orientations of reflection for medical education are: (i) reflection as epistemology of practice, and (ii) reflection as critical social inquiry. Three prevalent trends in the application of reflection to medical education are: (i) utilitarian applications of reflection; (ii) a focus on the self as the object of reflection, and (iii) reflection and assessment. These trends align with dominant epistemological positions in medicine, but not with those that underpin reflection. CONCLUSIONS We argue for continued theorising of and theoretically informed applications of reflection, drawing upon epistemologies of practice and critical reflection as critical social inquiry. These directions offer medical education research broad and deep potential in theories of reflection, particularly in relation to knowledge creation within uncertain and complex situations, and challenging of dominant discourses and structures. Future work could explore how dominant epistemological positions and discourses in medicine influence theories from other disciplines when these theories are deployed in medical education.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada; Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Wilson Centre for Research in Education, University Health Network, Toronto, Ontario, Canada
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Gates GE, Amaya L. Registered Dietitian Nutritionists and Nutrition and Dietetics Technicians, Registered, Are Ethically Obligated to Maintain Personal Competence in Practice. J Acad Nutr Diet 2015; 115:811-815. [DOI: 10.1016/j.jand.2015.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Indexed: 10/23/2022]
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Hodges BD. Sea monsters & whirlpools: Navigating between examination and reflection in medical education. MEDICAL TEACHER 2015; 37:261-6. [PMID: 25523011 DOI: 10.3109/0142159x.2014.993601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The 16th International Ottawa Conference/Canadian Conference on Medical Education (2014) featured a keynote deconstructing the rising discourse of competence-as-reflection in medical education. This paper, an elaborated version of the presentation, is an investigation into the theoretical roots of the diverse forms of reflective practice that are being employed by medical educators. It also raises questions about the degree to which any of these practices is compatible with assessment.
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Wass V, Harrison C. Empowering the learner to reflect: do we need another approach? MEDICAL EDUCATION 2014; 48:1146-7. [PMID: 25413907 DOI: 10.1111/medu.12612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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