Implementing Reflective Writing at a Newly Established Health Science Academy of Nepal: Exploring a Novel Practice, Overcoming Obstacles and Recommendations

Establishing new institutions for health professions provides the opportunity to implement innovative approaches catering to the current health needs and also allows to address the inadequacies of well-established institutions. Grabbing this opportunity, we initiated the implementation of reflective practices at Madan Bhandari Academy of Health Sciences, a new provincial university in Nepal. Though literature shows that reflection is a helpful tool to reflect on choices, experiences, and failures and obtain knowledge for the students, the adoption of reflective writing in health professions education in Nepal is limited. Therefore, we looked into the practices from other countries to adopt them in our settings and integrated them into our curriculum. But, we came across many impediments during the process-particularly those related to limited resources. We found innovative solutions like using technology and peer mentoring to overcome these challenges and integrated these practices to initiate reflective writing at the institution. The introspective "talking to oneself" has been a valuable strategy for implementing the reflective practices at our institution. Based on our experiences, we highly recommend educators in Nepal or similar settings embrace team-based writing practices that are contextually appropriate. But, we also recognize the benefits of team-based reflective writing that considers the cultural context. We hope this review will inspire educators, particularly those who lack the resources to initiate such practices at their institution. Our firsthand experience is detailed in this perspective article.

A Pilot Test

The reflective practice journal is a teaching methodology that facilitates the acquisition of professional, attitudinal values and skills, affording comprehensive training by reflecting on experiences that have been lived and showing feelings that, a priori, would be hidden. Our aim was to implement it in the international practicum in impoverished environments as a facilitating instrument of meaningful learning and the acquisition of professional skills, integrating affective and self-critical aspects. The project was developed with Nursing students at Catholic University of Valencia, in an impoverished environment. Qualitative reflections increased, highlighting humanity, closeness and attention focused on health promotion. The quality of the experience was 9.46/10. The mean score in self-criticism and expression was 4.57/5, and the self-evaluation of the acquisition of skills was 9.55/10. The double-blind peer evaluation of the performance of their practices in the international context was 9.68/10. The trust of the students with the teachers was evaluated as 10/10. The reflective practice journal facilitated the progression of learning, self-criticism, and the acquisition of values such as hospitality, the quality of care offered, and respect for customs and beliefs, as well as responsibility in the distribution of available resources and interventions.

Use of Reflective Journaling to Understand Decision Making Regarding Two Evidence-Based Psychotherapies for PTSD: Practice Implications

As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their successes and challenges in using prolonged exposure and cognitive processing therapy. This paper provides content analysis on the reflective journals of 24 of these providers. Five main themes were identified: EBPs are great but not sufficient for patients in residential treatment with chronic posttraumatic stress disorder and complicated life circumstances, and thus, more treatment is necessary after discharge. Modifications were made or thought needed for optimal outcome and successful delivery of these 2 EBPs; some providers blended aspects of prolonged exposure and cognitive processing therapy; what happens when providers and patients do not agree on choice of which EBP to first implement; and provider concerns on when to discontinue an EBP. Reflective journaling appears to be a promising way for trainers and treatment developers to gather important information about the clinical application and decision-making process for front-line providers, which may offer insight into how to improve EBP implementation and sustainability. Incorporating reflective journaling and strategies for accomplishing this into training, supervision, and consultation may also be 1 strategy for increasing feedback, expanding implementation, and informing ways to increase sustainability of EBPs in populations with multiple clinical and psychosocial needs.

"Blogging" about course concepts: using technology for reflective journaling in a communications class

OBJECTIVE

Web log technology was applied to a reflective journaling exercise in a communication course during the second-professional year at the University of Mississippi School of Pharmacy, to encourage students to reflect on course concepts and apply them to the environment outside the classroom, and to assess their communication performance.

DESIGN

Two Web log entries per week were required for full credit. Web logs were evaluated at three points during the term. At the end of the course, students evaluated the assignment using a 2-page survey instrument.

ASSESSMENT

The assignment contributed to student learning and increased awareness level for approximately 40% of the class. Students had few complaints about the logistics of the assignment.

CONCLUSION

The Web log technology was a useful tool for reflective journaling in this communications course. Future versions of the assignment will benefit from student feedback from this initial experience.