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Prendergast M, Cardoso Pinto AM, Harvey CJ, Muir E. Burnout in early year medical students: experiences, drivers and the perceived value of a reflection-based intervention. BMC MEDICAL EDUCATION 2024; 24:7. [PMID: 38172864 PMCID: PMC10765935 DOI: 10.1186/s12909-023-04948-0] [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: 02/25/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION According to the 11th Revision of the International Classification of Diseases, burnout is defined as a syndrome resulting from chronic work-related stress that has not been successfully managed. Burnout is increasingly prevalent amongst medical students and has been shown to lead to worsened academic engagement, feelings of inadequacy, poor mental health and increased risk of withdrawal from the course. The aim of this study was to explore the experience of burnout amongst early year medical students and evaluate the perceived impact of a reflection-based intervention on their awareness and experience of burnout. METHODS The reflection-based intervention comprised two tutorials covering the presentation, drivers, impact and management strategies for burnout syndrome. These were introduced into the second-year medical curriculum at Imperial College London. As part of the reflection-based intervention, students were invited to complete an anonymous Qualtrics form three times during the academic year. This included the Shirom-Melamed Burnout Measure (SMBM) and a free-text question prompting the student to consider their stressors at the time of completing the intervention. The former is composed of 14-questions measuring the extent of feelings or behaviours suggestive of burnout, divided into three categories: physical fatigue, cognitive weariness and emotional exhaustion. At the end of the academic year, students were invited to participate in an online focus group to further explore their experience of burnout and their perceived value of the reflection-based intervention. Results of the SMBM were explored descriptively; free-text questions and the focus group transcript were analysed using inductive thematic analysis. RESULTS A total of 59 submissions for the reflection-based intervention were analysed: 26 students participated and consented in the first round, 8 in the second and 25 in the third round. Overall median burnout scores were 4 (IQR 3-5), 2 (IQR 1-4) and 3 (IQR 2-5) in each round of the SMBM, respectively. A total of 8 (30.8%) met the threshold for severe burnout (≥ 4.4) in round 1 of the questionnaire, zero in the second round and 4 (16%) in the third round. Physical and cognitive fatigue showed higher median scores than emotional exhaustion in every round. Four students participated in the focus group, which had two sections. The first was reflecting on burnout in medical school and the intervention, which revealed four themes: (1) indicators of burnout (often insidious, but may involve lack of energy and motivation, or changes in perceived personality); (2) perceived drivers of burnout (perceived expectation that medical school is supposed to be challenging and consistent prioritisation of work over wellbeing); (3) working habits of medical students (unachievable self-expectations and feelings of guilt when not working); (4) value of the intervention (the teaching and reflection-based intervention prompted students to identify signs of burnout in themselves and consider management strategies). The second section included considerations for implementing burnout interventions into the medical school curriculum, which revealed three themes: (1) desire to learn about burnout (students hoped to gain insight into burnout and methods of prevention as part of their curriculum); (2) importance of community (group interventions and the involvement of Faculty helped students feel less isolated in their experiences); (3) feasibility of interventions (sustainable interventions are likely to be those that are efficient, such as using multiple-choice questions, and with allocated periods in their timetable). CONCLUSION Second-year medical students demonstrated symptoms and signs of burnout, including exhaustion, lack of motivation and changes in personality. They also expressed a desire to gain greater awareness of burnout and insight into preventative strategies within the medical curriculum. Whilst certain drivers of burnout can be prevented by students themselves through adequate prevention strategies, many remain systemic issues which require curriculum-level change to be effectively addressed. The students found that the reflection-based intervention was effective at improving their perception of burnout and a convenient tool to use, which could be implemented more widely and continued longer-term throughout medical school.
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Affiliation(s)
| | | | | | - Elizabeth Muir
- Department of Primary Care and Public Health, Imperial College, London, UK
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Walinga CW, Barnhoorn PC, Essers GTJM, Schaepkens SPC, Kramer AWM. 'You are not alone.' An exploratory study on open-topic, guided collaborative reflection sessions during the General Practice placement. BMC MEDICAL EDUCATION 2023; 23:769. [PMID: 37845655 PMCID: PMC10577966 DOI: 10.1186/s12909-023-04756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND To support professional development of medical students faced with challenges of the clinical phase, collaborative reflection sessions (CRSs) are used to share and reflect on workplace experiences. Facilitation of CRSs seems essential to optimise learning and to provide important skills for lifelong learning as a professional. However, little is known about which workplace experiences students share in CRSs without advance guidance on specific topics, and how reflecting on these experiences contributes to students' professional development. Therefore, we explored which workplace experiences students shared, what they learned from reflection on these experiences, and how they perceived the value of CRSs. METHODS We conducted an exploratory study among medical students (N = 99) during their General Practice placement. Students were invited to openly share workplace experiences, without pre-imposed instruction. A thematic analysis was performed on shared experiences and student learning gains. Students' perceptions of CRSs were analysed using descriptive statistics. RESULTS All 99 students volunteered to fill out the questionnaire. We found four themes relating to students' shared experiences: interactions with patients, complex patient care, diagnostic or therapeutic considerations, and dealing with collegial issues. Regarding students' learning gains, we found 6 themes: learning from others or learning from sharing with others, learning about learning, communication skills, self-regulation, determination of position within the healthcare team, and importance of good documentation. Students indicated that they learned from reflection on their own and peer's workplace experiences. Students valued the CRSs as a safe environment in which to share workplace experiences and helpful for their professional development. CONCLUSIONS In the challenging General Practice placement, open-topic, guided CRSs provide a helpful and valued learning environment relevant to professional development and offer opportunities for vicarious learning among peers. CRSs may also be a valuable tool to incorporate into other placements.
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Affiliation(s)
- Chris W Walinga
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | | | - Sven P C Schaepkens
- Department of General Practice, Erasmus University Medical Centre, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
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Zhuang Z, Zeng L. Reflecting on ICU patient's dignity using Taylor's Emancipatory Reflection Model. Nurs Ethics 2023:9697330231202229. [PMID: 37793894 DOI: 10.1177/09697330231202229] [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: 10/06/2023]
Abstract
Intensive Care Unit (ICU) patients not only require life-sustaining treatments but also the preservation of their psychological well-being and dignity, and ICU nurses face heavy work pressure, focusing more on life-sustaining treatments for patients, while the patient's psychological experiences are often overlooked. This article aims to explore the issue of nurse-led patient dignity preservation in the ICU from China. Reflection is a process of deep thinking and examining one's actions, experiences, perspectives, or emotions. It involves retrospectively reviewing, analyzing, and evaluating past events to gain insights, understanding, and personal growth. Through reflection, individuals can consider whether their actions align with their values and goals and whether they can learn valuable lessons from them. This article discusses the preservation of patient dignity in the ICU from China based on Taylor's Emancipatory Reflection Model, which involves four steps: constructing, deconstructing, confronting, and reconstructing. The process of reflection incorporates theories such as Maslow's Hierarchy of Needs, Comfort Theory, and the style of Paternalistic Decision-making. This study is of great significance in enhancing Chinese nurse's attention to patient dignity, improving the inpatient experience of ICU patients, and enhancing the quality of nursing practice by critically examining current nursing practices in China and providing improvement recommendations.
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Affiliation(s)
| | - Li Zeng
- Shenzhen Qianhai Shekou Free Trade Zone Hospital
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4
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Toubassi D, Schenker C, Roberts M, Forte M. Professional identity formation: linking meaning to well-being. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:305-318. [PMID: 35913664 PMCID: PMC9341156 DOI: 10.1007/s10459-022-10146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.
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Affiliation(s)
- Diana Toubassi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- University Health Network - Toronto Western FHT, 440 Bathurst Street - Suite 300, Toronto, ON, M5T 2S6, Canada.
| | - Carly Schenker
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Roberts
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Milena Forte
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Belfi LM, Chetlen A, Frigini A, Jay A, Methratta ST, Robbins J, Woods R, Deitte L. Recovering Joy in the Workplace Requires P.R.A.C.T.I.C.E. Acad Radiol 2023; 30:536-540. [PMID: 35654656 PMCID: PMC9151245 DOI: 10.1016/j.acra.2022.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Lily M. Belfi
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Room F-054, New York, NY,Address correspondence to: L.M.B
| | - Alison Chetlen
- Department of Radiology, Penn State University, Hershey, Pennsylvania
| | | | - Ann Jay
- Department of Radiology, MedStar Georgetown University Hospital, Washington DC
| | | | - Jessica Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan Woods
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lori Deitte
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Alo O. The role of ambidextrous leadership in developing team-level ambidexterity: Exploring the supporting roles of reflective conversations and ambidextrous HRM. AFRICA JOURNAL OF MANAGEMENT 2023. [DOI: 10.1080/23322373.2022.2155122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Obinna Alo
- Edge Hill University Business School, Edge Hill University, St Helen’s Road, Ormskirk L39 4QP, United Kingdom
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7
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Falon SL, Hoare S, Kangas M, Crane MF. The coping insights evident through self-reflection on stressful military training events: Qualitative evidence from self-reflection journals. Stress Health 2022; 38:902-918. [PMID: 35266279 PMCID: PMC10078775 DOI: 10.1002/smi.3141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 01/01/2023]
Abstract
Research has demonstrated that adaptive forms of self-reflection on stressor events and insight may strengthen resilient capacities. However, the coping insights that emerge during self-reflection are notoriously under-researched. In this research, we sought to explore the evidence for the self-reflective activities and coping insights drawn from the Self-Reflection and Coping Insight Framework and find evidence of new reflections or insights not captured within the framework. Qualitative analysis was used to examine weekly, written self-reflective journals completed by Officer Cadets involved in a randomised-controlled trial of Self-Reflection Resilience Training. Sixty-eight Officer Cadets who submitted their journals for analysis were included. Journals were analysed using a deductive thematic approach. Findings revealed that self-reflective activities occurred frequently over the course of the intervention. Coping insights were comparatively less frequent, but conveyed complex ideas about the self in the context of stressor exposure, broad principles about stress and coping, and nuanced interpretations regarding the interaction between the efficacy of coping approaches and broader contextual and intrapersonal factors. These findings demonstrate the critical role of coping insight during Self-Reflection Resilience Training, with implications for developing a validated self-report measure of self-reflective activity and coping insight.
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Affiliation(s)
- Samantha Leigh Falon
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Scott Hoare
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Maria Kangas
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, New South Wales, Australia
| | - Monique Frances Crane
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
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Brown A, Grierson L. Two sides of the same coin: Quality improvement and program evaluation in health professions education. J Eval Clin Pract 2022; 28:3-9. [PMID: 34291535 DOI: 10.1111/jep.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Health professions education is in constant pursuit of new ways of teaching and assessment in order to improve the training of healthcare professionals. Educators are often challenged with designing, implementing, and evaluating programs in the context of their professional practice, particularly those in response to dynamic and emerging social needs. This article explores the synergies and intersections of two approaches-quality improvement and program evaluation-and the potential utility of their combinations within our field to design, evaluate, and most importantly, improve educational programming. We argue that the inclusion of established quality improvement frameworks within program evaluation provides a proven mechanism for driving change, can optimize programming within the multi-contextual education systems, and, ultimately, that these two approaches are complementary to one another. These combinations hold great promise for optimizing programming in alignment with social missions, where it has been difficult for institutions worldwide to generate and capture evidence of social accountability.
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Affiliation(s)
- Allison Brown
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence Grierson
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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9
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Ziada HM, Ditmyer MM, Abubakr NH. Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:157-165. [PMID: 33730391 DOI: 10.1111/eje.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development. MATERIALS AND METHODS Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes. RESULTS Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate. CONCLUSIONS The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.
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Affiliation(s)
- Hassan M Ziada
- Department of Clinical Sciences, University of Nevada, Las Vegas, Nevada, USA
| | - Marcia M Ditmyer
- School of Dental Medicine, University of Nevada, Las Vegas, Nevada, USA
| | - Neamat H Abubakr
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, Nevada, USA
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Park KH, Kam BS, Yune SJ, Lee SY, Im SJ. Changes in self-reflective thinking level in writing and educational needs of medical students: A longitudinal study. PLoS One 2022; 17:e0262250. [PMID: 35061778 PMCID: PMC8782325 DOI: 10.1371/journal.pone.0262250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The purpose of this study was to longitudinally examine the change in understanding of the self-reflection method, reflective thinking, and writing attitude and perception. Moreover, we investigated students’ educational needs and methods regarding self-reflection. Methods The subjects were 117, who were in the pre-medical course in 2017 and were promoted to the medical course in 2019. Questions concerning students’ understanding of self-reflection methods, their attitude and perception of reflective writing, and educational needs and methods regarding self-reflection were self-developed. For students’ reflective thinking level in writing, we used the approach developed by Galvez-Martin, Bowman, and Morrison and adapted by Kwon. For dada analysis, χ2 test, t-test, frequency analysis was used. Results We found that students’ level of understanding regarding self-reflection methods increases slightly, but not significant (χ2 = 2.238, p>0.05). There was no significant change in the level of reflective thinking in writing (χ2 = 8.003, p>0.05). The students’ attitude toward reflective writing decreased in the medical course than in the pre-medical course (t = 3.475, p<0.001). The perception that reflective writing was helpful for individual improvement decreased during the medical course (t = 4.931, p<0.001). The need for self-reflection education increased in the medical course (t = -2.659, p<0.001). They preferred implementation in the first year of the medical course as an instructor-led special lecture. Conclusion Self-reflective ability is not naturally developed as students’ progress through grade levels. Educational intervention is needed to help students understand approaches to self-reflection and its importance in enabling them to develop their abilities as well as to participate actively in reflective writing.
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Affiliation(s)
- Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, South Korea
| | - Bee Sung Kam
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
| | - So Jung Yune
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
- * E-mail:
| | - Sang Yeoup Lee
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
| | - Sun Ju Im
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
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11
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Olmos-Ochoa TT, Fenwick KM, Ganz DA, Chawla N, Penney LS, Barnard JM, Miake-Lye IM, Hamilton AB, Finley EP. Reflective writing: a tool to support continuous learning and improved effectiveness in implementation facilitators. Implement Sci Commun 2021; 2:98. [PMID: 34479654 PMCID: PMC8417958 DOI: 10.1186/s43058-021-00203-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation facilitators support the adoption of evidence-based practices and other improvement efforts in complex healthcare settings. Facilitators are trained to develop essential facilitation skills and facilitator effectiveness is typically evaluated post-implementation, but little is known about how facilitators apply and adapt didactic knowledge after training, or how learning and refining experiential knowledge occurs during the facilitation process. We propose the use of reflective writing as a tool to document and support facilitator learning and facilitator effectiveness. METHODS Using an instrumental case study of the Coordination Toolkit and Coaching (CTAC) project, we explore the use of reflective writing by facilitators to support their learning and effectiveness. Six primary care clinics participated in weekly hour-long facilitation calls over a 12-month period to implement quality improvement projects related to care coordination. Two facilitators completed templated reflections after each facilitation call for their assigned sites, totaling 269 reflections. We used the declarative-procedural-reflective model, which defines the process of skill development in clinical practice, to qualitatively analyze the reflections. Two independent coders used content analysis principles to code text that captured facilitators' observations, evaluations, interpretations, and communication. Descriptive statistics were used to analyze reflections by facilitator and by code within and across reflections. RESULTS CTAC facilitators primarily used the reflections to summarize the calls (observation), assess the facilitation process and the tasks and activities they used (evaluation), document their thoughts about how to improve their own effectiveness (interpretation), and describe their communication with implementing teams. Ninety-one percent of reflections included observations, 42% interpretation, 41% evaluation, and 44% facilitator communication. In total, we coded 677 segments of text within reflections: 39% represented observation, 20% interpretation, 18% evaluation, and 23% facilitator communication. CONCLUSIONS The process of reflective writing allowed the CTAC facilitators the time and structure to evaluate their facilitation and to think critically about how to adjust their facilitation in response to their observations and interpretations. Reflective writing is a feasible and acceptable tool to support and document facilitator learning and effectiveness. TRIAL REGISTRATION The project was registered with ClinicalTrials.gov ( NCT03063294 ) on February 24, 2017.
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Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.
| | - Karissa M Fenwick
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Neetu Chawla
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lauren S Penney
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jenny M Barnard
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA
| | - Isomi M Miake-Lye
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Erin P Finley
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System - Sepulveda, 16111 Plummer Street (152), North Hills, CA, 91343, USA.,Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, 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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Imperato A, Strano-Paul L. Impact of Reflection on Empathy and Emotional Intelligence in Third-Year Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:350-353. [PMID: 33420702 DOI: 10.1007/s40596-020-01371-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study analyzed the impact that structured Reflection Rounds had on self-reported empathy and emotional intelligence scores for third-year medical students. METHODS Third-year students at the Renaissance School of Medicine at Stony Brook University (RSOM) were required to participate in Reflection Rounds during their core clinical clerkships. Over the study period, 285 students participated. Reflection Rounds are facilitated, small-group meetings, where students reflect upon their thoughts, feelings, and emotions about clinical experiences and receive feedback from peers and a trained facilitator. Empathy and emotional intelligence (EI) scores were measured pre- and post-intervention utilizing the Jefferson scale of empathy (JSE) student version and Wong law emotional intelligence scale (WLEIS) (Hojat 2016; Wong and Law Leadersh Q. 13:243-74, 2004). RESULTS Participation in the study was voluntary. Pre-intervention surveys were collected from 185 students for the JSE and 173 students for the WLEIS. Post survey responses were collected from 120 students for both scales. Empathy scores increased from 80.4 to 82.6 (p = 0.02) post-intervention. No significant difference in EI scores was demonstrated post-intervention, 5.4 to 5.5 (p = 0.55) CONCLUSION: Students who participated in Reflection Rounds did not demonstrate the erosion of empathy that has been previously documented following the completion of the clerkship year. Improvements in empathy scores were demonstrated. No change in EI was observed post-intervention. It is possible that an intervention such as Reflection Rounds may represent a way of preventing the empathy decline that can be seen in medical students as they progress through their training.
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Affiliation(s)
| | - Lisa Strano-Paul
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
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Kiessling C, Mennigen F, Schulte H, Schwarz L, Lutz G. Communicative competencies anchored longitudinally - the curriculum "personal and professional development" in the model study programme in undergraduate medical education at the University of Witten/Herdecke. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc57. [PMID: 33824893 PMCID: PMC7994876 DOI: 10.3205/zma001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 06/12/2023]
Abstract
Background: In October 2018, the University of Witten/Herdecke (UW/H) launched the new reformed medical education programme called Medicine 2018+. A major innovation compared to the existing model programme was the introduction of thematic focuses. A longitudinal communication skills curriculum was integrated into the new thematic focus "professional and personal development - inner work" (IAP). With the start of the new programme, the IAP curriculum has been built step-by-step over time, i.e. the first four semesters have already been implemented, the following semesters are being planned. Project description: IAP aims to provide students with patient-centred medicine. Five areas of competence were defined: Doctor-patient communication, team competence, staying healthy, my paths to becoming a doctor, medicine and society. The focus of this article is on the communication curriculum. The first year of study focusses on the training of basic communication skills. In the 2nd year of study, students practice these basic skills in small groups with simulated patients (SP), whereby the emphasis in the 3rd semester is on history taking and in the 4th semester is on sharing information. In the 3rd semester, students complete a communication station in an OSCE. From the 5th semester onwards, the focus of training is on the consolidation of basic and advanced communication skills, which can be applied in clinical clerkships, and the reflection of clinical experiences. Key didactic elements are, in addition to teaching the theoretical basics, experience-based small group work with and without SP, feedback and reflection. The evaluation of the summer semester 2020 showed high agreement ratings of the students regarding the overall satisfaction with the individual courses (83-100% agreement). Discussion: The introduction of IAP has been very positively received by the students. Challenges are the adequate handling of the increasing student workload when planning new courses, the implementation of a longitudinal e-portfolio as well as the recruitment and training of clinical teachers and SPs. Conclusion: As the evaluation results of the summer semester 2020 show, the first steps of implementing a longitudinal communication curriculum at UW/H have been successful. Helpful strategies were the orientation on published examples from other faculties as well as regular feedback and discussions with students and teachers in order to adapt and integrate educational considerations into the existing model programme in Witten.
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Affiliation(s)
- Claudia Kiessling
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Florian Mennigen
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Heike Schulte
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Laura Schwarz
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Gabriele Lutz
- Universität Witten/Herdecke, Fakultät für Gesundheit, Department für Humanmedizin, Witten, Germany
- Gemeinschaftskrankenhaus Herdecke, Psychosomatische Abteilung, Herdecke, Germany
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Roling G, Lutz G, Edelhäuser F, Hofmann M, Valk-Draad MP, Wack C, Haramati A, Tauschel D, Scheffer C. Empathy, well-being and stressful experiences in the clinical learning environment. PATIENT EDUCATION AND COUNSELING 2020; 103:2320-2327. [PMID: 32389386 DOI: 10.1016/j.pec.2020.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/27/2019] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study examines whether students in the clinical phase show reduced well-being and lower empathy scores compared to preclinical students. Furthermore, it explores students' most stressful experiences. METHODS A cross-sectional mixed-methods study was conducted among medical students of the revised patient- and student-centred curriculum at Witten/Herdecke University (Germany). An online survey included questions regarding empathy (JSPE-S), well-being (WHO-5), distressing factors in the learning and clinical environments, mistreatment and thoughts of dropping out. RESULTS 176 (34 %) of 517 medical students completed the questionnaire, 73 being preclinical and 103 clinical students. Despite lower well-being, clinical student did not demonstrate lower empathy levels. Main stressors during the clinical phase were negative physician role models and financially focussed care rather than challenging patient encounters. Compared to preclinical students, clinical students showed more mistreatment experiences and higher ratings towards thoughts of dropping out. CONCLUSION Our results illustrate contemporary challenges to establishing a learner-centred clinical environment that nurtures well-being and empathy of medical students. The sustainment of empathy despite more stressful experiences and lower well-being may be due to protective factors. PRACTICE IMPLICATIONS The paper suggests activities to support clinical students to find ways to adapt the clinical learning environment to students' needs.
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Affiliation(s)
- Gudrun Roling
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Gabriele Lutz
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany; Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke. Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany; Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke. Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Marzellus Hofmann
- Office for Student Affairs, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Maria P Valk-Draad
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Caroline Wack
- Student Council, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany; Department of Internal Medicine, Gemeinschaftskrankenhaus Herdecke. Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Aviad Haramati
- Georgetown University, School of Medicine, Center for Innovation and Leadership in Education, USA
| | - Diethard Tauschel
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Christian Scheffer
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany; Department of Internal Medicine, Gemeinschaftskrankenhaus Herdecke. Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany.
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Baugh RF. The Evolution of Social Beliefs 1960-2016 in the United States and Its Influence on Empathy and Prosocial Expression in Medicine. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:437-446. [PMID: 32636695 PMCID: PMC7334402 DOI: 10.2147/amep.s246658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
This perspective surveys healthcare's response to the increased prominence of racial, ethnic, religious and sexual minorities as well as females in American culture. It argues for understanding physicians both as products of the broader society and its changes. Starting in the 1960s, empiric evidence for the rise of reactionary viewpoints in response to major social movements is outlined. Structural reasons for the prevalence of such ideologies within medicine are highlighted. Its negative consequences for minority health are addressed. Finally, the author turns to compensatory strategies to improve the social environment within healthcare. Alternative selection strategies for medical school are proposed, with a stronger focus on empathetic candidates.
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Affiliation(s)
- Reginald F Baugh
- University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
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Warrier S, Cahill K, Catanese S, Sobota M, Gardner R. A Roadmap for Creating a Successful Peer Mentorship Group for Medical Educators. Am J Med 2020; 133:639-643. [PMID: 32007454 DOI: 10.1016/j.amjmed.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Sarita Warrier
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Kate Cahill
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Stephanie Catanese
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Mindy Sobota
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rebekah Gardner
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
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Armitage-Chan E, Reissner S. How do veterinary students engage when reflecting on their development towards being veterinary surgeons? Vet Rec 2020; 187:e77. [PMID: 32303664 DOI: 10.1136/vr.105692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Reflection has been widely acknowledged to contribute to professional development, the ability to manage tension and enhanced resilience. However, many practitioners struggle to reflect productively due to a lack of clarity of what constitutes effective reflection. METHODS To help develop reflective competence among future professionals, 30 veterinary students' reflective assignments were analysed by thematic text analysis. Theoretical frameworks were based on published criteria for critical and core reflection. RESULTS Reflection was described through resources (the tools used), practices (the ways of using these tools) and outcomes (what was achieved). This helped to distinguish simple skills based reflection from higher-level core reflection. Simple skills-based reflection was associated with an identity of expert learner: students perceive that their task is to identify a knowledge deficit that can be easily rectified through new learning. Core reflection was associated with students articulating an identity of adaptable professionals: rather than veterinary challenges being resolved simply through application of a body of knowledge, wider complexities of professional practice are recognised, including a need to resolve tension between their own and other stakeholders' priorities, values and beliefs. CONCLUSION Scaffolding an iterative, cyclical reflection process may support outcomes oriented towards resilience and the management of tension.
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Affiliation(s)
| | - Stefanie Reissner
- Newcastle University Business School, Newcastle upon Tyne, Newcastle upon Tyne, UK
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Zusevics KL, Kaemmerer NN, Lang J, Link J, Bluma DD. A Unique Approach to Quality Improvement Within the Stroke System of Care Utilizing Developmental Evaluation. Health Promot Pract 2020; 22:224-235. [PMID: 32285693 DOI: 10.1177/1524839919894305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is a significant cause of death that requires multiple systems of care to work together to prevent incidence and improve patient outcomes. The Wisconsin Coverdell Stroke Program partnered with a Model Hospital to understand and improve the stroke system of care in one community. Developmental evaluation (DE) is an approach in which evaluators collaborate closely with project stakeholders to examine complex processes and systems within changeable contexts to develop interventions to improve outcomes. DE was used to assess this community's stroke systems across the care continuum through process mapping with Model Hospital staff and through key stakeholder interviews with Model Hospital and emergency medical services staff, patients, and caregivers. Process mapping identified how patients and health care data flow through the system of care and highlighted areas where streamlining could improve the movement of patients and data across the care continuum. Interviews with stakeholders unveiled challenges and successes about how patient data are accessed and shared across the care continuum, and ideas for improving systems to be more efficient and supportive of stroke prevention and patient outcomes. Overall, DE was valuable in gaining an in-depth understanding of this complex environment to develop strategies to enhance stroke systems of care.
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Affiliation(s)
| | | | - Joshua Lang
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jessica Link
- Wisconsin Division of Public Health, Madison, WI, USA
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Krishnasamy C, Ong SY, Loo ME, Thistlethwaite J. How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57. MEDICAL TEACHER 2019; 41:1220-1231. [PMID: 31389720 DOI: 10.1080/0142159x.2019.1630731] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Background: Empathy and compassion are important in healthcare delivery, and are necessary qualities in medical students. Aims: To explore medical students', patients' and educators' perceptions of what affects empathy and the expression of compassion; and to address gaps in knowledge, attitudes and skills on how education affects empathy and the expression of compassion in medical students. Methods: The seven steps by Noblit and Hare were used for this meta-ethnography. Databases were searched for studies in English, published from 2007 to 2017 with outcomes of empathy and compassion. Key themes and concepts were identified, and accounts from the studies were used to build interpretations. Findings: Thirty-three qualitative studies were included and four main themes were derived: seeing the patient as a person; appreciating the elements of empathy and compassion; navigating in the training environment; and being guided by ideals. Interactions between the patient, the medical student and training environment which affect the development of empathy and compassion are illustrated in a conceptual model. Conclusions: This meta-ethnography extends our understanding of how medical education affects the expression of empathy and compassion in medical students. The results provide important considerations for medical educators and faculty developers in further developing and improving medical curricula.
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Affiliation(s)
| | - Sik Yin Ong
- HOMER, NHG Education, National Healthcare Group , Singapore , Singapore
| | - May Eng Loo
- HOMER, NHG Education, National Healthcare Group , Singapore , Singapore
| | - Jill Thistlethwaite
- NPS MedicineWise , Sydney , Australia
- FASS (Faculty of Social Sciences), University of Technology Sydney , Ultimo , Australia
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Schrepel C, Jauregui J, Brown A, Shandro J, Strote J. Navigating Cognitive Dissonance: A Qualitative Content Analysis Exploring Medical Students' Experiences of Moral Distress in the Emergency Department. AEM EDUCATION AND TRAINING 2019; 3:331-339. [PMID: 31637350 PMCID: PMC6795361 DOI: 10.1002/aet2.10380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND As undergraduate medical students are acculturated into clinical practice, they develop a set of refined professional values that impact their decision making. We aimed to use students' reflective narratives on ethical dilemmas to identify how students experience moral distress while working in the emergency department (ED) to better understand how to support them in the development of their own agency to act ethically. METHODS Students rotating in our emergency medicine clerkship are required to submit an essay describing an ethical dilemma they encountered. We selected a random sample of these reflective pieces from the 2015 and 2016 academic years and used an exploratory qualitative thematic analytic approach to identify frequently recurring themes. This process was continued until thematic sufficiency was reached. RESULTS Two-hundred essays were coded, and seven unique themes were identified. The moral distress students described in reflective writing narratives stemmed from patient-provider discord, uncertainty, and social injustices. In each case, students were expressing the cognitive dissonance they experienced as they began to reconcile the difference between their perceptions of optimal patient care and the actual care delivered to the patient. CONCLUSION Understanding medical students' cognitive dissonance in the ED will help educators support their students as they negotiate the differences between preferences and principles while being acculturated into clinical practice. Future work should develop specific interventions to promote educator understanding of learners' moral distress and to develop novel models of support for learners.
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Affiliation(s)
- Caitlin Schrepel
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Joshua Jauregui
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Alisha Brown
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Jamie Shandro
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Jared Strote
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
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Walsh G, Hayes B, Freeney Y, McArdle S. Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors. BMJ Open 2019; 9:e030209. [PMID: 31492785 PMCID: PMC6731950 DOI: 10.1136/bmjopen-2019-030209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify priority interventions for the prevention and reduction of work stress and burnout in hospital doctors through analysis of (1) doctors' experiences of work stress and burnout and (2) their preferences with respect to interventions. DESIGN Qualitative design using semistructured interviews analysed with deductive thematic analysis. SETTING Hospitals in Ireland. PARTICIPANTS 32 hospital doctors (16 practising consultants and 16 doctors in training) from a range of specialties, career stages, hospital types and locations. RESULTS Practical, system-focused interventions were found to be most needed. Challenges with basic entitlements, that is, accessing statutory leave, knowing in advance when leave can be taken and being adequately covered when on leave were identified as requiring urgent attention. Other priority interventions identified were the integration of psychological support in the everyday working environment, time and training for clinical line managers to perform key management activities such as debriefing and education interventions which highlight work stress risks and care pathways, teach self-care and train doctors in how to support one another. CONCLUSIONS Hospital doctors are feeling the effects of greater demand and fewer resources. What they most urgently need is adequate staffing levels, access to statutory leave and adequate cover when on leave. Doctors do not receive the support they need from their clinical line managers, who lack the skills and time to excel as people managers. Organisations should focus on developing clinical management skills across the system. The culture of medicine needs to change from stigmatisation and competitiveness to compassion and collaboration. Organisations, medical schools and professional bodies can steer this change through education.
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Affiliation(s)
- Gillian Walsh
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Research, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Blánaid Hayes
- Research, Royal College of Physicians of Ireland, Dublin, Ireland
- Occupational Health, Beaumont Hospital, Dublin, Ireland
| | - Yseult Freeney
- Business School, Dublin City University, Dublin, Ireland
| | - Siobhain McArdle
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Hendry J. Promoting compassionate care in radiography – What might be suitable pedagogy? A discussion paper. Radiography (Lond) 2019; 25:269-273. [DOI: 10.1016/j.radi.2019.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
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Li C, Hillen T, Reiss D, Kirtchuk G, Scott S, Maier M. The interpersonal dynamics consultation in physical health settings: a model for reflective practice. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
SUMMARYThe interpersonal dynamics between patient and doctor remain a daily challenge for clinicians, and reflective practice is a tool that allows them better understanding of how patients engage with treatment. The interpersonal dynamics consultation is a form of group-based reflective practice for patients with difficult relational (interpersonal) styles. It includes the whole multidisciplinary team in a systematic consultation in order to arrive at new understanding and management plans for these patients. Interpersonal dynamics consultations have been used successfully for many years in mental healthcare, and this article has arisen from a project exploring their application in physical healthcare settings. The project works to promote effective working at the interface of physical and mental healthcare and facilitates the important translational work of making psychiatry and psychotherapeutic ideas applicable in a broader context. This article outlines the interpersonal dynamics consultation model and illustrates its use in three fictitious cases from different medical specialties.LEARNING OBJECTIVESAfter reading this article you will be able to:•describe the ways in which reflective practice is beneficial to clinical work•describe the basic structure of the interpersonal dynamics consultation, including the four interpersonal perspectives•recognise the types of cases where interpersonal dynamics consultation might be most useful.DECLARATION OF INTERESTNone.
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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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An Evidence-based Approach to Measuring Affective Domain Development. J Prof Nurs 2018; 35:216-223. [PMID: 31126399 DOI: 10.1016/j.profnurs.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/13/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Educational taxonomies are utilised within nursing programmes to design curriculum, develop learning objectives, and measure attainments including the assessment of values, behaviours, and attitudes. Current measurement of the affective domain is limited, relying on quantitative tools, often immediately before and after learning activities. PURPOSE This paper examines the reliability of a qualitative framework to assess the long-term impact of learning activities known to stimulate affective domain development. METHOD Epstein's (1977) qualitative framework was applied to the self-reported responses of twelve international nurses (20-24 months post nurse registration) who had engaged in learning activities during their pre-registration programme that were considered to be enrichment (international placement, interprofessional learning, simulation and blended learning). RESULTS Epstein's framework was used to measure the degree of affective domain development from the self-reported responses of the students. The degree of modification in affective domain development was assessed as dentification level (assuming a different attitude or behaviour) for four nurses and internalisation stage for eight nurses (embracing new values and attitudes). CONCLUSION Epstein's framework is a reliable tool that can capture the short and long-term modification in affective domain development of nurses after they have experienced transformational learning activities. Key elements that move a nurse from identification to internalisation level are the motivating reason for undertaking the activity and reflection on the learning.
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Scheffer C, Valk-Draad MP, Tauschel D, Büssing A, Humbroich K, Längler A, Zuzak T, Köster W, Edelhäuser F, Lutz G. Students with an autonomous role in hospital care - patients perceptions. MEDICAL TEACHER 2018; 40:944-952. [PMID: 29347873 DOI: 10.1080/0142159x.2017.1418504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND There have been calls to enhance clinical education by strengthening supported active participation (SAP) of medical students in patient care. This study examines perceived quality of care when final-year medical students are integrated in hospital ward teams with an autonomous relationship toward their patients. METHODS We established three clinical education wards (CEWs) where final-year medical students were acting as "physician under supervision". A questionnaire-based mixed-method study of discharged patients was completed in 2009-15 using the Picker Inpatient Questionnaire complemented by specific questions on the impact of SAP. Results were compared with matched pairs of the same clinical specialty from the same hospital (CG1) and from nationwide hospitals (CG2). Patients free-text feedback about their hospital stay was qualitatively evaluated. RESULTS Of 1136 patients surveyed, 528 (46.2%) returned the questionnaire. The CEWs were highly recommended, with good overall quality of care and patient-physician/student-interaction, all being significantly (p < 0.001) higher for the CEW group while experienced medical treatment success was similar. Patient-centeredness of students was appreciated by patients as a support to a deeper understanding of their condition and treatment. CONCLUSION Our study indicates that SAP of final-year medical students is appreciated by patients with high overall quality of care and patient-centeredness.
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Affiliation(s)
- Christian Scheffer
- a Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health , Witten Herdecke University , Witten , Germany
- b Department for Internal Medicine , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
| | - Maria Paula Valk-Draad
- a Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health , Witten Herdecke University , Witten , Germany
| | - Diethard Tauschel
- a Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health , Witten Herdecke University , Witten , Germany
- c Department for Clinical Education, Faculty of Health , Witten Herdecke University , Witten , Germany
| | - Arndt Büssing
- d Institute for Integrative Medicine, Faculty of Health , Witten Herdecke University , Witten , Germany
- e Professorship for Quality of Life, Spirituality and Coping , Witten Herdecke University , Witten , Germany
| | - Knut Humbroich
- f Department for Neurology , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
| | - Alfred Längler
- g Department for Pediatrics , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
- h Professorship for Integrative Pediatrics , Witten Herdecke University , Witten , Germany
| | - Tycho Zuzak
- g Department for Pediatrics , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
| | - Wolf Köster
- b Department for Internal Medicine , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
| | - Friedrich Edelhäuser
- a Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health , Witten Herdecke University , Witten , Germany
- i Department for Early Rehabilitation , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
| | - Gabriele Lutz
- a Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health , Witten Herdecke University , Witten , Germany
- j Department for Psychosomatic Medicine , Gemeinschaftskrankenhaus Herdecke , Witten , Germany
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Welp A, Johnson A, Nguyen H, Perry L. The importance of reflecting on practice: How personal professional development activities affect perceived teamwork and performance. J Clin Nurs 2018; 27:3988-3999. [PMID: 29775493 DOI: 10.1111/jocn.14519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 03/06/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the relationships between participation in personal professional development activities (e.g., coaching, mentoring), teamwork and performance; to investigate the mediating and moderating effects of reflective thinking and perceived usefulness of development activities. BACKGROUND Professional development is associated with better performance and attitudes towards one's work. This study adds to this research by focusing on understanding this effect and the conditions under which this occurs. DESIGN Cross-sectional survey study. METHODS Participants were 244 nurses working in a large, metropolitan acute public hospital. They completed a questionnaire consisting of validated measures and provided information on frequency of participation and perceived usefulness of personal professional development activities. We analysed data using regression-based moderated mediation analyses. RESULTS The relationship between frequency of participation in personal professional development activities and both perceived teamwork and performance was mediated by reflective thinking. Perceived usefulness of development activities moderated the relationship between frequency of participation in personal professional development activities and reflective thinking. CONCLUSION Our results highlight the importance of professional development activities that go beyond knowledge- or skill-based training. Activities that cater to nurses' personal professional development needs are also associated with more positively perceived teamwork and performance. Results provide insights into the mediating mechanisms: Participation in personal professional development activities encouraged reflective thinking, which was associated with better perceived teamwork and performance. This association between personal professional development activities and reflective thinking was even stronger where nurses perceived the activities as useful. RELEVANCE TO CLINICAL PRACTICE Personal professional development activities enhance reflection in and on practice as these activities were linked with higher perceived quality of care and teamworking. It is important to ensure that the positive effects of personal professional development activities should target nurses' professional development needs and need to be perceived as useful by those who undertake them.
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Affiliation(s)
- Annalena Welp
- Work and Organisational Studies, University of Sydney Business School, Sydney, New South Wales, Australia
| | - Anya Johnson
- Work and Organisational Studies, University of Sydney Business School, Sydney, New South Wales, Australia
| | - Helena Nguyen
- Work and Organisational Studies, University of Sydney Business School, Sydney, New South Wales, Australia
| | - Lin Perry
- South Eastern Sydney Local Health District and Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Kim YH, Min J, Kim SH, Shin S. Effects of a work-based critical reflection program for novice nurses. BMC MEDICAL EDUCATION 2018; 18:30. [PMID: 29482527 PMCID: PMC5828399 DOI: 10.1186/s12909-018-1135-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/21/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Critical reflection is effective in improving students' communication abilities and confidence. The aim of this study was to evaluate the effectiveness of a work-based critical reflection program to enhance novice nurses' clinical critical-thinking abilities, communication competency, and job performance. METHODS The present study used a quasi-experimental design. From October 2014 to August 2015, we collected data from 44 novice nurses working in an advanced general hospital in S city in Korea. Nurses in the experimental group participated in a critical reflection program for six months. Outcome variables were clinical critical-thinking skills, communication abilities, and job performance. A non-parametric Mann-Whitney U-test and a Wilcoxon rank sum test were selected to evaluate differences in mean ranks and to assess the null hypothesis that the medians were equal across the groups. RESULTS The results showed that the clinical critical-thinking skills of those in the experimental group improved significantly (p = 0.003). The differences in mean ranks of communication ability between two groups was significantly statistically different (p = 0.028). Job performance improved significantly in both the experimental group and the control group, so there was no statistical difference (p = 0.294). CONCLUSIONS We therefore suggest that a critical reflection program be considered an essential tool for improving critical thinking and communication abilities among novice nurses who need to adapt to the clinical environment as quickly as possible. Further, we suggest conducting research into critical reflection programs among larger and more diverse samples.
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Affiliation(s)
- Yeon Hee Kim
- Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505 Republic of Korea
| | - Ja Min
- Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505 Republic of Korea
| | - Soon Hee Kim
- Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505 Republic of Korea
| | - Sujin Shin
- College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760 Republic of Korea
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Peterson WJ, House JB, Sozener CB, Santen SA. Understanding the Struggles to Be a Medical Provider: View Through Medical Student Essays. J Emerg Med 2017; 54:102-108. [PMID: 29100653 DOI: 10.1016/j.jemermed.2017.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/08/2017] [Accepted: 09/15/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The clinical learning environment helps to shape the professional identity of medical students. This process begins from existing personal identity and is influenced by various factors, including clinical experiences and clinical learning environment. OBJECTIVE The purpose of this study was to examine medical students' reflections as a way to identify and better characterize the modern struggles that medical students face, in order to inform the development of professional identity. METHODS Students rotating in their emergency medicine clerkship wrote reflections on dilemmas that highlighted common struggles of becoming a doctor. Qualitative analysis was performed to determine common themes from the essays. The research team coded 173 reflections and identified themes and major domains. RESULTS The first domain was Patient-Provider Conflict, including challenging patient (34%), difficult communication (25%), competing priorities between patients' interest and trainees need to learn (19%), and bias (13%). The second domain was Provider-Specific Issues, such as the "gray zone," in which there is not a clear standard of practice (29%), end-of-life care (14%), emotional struggle (6%), and fear of litigation (5%). The final domain was Systems Issues, such as cost of care (12%) and role of the emergency department (6%). CONCLUSIONS The reflections point to a wide variety of challenges that students confront in practice that will contribute to how they develop into physicians.
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Affiliation(s)
- William J Peterson
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joseph B House
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Cemal B Sozener
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sally A Santen
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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Lutz G, Pankoke N, Goldblatt H, Hofmann M, Zupanic M. Enhancing medical students' reflectivity in mentoring groups for professional development - a qualitative analysis. BMC MEDICAL EDUCATION 2017; 17:122. [PMID: 28709462 PMCID: PMC5512833 DOI: 10.1186/s12909-017-0951-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/26/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Professional competence is important in delivering high quality patient care, and it can be enhanced by reflection and reflective discourse e.g. in mentoring groups. However, students are often reluctant though to engage in this discourse. A group mentoring program involving all preclinical students as well as faculty members and co-mentoring clinical students was initiated at Witten-Herdecke University. This study explores both the attitudes of those students towards such a program and factors that might hinder or enhance how students engage in reflective discourse. METHODS A qualitative design was applied using semi-structured focus group interviews with preclinical students and semi-structured individual interviews with mentors and co-mentors. The interview data were analyzed using thematic content analysis. RESULTS Students' attitudes towards reflective discourse on professional challenges were diverse. Some students valued the new program and named positive outcomes regarding several features of professional development. Enriching experiences were described. Others expressed aversive attitudes. Three reasons for these were given: unclear goals and benefits, interpersonal problems within the groups hindering development and intrapersonal issues such as insecurity and traditional views of medical education. Participants mentioned several program setup factors that could enhance how students engage in such groups: explaining the program thoroughly, setting expectations and integrating the reflective discourse in a meaningful way into the curriculum, obliging participation without coercion, developing a sense of security, trust and interest in each other within the groups, randomizing group composition and facilitating group moderators as positive peer and faculty role models and as learning group members. CONCLUSIONS A well-designed and empathetic setup of group mentoring programs can help raise openness towards engaging in meaningful reflective discourse. Reflection on and communication of professional challenges can, in turn, improve professional development, which is essential for high quality patient care.
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Affiliation(s)
- Gabriele Lutz
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Nordrhein-Westfalen Germany
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | | | | | - Marzellus Hofmann
- Office for Student Affairs, Department for Health, Faculty of Medicine, Witten / Herdecke University, Witten, Germany
| | - Michaela Zupanic
- Office for Student Affairs, Department for Health, Faculty of Medicine, Witten / Herdecke University, Witten, Germany
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Lutz G, Roling G, Berger B, Edelhäuser F, Scheffer C. Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis. BMC MEDICAL EDUCATION 2016; 16:301. [PMID: 27881123 PMCID: PMC5121969 DOI: 10.1186/s12909-016-0823-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/14/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students' experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students' ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency. METHODS Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity. RESULTS Reflection on real difficult clinical communication situations appears to increase medical students' ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer. CONCLUSIONS Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students' overall communicative competency.
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Affiliation(s)
- Gabriele Lutz
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Gudrun Roling
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
| | - Bettina Berger
- Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Witten, Germany
| | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Christian Scheffer
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Internal Medicine, Clinical Education Ward for Integrative Medicine (CEWIM), Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
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Aherne D, Farrant K, Hickey L, Hickey E, McGrath L, McGrath D. Mindfulness based stress reduction for medical students: optimising student satisfaction and engagement. BMC MEDICAL EDUCATION 2016; 16:209. [PMID: 27535243 PMCID: PMC4989331 DOI: 10.1186/s12909-016-0728-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/08/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Medical practitioners and students are at increased risk of a number of personal and psychological problems. Stress and anxiety due to work-load and study requirements are common and self-care methods are important in maintaining well-being. The current study examines perceptions of and satisfaction ratings with a mindfulness based stress reduction (MBSR) programme for 1(st) year (compulsory) and 2(nd) year (optional) Graduate Entry Medical School students. METHODS A mixed method pre and post study of Year 1 (n = 140) and Year 2 (n = 88) medical students completing a 7 week MBSR course compared student satisfaction ratings. Thematic analysis of feedback from the students on their perception of the course was also carried out. RESULTS Year 1 students (compulsory course) were less satisfied with content and learning outcomes than Year 2 students (optional course) (p < .0005). Thematic analysis of year 1 student feedback identified themes including great concept, poorly executed; and less discussion, more practice. Year 2 themes included session environment and satisfaction with tutors. CONCLUSIONS The MBSR course was associated with high levels of satisfaction and positive feedback when delivered on an optional basis. Catering for the individual needs of the participant and promoting a safe environment are core elements of a successful self-care programme.
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Affiliation(s)
- Declan Aherne
- Counselling Department, University of Limerick, Limerick, Ireland
| | - Katie Farrant
- Counselling Department, University of Limerick, Limerick, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Louise Hickey
- Counselling Department, University of Limerick, Limerick, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Emma Hickey
- Counselling Department, University of Limerick, Limerick, Ireland
| | - Lisa McGrath
- Counselling Department, University of Limerick, Limerick, Ireland
| | - Deirdre McGrath
- Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
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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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Wald HS. Refining a definition of reflection for the being as well as doing the work of a physician. MEDICAL TEACHER 2015; 37:696-699. [PMID: 25897706 DOI: 10.3109/0142159x.2015.1029897] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Reflection is core to professional competency and supports the active, constructive process of professional identity formation. AIMS Medical educators thus grapple with operationalizing and effectively integrating reflection as a foundational construct within health care professions education and practice. METHODS Core elements of reflection including role of emotions and awareness of self, other and situation, do not appear within various working definitions of reflection. RESULTS This observation as well as noted recent shift in medical education toward emphasis on the "being" as well as "doing the work" of a physician led to the author's proposed refining of Sandars' reflection definition and expansion of Nguyen et al.'s reflection model. CONCLUSIONS A refined reflection definition is offered for a more inclusionary approach. A caveat regarding potential for expected reflective learning outcomes (given reflection as a process) is provided and the integral role of mentor-enhanced reflection is discussed. Reflection as a continuum is highlighted and exemplified within Wald et al.'s REFLECT rubric and Nguyen et al.'s reflection model.
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Affiliation(s)
- Hedy S Wald
- a Warren Alpert Medical School of Brown University , USA
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Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:753-60. [PMID: 25901874 DOI: 10.1097/acm.0000000000000725] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identity formation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized and/or formal and informal curricular approaches. How can we best support the complex iterative PIF process for a humanistic, resilient health care professional? How can we effectively scaffold the necessary critical reflective learning and practice skill set for our learners to support the shaping of a professional identity?The authors present three pedagogic innovations contributing to the PIF process within undergraduate and graduate medical education (GME) at their institutions. These are (1) interactive reflective writing fostering reflective capacity, emotional awareness, and resiliency (as complexities within physician-patient interactions are explored) for personal and professional development; (2) synergistic teaching modules about mindful clinical practice and resilient responses to difficult interactions, to foster clinician resilience and enhanced well-being for effective professional functioning; and (3) strategies for effective use of a professional development e-portfolio and faculty development of reflective coaching skills in GME.These strategies as "bridges from theory to practice" embody and integrate key elements of promoting and enriching PIF, including guided reflection, the significant role of relationships (faculty and peers), mindfulness, adequate feedback, and creating collaborative learning environments. Ideally, such pedagogic innovations can make a significant contribution toward enhancing quality of care and caring with resilience for the being, relating, and doing of a humanistic health care professional.
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Affiliation(s)
- Hedy S Wald
- H.S. Wald is clinical associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. D. Anthony is associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. T.A. Hutchinson is professor of medicine and director, McGill Programs in Whole Person Care, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S. Liben is associate professor of pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada. M. Smilovitch is associate professor of medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada. A.A. Donato is clinical associate professor of medicine, Jefferson Medical College, Philadelphia, Pennsylvania
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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: 129] [Impact Index Per Article: 14.3] [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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Salander P, Sandström M. A Balint-inspired reflective forum in oncology for medical residents: main themes during seven years. PATIENT EDUCATION AND COUNSELING 2014; 97:47-51. [PMID: 25034638 DOI: 10.1016/j.pec.2014.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/04/2014] [Accepted: 06/15/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Reflection groups for clinicians, often called Balint groups, are a way of refining professional competence in health care. This study presents a model for reflective practice in a group setting and describes the kinds of troublesome cases that medical residents are concerned about. METHODS From 2005 to 2012 a Balint-inspired reflective forum has been a part of the academic seminar program for physicians in training in a Department of Oncology at a Swedish university. The present study is focused on all 63 cases presented in the forum. RESULTS The cases were categorized into three kinds of challenges: Communication challenges in the patient-physician relationship, Communication challenges in organizational matters, and Communication challenges with close relatives of the patient. CONCLUSION The study tells us something about the vulnerability of being a medical resident and the identified challenges have bearings on medical education curricula as well as on how the training of junior physicians is organized. PRACTICE IMPLICATIONS The cases are contextual and multifaceted, and a forum of this kind might therefore be regarded as a potential way to develop professional competence and to refine communication in clinical practice. A structured evaluation of the forum would be valuable.
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Affiliation(s)
- Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden.
| | - Maria Sandström
- Department of Radiation Sciences-Oncology, Umeå University, Umeå, Sweden
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Humphris G, Entwistle V, Eide H, Visser A. The science of health communication: impressions from the International Conference on Communication in Healthcare in St Andrews, Scotland, UK. PATIENT EDUCATION AND COUNSELING 2013; 92:283-285. [PMID: 23962541 DOI: 10.1016/j.pec.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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