'Oh yes, that is also reflection'-Using discursive psychology to describe how GP registrars construct reflection

Unravelling the art of developing skilled communication: a longitudinal qualitative research study in general practice training

Doctor-patient communication is a core competency in medical education, which requires learners to adapt their communication flexibly to each clinical encounter. Although conceptual learning models exist, information about how skilled communication develops over time is scant. This study aims to unpack this process of communication learning and to identify its facilitators. We conducted a longitudinal qualitative study employing a constructivist grounded theory approach in a General Practice training setting. Over a 6-month period, we closely monitored 8 first-year and 5 third-year trainees (n = 13) by means of clinical observations, stimulated recall interviews and audio diaries. In an iterative process of data collection and analysis, we triangulated these sources across trainees (horizontal analysis) and over time (vertical analysis) to identify how themes evolved. This analysis led us to the construction of a six-stage cyclic conceptual model during which trainees: (1) have an impactful experience; (2) become aware of own communication; (3) look for alternative communication behaviours; (4) experiment with new behaviours; (5) evaluate the effectiveness; and (6) internalise the new communication behaviours. Additionally, conditions were found to support learning and reflection. Becoming a skilled communicator seems to require a continuous approach, with repeated practice and reflection to adapt and internalise communication in the clinical encounter. Consequently, we recommend that trainees be supported with tailored feedback to strengthen their communication repertoire. Ideally, they should be guided by supervisors who serve as coaches in a safe learning environment with regular, planned learning activities.

Medical students' perspectives of reflection for their professional development

BACKGROUND

Reflection is a critical component of learning which plays a significant role in improving knowledge and skills. It is a metacognitive process that aims to create a deeper understanding of the situation. This study sought to explore the perspectives of medical students concerning the role of reflection in their professional development.

METHODOLOGY

This qualitative content analysis study was undertaken with 20 medical students across different year levels in 2023. Participants entered the study by purposive sampling. Data was collected through individual semi-structured interviews. Interviews were audio recorded and transcribed verbatim. Collected data was analyzed based on the steps proposed by Graneheim and Lundman. Data analysis was performed using MAXQDA-10 software.

RESULTS

A total of 168 primary codes were extracted. After removing duplicate codes and merging similar codes, finally 54 codes were extracted, which were placed in 3 main themes and 7 subthemes. They encompassed: self-awareness (self-acceptance, metacognitive self-exploration, semantic perception); professional competence (self-directed learning, professional commitment); and reflection culture (organizational climate, educational structure).

CONCLUSIONS

Findings revealed that the most important aspect of reflection is the recognition and acceptance of individual identity, along with the metacognitive awareness of how to know, especially in the early years, and understanding the meaning of behaviors and relationships over time. Students explained the undeniable impact of reflection on individual and self-directed learning and the development of professional commitment during their studies. The findings of this study, specifically major themes from reflection culture narratives, provide us with a better understanding of the lack of a positive organizational atmosphere, inappropriate educational structure and intensive clinical rotations, as well as lack of trust between students and medical teachers, which negatively impact on or hinder professional development. It seems that by faculty development initiatives, mentoring, group reflection sessions, reflective practices can turn into an opportunity to improve the quality of education.

Teaching of reflection in higher education: a narrative review

Background

Healthcare professional students (HCPs) are encouraged to utilise reflection during and after their study programmes as a part of their life-long learning skill and professional competencies. However, the way in which the concept of reflection is taught and its' influence students' capacity to reflect have not been fully explored. This narrative review aimed to explore how the concept of reflection is taught in higher education and how the teaching of reflection influences HCP students' capacity to reflect.

Methods

Articles that were published during 2014-2024 within three databases, PubMed, CINAHL and ERIC were searched. 1929 articles were eligible for screening. 93 articles were further assessed for eligibility.

Results

18 articles were included. The included articles were geographically well-distributed in both the Global North and Global South countries, indicating universal interest in the topic. Eight articles had qualitative study designs; six had quantitative designs and four had mixed-method designs.Conceptually, the teaching of reflection could be categorised as a spectrum, ranging from: i) structured format (reflective templates or debriefing); ii) semi-structured format (physical/virtual small group discussions, video recordings, AI generative arts, in-verse reflection and concept mapping) and iii) flexible and creative (art-based pedagogy or narratives).All included articles indicated students actual and perceived better understanding of reflection. This claim is supported both quantitatively and qualitatively via either validated instruments or narratives and themes based on students' textual outputs.

Conclusions

This review identified several teaching methods that help facilitating students' capacity to reflect. Findings are unable to recommend the most efficient way to teach reflection since it depends on students' progress in their programmes. However, a more relational approach to teaching of reflection is recommended. Students might begin their reflective journey with a structured format of teaching of reflection then gradually move to less-rigid format of the teaching to empower students' autonomy.

Towards a culture and pedagogy of reflection

What does it mean to cultivate a "healthy reflection culture" in HPE? For @moniztracy1 and @StellaHPE, it means acceptance and management of “not knowing” and an explicit framing of the essence of being a professional practitioner; to get there, writing can help.

Enhancing nursing students' reflection through Padlet: an action research

Background

Reflective practice is encouraged amongst healthcare students, including nursing students. However, students do not have a 'safe space' to practice reflection before being assessed. Padlet is an interactive platform that can potentially facilitate students' reflection via its features that enables anonymous participation, asynchronous participation and collaborative learning environment. This study aims to explore the influence of current reflection teaching method on students' reflective practice and how Padlet can facilitate students' reflective practice.

Methods

An action research was undertaken with 22 first year nursing students from Feb to May 2023. Participants answered questions anonymously pre-class and post-class in two Padlet boards. The researcher gave constructive feedback and signposted good examples of reflection to participants thus enabling 'champion' students to emerge during the process. Anonymous texts from two Padlet boards were analysed using reflexive thematic analysis technique.

Results

Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Students joined the study with different presumptions and understanding of reflection, ranging from descriptive understanding of the concept, a total misunderstanding of the concept and in-depth understanding of reflection. They all indicated a changed understanding of reflection post-class and emphasized the benefits of a socially constructed learning process. Participants suggested the use of reflective tools (via reflective models) and triggers (via probing questions and feedback) as useful to facilitate their reflection.

Conclusions

This study indicates that the current teaching materials enable students to enhance their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet proves a promising tool to enhance students' reflection via its function to enable anonymity, asynchronous participation and socially constructed learning environment.