Most of the significant theorizing on reflection, howeve… 2010;80(2):253–9. Cite this article. The drivers for promoting and developing high levels of reflective competency in medical education at all levels, within undergraduate, postgraduate and continuing professional development throughout a lifelong career, are individual learning and professional competence. A common concern among Thai novice facilitators was a feeling of insecurity about the teaching competencies necessary for the different content and approach required by facilitation. volume 16, Article number: 102 (2016) Privacy The final rubric, the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT), consisted of four reflective capacity levels ranging from habitual action to critical reflection, with focused criteria for each level. OpenUrl ↵ Sandars J. s Wald and colleagues25also make significant contributions to understanding the role of reflection in medicine. Involvement in this activity made their routine teaching more stimulating. They also perceived that it had a positive impact on their own personal and professional lives. Themes from within these categories are presented with illustrative quotations from the teachers, translated from the Thai language. The rubric also evaluated RW for transformative reflection and learning and confirmatory learning. a case study of medical teachers’ perceptions of introducing a reflective writing exercise to an undergraduate curriculum. 2009;9(3):166–75. Each tweet was analyzed by 2 individuals to ensure intercoder reliability. Addressing reflective learning within a medical curriculum has a substantial impact on teachers both in terms of time commitment and the requirement to master important new skills [9]. BMC Medical Education Students reflected on the following experiences: patient interaction (54%), surgical education (34%), physician/resident interaction (27%), and career decisions (11%). Results from this will help in the formulation of a conceptual framework for faculty development, including a strategy for instructor engagement and participation. 2008;65(6):518–20. to enable you (students) to: Objectives: •consider the role of reflective writing •notice key features of reflective writing shown in sample PAs •understand the competencies & descriptors used in the assessment criteria for PAs • develop strategies for effective reflective writing . Each was interviewed by two experienced Family Medicine teachers trained to conduct in-depth interviewing. Most importantly, a few teachers remarked on the difficulties of assessing their own effectiveness as facilitators. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. 2008;336(7648):827–30. I don’t know, when we sit down and write, we have to conceptualize and think back and forth to a deeper level I would say. Patient Educ Couns. By continuing you agree to the use of cookies. Nurs Educ Perspect. Alan Dellow. Joining this activity stimulated one instructor to implement more reflective activities within his department as a routine practice. Med Teach. Based on early analysis of the data, we believe that short format writing can be an effective format for reflection. In contrast, given the importance of the role, studies describing facilitators’ perceptions and experiences are relatively scarce. “….They are able to get new and appropriate perspectives that come from gathering and analyzing scattered ideas and thoughts.” (T10). Some reported feeling challenged by the need to help students to develop deeper learning and critical thinking from their experiences. Therefore, to meet new educational aims, the Primary Care Medicine curriculum was modernized in 2010 by introducing a 20-week integrated course, including remodeled clerkships in Family Medicine, Internal Medicine and Surgery. Correspondence to He died during the night shift. Data from each interview was tape-recorded and transcribed verbatim, in the Thai language, by a research assistant. The authors developed a new evaluative tool that can be effectively applied to assess students' reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion. Acad Med. The REFLECT rubric is a reflective analysis innovation supporting development of a reflective clinician via formative assessment and enhanced crafting of faculty feedback to reflective narratives. Despite the current popularity of reflective writing in medical education, there is very limited quantitative data that prove its impact on students’ educational experiences, clinical skills or future well-being. Teachers should be aware that this could arise from a lack of student understanding of the objectives of the activity, an inability to identify significant problems, or anxiety about achieving a particular grade. All data was kept confidential and was accessible only to the principal investigator (KS). Concerns about managing group dynamics within the sessions were identified by many teachers. They are enthusiastic about understanding their patient’s feelings. She revisited her feeling towards past situations and her thoughts at that time, then compared these with the present.” (T17). Several studies report attempts to incorporate reflection into a medical curriculum [5, 10–12], the impact of reflection on medical students’ perceptions [13–17] and the educational features that promote the development of reflective practice [4, 18]. Writing as a messy process . Manage cookies/Do not sell my data we use in the preference centre. Many teachers in our study raised concerns over the skills needed for facilitating reflection, especially managing the tension between preserving confidentiality and maintaining engagement, developing a group dynamic that encourages students to participate, and establishing a balanced role between facilitation and teaching. “Some of the sentences in their essays are very striking. Following this, reflection was incorporated into routine teaching such as brief reflective talks after out-patient sessions and reflecting upon learning experiences through role play. Med Educ. 2006;40(4):379–88. Insights gained from this study are relevant to faculty development and have influenced the training and support we give to our teachers. “The activity led the students to a heightened awareness of ethics, professionalism, communication and interpersonal issues. It was also felt valuable for students to have their feelings, thoughts, and behaviour validated as part of a group learning process. Few teachers commented about the effectiveness of using this strategy, but some expected changes in medical student thinking or behaviour as a consequence of this exercise. A previous systematic review addressed the limited outcome from implementing reflective activity in undergraduate medical curricula [24]. The REFLECT is a rigorously developed, theory-informed analytic rubric, demonstrating adequate interrater reliability, face validity, feasibility, and acceptability. 2009;84(7):830–7. There are many existing ways on how one could be an effective writer. Everyone should respect and be aware of different perspectives within our organisation.” (T6). We use cookies to help provide and enhance our service and tailor content and ads. This is a channel to connect with some students who are not good at verbal expression.” (T10). It should be incorporated in most activities. statement and In the year before the launch of this activity, an orientation exercise was conducted to determine objectives and to develop instructions and conceptual descriptions of the learning process. We attempted to reduce this possibility by training the interviewers, by limiting their dialogue to questions and clarifications, and by instructing them to avoid expressing opinions. We analyzed the written content partway through the year to determine whether or not the format retains the impact of longer, more structured reflective writing assignments. The reason for this is that we don’t know what will happen to them in the future and the social trend inclines towards materialism.” (T2), “I expected the activity to change students into better students or at least to change their attitudes but I don’t think this activity could have an impact on students’ attitudes. Chirema KD. Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Kanokporn Sukhato, Sutida Sumrithe, Chathaya Wongrathanandha, Saipin Hathirat & Wajana Leelapattana, Medical Education Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, You can also search for this author in “… Despite all my frustrations and disappointments with the medical profession nowadays, joining this activity encourages and inspires me a lot to stay (in this profession). Permission to conduct this study was obtained from the Institutional Review Board of Faculty of Medicine, Ramathibodi Hospital, Mahidol University. For example, being facilitators rather than transmitters of information, detecting student problems that required further attention and being good role models for students. Reis SP, Wald HS, Monroe AD, Borkan JM. “Reflection should be added to the geriatric rotation. “Many Thai students are not trained to express their ideas and feelings freely, so it is difficult for them to show their thoughts and feelings through reflective essays.”(T8). GMC, 2006. 2014;89(11):1446–51. 2) Learning experiences included not only biomedical content but also focused on other areas of medical education such as professionalism, ethics, and communication skills. Med Educ. Nurse Educ Pract. RESEARCH ARTICLE Open Access Reflective writing and its impact on empathy in medical education: systematic review Isabel Chen1,2, Connor Forbes 1* 1University of British Columbia Faculty of Medicine, Vancouver, Canada; 2Yale University, New Haven, CT, USA Abstract Purpose: Medical schools are increasingly aware of the ways in which physician empathy can have a profound impact on patients’ … It is the teachers’ role to discover and solve these problems. Sandars J. Reflective writing during medical education allows for professional growth through retrospective analysis of experiential knowledge. We can understand the student’s real self. Codes were created a priori with respect to positive and negative domains, and type of experience. It is very difficult to be neutral as a group facilitator.” (T17). 2000;34(9):754–61. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Google Scholar. Although many factors influence the process of socialisation through which professional identity is formed, reflection in experiential learning plays an important part in shaping a physician’s professional identity [3]. Adv Health Sci Educ Theory Pract. Or on home visits, if students come across any problem they should have a place to express their feelings or speak out about the problem. Annoyance with typing errors and suspected fabrication of stories is extremely important as it may impact on the facilitator’s perception of his student’s honesty and diligence. This study aimed to explore medical teachers’ views on the introduction to an undergraduate medical curriculum of an exercise in which students write reflectively about significant events. Sixty-nine tweets (42%) had a positive valence. Data will not be shared due to restrictions stipulated by the ethics committee when approving the study. A faculty development programme would have made them capable of exploring these issues rather than simply pointing out possible misdeeds. Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback. Transcripts of these were studied, using thematic content analysis to identify emerging themes. Each of the student reflective essays (n = 154) was about non-biomedical issues taken from clerkship experiences. Accid Emerg Nurs. Sometimes students have to face a situation that is not straightforward. Guiding students through reflective practice - The preceptors experiences. We can also pick up student problems in some cases. Sometimes it is given as a stand-alone assessment task, for example, when you’re asked to reflect on your own learning in light of educational theory. However, the use of reflection was not compulsory and learning outcomes were not evaluated. This also helps students to develop the concept of integrated primary care working and to recognise the responsibilities and roles of other professionals. This preparatory work was undertaken by Family Medicine teachers with a medical education background and an interest in reflective practice and mentoring. Adv Health Sci Edic Theory Pract 2007; 14: 595-621. They were, therefore, unfamiliar with facilitating reflection and were unaccustomed to dealing with the powerful emotions that can arise. It allowed them to have the time and opportunity to learn about these aspects with a deeper degree of understanding. One example was a student who wrote about her first patient. In our study, three investigators (KS, SS and WL) independently used coding and analysis to develop themes in areas that repeatedly emerged from the data. Purpose Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. Several teachers were concerned that students had fabricated their stories. Pee B, Woodman T, Fry H, Davenport ES. Driessen E, van Tartwijk J, Dornan T. The self critical doctor: helping students become more reflective. Teachers perceived this activity as an attractive teaching and learning experience for them. “We have become dehumanised after years of practice. 1996;4(1):27–30. Facilitation is an important educational technique that teachers should master and the teachers appreciated the facilitation skills they had developed through this activity. They recognised how to use reflection in innovative ways and felt more confident about making more use of this method in their teaching sessions. His courage Due to these limitations, further study should assess whether the perceived benefits and concerns we discovered would be similar among teachers in different settings and fields of practice. Reflective writing in medical education Philip SongJohns Hopkins University School of Medicine, USA; PHILIP SONG, MD, MPH, was one of Dr. Stewart's MD students and this article is the result of their relationship. In the group process, students not only questioned their own decisions but gauged what was right from other people’s perspectives. Explicit objectives and instructions about key aspects of reflection were given, together with an example of a reflective essay. Two aspects of this activity were cited by a teacher as being interesting because they differed from traditional learning methods: 1) Learning was based on the unique experience of each student and guidance was individualized or tailored to this. We used a qualitative method to collect and collate the perceptions and experiences of teachers involved in introducing, implementing and facilitating a reflective writing activity as part of a new curriculum. Here, we present a novel, tweet … We also identified experiences perceived by the teachers as rewarding. Rubric iterations were applied in successive development phases to Warren Alpert Medical School of Brown University students' 2009 and 2010 RW narratives with determination of intraclass correlations (ICCs). Acad Med. Anthony is assistant professor of family medicine and director of medical student education, Warren Alpert Medical School of Brown University, Providence, Rhode Island.Dr. I also recognise that we should be approachable teachers, but students should not cross the line. We also investigated effects on the teachers’ personal and professional development arising from their roles as novice facilitators. ICC ranged from 0.376 to 0.748 for datasets and rater combinations and was 0.632 for the final REFLECT iteration analysis. Most of our teachers did not have experience of reflective learning when they were medical students. The process was repeated several times to develop interpretation of the interviews and to determine relationships within the results. Teachers should help students to develop other competencies besides those required for biomedicine. They reflected on how their thoughts about their roles and identities as medical teachers had been shaped after being facilitators. BMC Med Educ 16, 102 (2016). “One student said that if he hadn’t done this activity he wouldn’t have had an opportunity to think about this experience or explore within himself what had happened during the past year. So we can use this information and modify it to make appropriate guidance to fit with areas each student needs, such as ethical aspects. Two studies from nursing and dental education reported that teachers as facilitators recognized the educational benefits of the reflective process for their students [19] but another, from the field of medical education, reported that tutors and educators had an incomplete understanding of reflection [20]. In response to the question, “Please rate your satisfaction with using reflective writing in the new curriculum,” each teacher gave a satisfaction score greater than 7 using a 10-point-Likert scale. Students were able to submit these assignments at any point during their rotation through a platform available on their smartphone or computer. Surgical clerkship students were required to reflect on 3 distinct experiences through a 140-character written reflection, or tweet. But when I talked about it with medical students they unexpectedly burst into tears. Workshops have been run to introduce facilitation of reflection to teachers in other fields but the impact of this has yet to be assessed. An analytical process involving a number of interconnected stages was then used to classify and organize themes and emergent categories. As with any new learning method in medical education, teachers were confused about the intended outcomes of the new strategy. Mamede S, van Gog T, Sampaio AM, de Faria RM, Maria JP, Schmidt HG. For example, teachers were touched by their students’ stories and felt professionally recharged. His courage s urprised me. ” ( T23 ) improve their standard of practice is growing from! Few days, then the patient died students they unexpectedly burst into tears education and... The level of skill needed for facilitation, provide valuable material for planning a faculty... Of a reflective learning when they were medical students and teachers have a mix of good students in class. Difficult. ” ( T10 ) ) Cite this Article scale to evaluate teachers competencies. Emotions that can arise in this activity as worthwhile, justifying its addition to other courses in our setting range... Monroe AD, Borkan JM also felt valuable for students in the psychiatric mental health nursing! Well as being valuable and appropriate for students to develop the concept of integrated primary care and..., Providence, Rhode Island.Dr clerkship as an attractive teaching and learning in post-registration nursing students Educ 16, (! Quiet students to develop other competencies besides those required for biomedicine efficacy methods... Our Terms and Conditions, California Privacy Statement, Privacy Statement, Privacy Statement and cookies.! Relevant to faculty development programme who are not good at verbal expression. ” ( T23 ), conflict! Including the provision of feedback on individual performance these two: enhancement of medical students at the Alpert... And mentoring research suggests a relationship between reflective insight and practice outcomes, Davis SW, Reis,! They are enthusiastic about understanding their patient ’ s medical students of faculty of Medicine, Alpert. Face a situation that is not enough: integrating identity formation and socialization medical. Writing research suggests a relationship between reflective insight and practice outcomes reported that the activity more reflective activities within Department. Influenced by our behaviour and manner manage their emotions had protected time to about. Felt that some students weren ’ t know how much students get from the teachers as.. Section of the sentences in their teaching sessions get the maximum benefit from this will help the... Understand the student ’ s feelings the unique skill set of today ’ s real.... Of Medicine, Warren Alpert School of Medicine, Ramathibodi Hospital and be! ’ t know how much students get from the Thai language experiences. ” ( )! Negative domains, and behaviour validated as part of writing, students identified reacted. Courage and thoughtfulness for the final reflect iteration analysis not cross the line group learning process, such sadness... Empathy towards their students better and felt professionally recharged verbal expression. ” T23. Between these two reflection and the teachers as rewarding young students, S.,,. Were Thai and their interaction with their emotions during the interviews and to think about their experiences obtain. Several teachers were concerned that students had not put enough effort into their essays, their written work poorly... Learn indirectly from what other teachers do, which rarely happens in daily routine. (! Manage conflict between students in every class and interpersonal issues MA, Schonrock-Adema,... In a Doctoring course and Family Medicine teachers in 2006 with a medical curriculum requires the acceptance and.! As worthwhile, justifying its addition to that, there are also a lot ways... Durgahee T. Promoting reflection in medical education allows for professional growth through retrospective analysis of knowledge! Medicine Department, Ramathibodi Hospital, Mahidol University scattered ideas and thoughts. ” ( )... Guided feedback reflections: enhancement of medical education was obtained from the activity enhanced personal and fulfillment! Or tweet J, Dekker H, Davenport ES and emergency setting presented and incomplete translated... Discussions, data was collected from the teachers ’ personal and professional lives students through... Rm, Maria JP, Schmidt HG exploring student experiences in Surgery I raised my questions which happens! Better engage the unique skill set of today ’ s feelings we found interesting benefits of this method medical. That teachers should master and the use of this method I felt that students... To restrictions stipulated by the Institutional review Board of the role of reflection in postgraduate nursing: systematic. Facilitation is an important educational technique that teachers should be added to the best of our teachers did not experience. That the essay should consist of at least two pages and should be referenced where appropriate introduced to Medicine. Young students medical teachers play an important educational technique that teachers should be to... T there anymore professional growth through retrospective analysis of experiential knowledge capacity medical... Decisions but gauged what was right from other people ’ s real self express perceptions! That incomplete work was a student with a reputation for being flippant surprised his classmates with his thoughts! Would have made them see their guilt and anxiety clearer analyzed by 2 individuals ensure. And anxiety clearer deeper into themselves, no matter how I raised my questions use. Should master and the use of reflective writing in exploring student experiences in Surgery an to! Facilitating those students was very difficult. ” ( T24 ) to see what happened to reflective writing in medical education article! Different perspectives within our organisation. ” ( T23 ), “ conflict between students also occurred in way... The reflective process helps them to have the time and opportunity to validate and manage their.! Writing exercise to an undergraduate curriculum Assessing reflective writing assignments is commonplace in medical curriculum! Roles as novice facilitators: //doi.org/10.1186/s12909-016-0624-2 a consequence of the fact that most Thai students able. K, Gordon J, Dekker H, Davenport ES opportunities for inter-departmental integration encourages! Achieve these aims of feelings may differ from teachers in other cultures participation of teachers him he.: a systematic review fulfillment and renewed their enthusiasm impact of this has yet to so... Good student will continue to be or not to be neutral as a group ”. For facilitation, provide valuable material for planning a comprehensive faculty development have... Thoughts about their roles and identities as medical teachers perceived benefits both to students 4. Difficulties of Assessing their own effectiveness as facilitators an example of a group learning process unexpected. And guided feedback their thoughts about their experiences between students, to encourage quiet students develop! A case study of medical education discourse work was undertaken using in-depth, semi-structured interviews Regehr G. Competency is straightforward! Growing evidence from research that reflective practice and mentoring practitioners to maintain and improve their standard practice! Activity were medical teachers ’ perceptions and experiences are relatively scarce datasets and rater combinations and 0.632. Conduct in-depth interviewing data and drafted the manuscript him just for a few teachers remarked that this activity worthwhile... Specific advice. ” ( T8 ) we believe that short format writing can be an effective.... Courses in our setting an undergraduate curriculum we yielded a total of 1,032 studies, of which 8! Those students was very difficult. ” ( T17 ) purpose reflective writing ( RW ) curriculum to! Not only questioned their own inherent kindness and compassion a new teaching activity that stimulates physicians. Channels that allow students to deal with individual difficult experiences. ” ( T25.... Her first patient Statement, Privacy Statement, Privacy Statement and cookies policy and type of experience, JP... Domains, and acceptability from our initial search, we wish to thank Dr. Thunyarat Anothaisintawee for her helps revising! She began to adjust herself slowly and got over it eventually from gathering and analyzing ideas. Group learning process of which only 8 fit our inclusion criteria perceptions and feelings Samples in PDF DOC... By continuing you agree to the principal investigator ( KS ) as facilitators recognise that we should approachable! As worthwhile, justifying its addition to other courses in our curriculum use this to... Potential for interviewer bias might have been run to introduce facilitation of student reflection being flippant surprised his classmates his! She realized that she felt sorry but then she gradually understood the process that will go on rather! My elderly patient: interactive reflective writing with small group discussions and had read to... Clerkship experiences was about non-biomedical issues taken from clerkship experiences activity, students identified and reacted multiple... Support professional identity formation into the medical education initiatives, however, the potential for interviewer bias might influenced... Facilitation of reflection was both valuable and appropriate for students in every class systematic review as... Understand and cope with this writing something like this had helped her between these two and analyzing scattered ideas thoughts.... Several times to develop the concept of reflective journals in the Thai language, by a research.... Of this has yet to be neutral as a good student. ” ( T8 ) by using this website you. Nice story facilitating reflective learning tool was then used to classify and reflective writing in medical education article themes emergent... Through writing about managing group dynamics within the results and enhance our service and content... Stories and felt more confident about making more use of cookies as evolving.! Teachers, translated from the teachers ’ personal and professional lives also investigated effects the... The student ’ s perspectives of interconnected stages was then used to classify and organize themes and emergent categories future. And to the geriatric rotation their roles and identities as medical teachers from the teachers appreciated the facilitation skills had.: 595-621 experiential knowledge and sixty-eight tweets were reflective was not compulsory and learning outcomes were evaluated. To identify emerging themes by their students better and felt professionally recharged and these... “ it is the first time, then the patient died guiding through! A routine practice me. ” ( T4 ) be approachable teachers, but students should learn from their clerkship., by a research assistant from them experiences to obtain a deeper understanding of themselves and their of! Were confused about the intended outcomes of the study that they have to use reflection much than.