Reflection In Medical Education Research Articles

Impact of art and reflective practice on medical education in the emergency department.

There is heightened intrigue surrounding the application of arts-based pedagogy in medical education. Art encompasses multiple forms of expression and is used to convey specific meaning and emotion, whereas provoking critical reflection. Our aim was to explore the effectiveness of art and reflective practice in medical education, in the context of the ED. Longitudinal methodological study design. Prior to the first, and after the final clinical practicum, medical students watched a 3-min film: 'The Art of the ED'. Written reflections focused on changing perceptions towards the film during their medical education programme. Data were thematically analysed. Three themes were collected from 25 written reflections and included: 'professional growth' exploring personal and professional development across the medical programme; seeing 'patients are people'; and the purpose, structure and function of an ED exposed in 'the reality of ED'. Results highlight that arts-based pedagogy can facilitate meaningful and critical reflection in medical students, whereas also fostering professionalism. Reflecting on the film broadened their perspective into a realm of new possibilities, challenging them to identify implicit bias around ED, and promote professional identity formation. The combination of art and reflection in medical education enhances reflective learning and can lead to transformative change, including the development of core doctoring values of service, empathy and respect for patient. There are clear benefits to medical education incorporating more arts-based pedagogy that promotes reflective exploration and interpretation of the psychosocial context of health and illness, delivery of more holistic models of care and their role as doctors.

Mind The Gap: A Philosophical Analysis of Reflection’s Many Benefits

Issue : Expectations of reflection run high in medical practice and medical education; it is claimed as a means to many ends. In this article, the authors do not reject the value of reflection for medical education and medical practitioners, but they still ask why reflection can (potentially) yield so many different benefits, and what that implies for the status of reflection in medical education practice. Evidence : Based on a conceptual analysis of debates about reflection in the philosophical tradition, the authors argue that there are two quintessential gaps that play a role in the proliferation of (potential) benefits. First, reflection deals with bridging the gap between theory and practice; second, it deals with bridging the gap between the individual sense and communal sense. These gaps prevent the systematization of reflection, and they are fundamental to human thinking and experience in any situated environment, which led contemporary research on reflection to list a wide variety of benefits. Implications : The authors argue that if reflection resists systematization, it cannot be learned by following rules or protocols, but only practiced. Then, reflection should no longer be taught and researched as an individual skill one learns, nor as a means to some particular, beneficial end. Rather, one should practice reflection, and experience what it means to be part of a community wherein professionals jump the theory–practice gap constantly in a myriad of situations. Based on their analysis, the authors provide three concrete recommendations for reflection in medical education. First, to give precedence to reflective activities that encompass both gaps wherein situated examples can flourish; second, to use reflective guidelines as sources of inspiration; third, to show reserve about assessing reflection.

Reflection in Rural Family Medicine Education.

Reflection in medical education is vital for students’ development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents’ learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents’ desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during “doorknob” times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents’ learning and sustainability of rural medical care.

A Letter to My Future Self: A Student and an Educator's Experiences with Future-Oriented Reflection in Medical Education.

A Letter to My Future Self: A Student and an Educator's Experiences with Future-Oriented Reflection in Medical Education.

Can learning from workplace feedback be enhanced by reflective writing? A realist evaluation in UK undergraduate medical education

ABSTRACT Introduction: Doctors and medical students in the UK are currently required to provide evidence of learning by reflective writing on (among other things) feedback from colleagues. Although the theoretical value of reflecting-on-action is clear, research is still needed to know how to realise the potential of written reflection in medical education. This study arose out of efforts to improve medical student engagement with a reflective writing exercise. We used realist methodology to explain the disinclination of the majority to do written reflection on workplace feedback, and the benefits to the minority. Method: Realist evaluation is a suitable approach to researching complex interventions which have worked for some and not for others. Focus groups were held over a three-year period with year 3 and 4 students. Focus group transcripts were coded for context-mechanism-outcome configurations (the realist approach to analysing data) explaining students’ choice not to write a reflection, to write a ‘tick-box’ reflection or to write for learning. A sub-set of eight students’ reflections were also analysed to ascertain evidence of learning through reflection. Results and discussion: 27 students participated in 4 focus groups. Three summary theories emerged showing the importance of context. Firstly, written reflection is effortful and benefits those who invest in it for intrinsic reasons in situations when they need to think more deeply about a learning event. Secondly, following a reflective feedback discussion writing a reflection may add little because the learning has already taken place. Thirdly, external motivation tends to result in writing a ‘tick-box’ reflection.

Validation of Groningen Reflection Ability Scale Questionnaire and Evaluation of Reflection Ability Level of Health Care Management Students

Background: Reflection has been extensively used in different areas for better thinking about previous experiences and reaching to new behaviors, which leads to an improvement in personal skills and knowledge. Reflection ability is one of the most essential competencies for healthcare professionals and medical students, which is emphasized in several medical courses and references. This ability is improved with practice and repetition. Therefore, reflection in medical education is very important. Thus the aim of the present study was evaluation of reliability and validity of the tool for assessing this skill and determination of reflection ability level of health care management students. Methods: The present descriptive and cross-sectional research, performed in two phases. The study population were 30 students of health care management. In the first phase, after the translation of the questionnaire, the reliability and validity of the questionnaire was determined. In the second phase and for evaluation of reflection ability level in health care management students, the Groningen Reflection Ability Scale questionnaire was completed by students and data analyzed with independent t-test and Pearson correlation statistical tests. Results: The reliability and validity of the questionnaire were confirmed (Cronbach's alpha = 0.73). The reflection ability score of students was 82.13 ± 4.24. After a statistical analysis of data among genders, although the reflection scores of males (83.58 ± 4.37) were higher than females (81.17 ± 3.97), but this difference was not statistically significant (P-value ≥ 0.05). Also, the difference between demographic variables and reflection ability scores was not statistically significant (P-value ≥ 0.05). Conclusion: This study showed that the GRAS questionnaire is a useful tool for assessing the reflection ability and students have medium scores of reflection ability so educational managers should pay serious attention in planning related fields.

Reflection in medical education: intellectual humility, discovery, and know-how.

Reflection has been proclaimed as a means to help physicians deal with medicine's inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including the illusion of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be (a) an imperative for educators seeking to guide learners to manage the complexity and "messiness" of medical practice, and (b) a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship.

The reflective zombie: Problematizing the conceptual framework of reflection in medical education.

Reflection is an ambiguous and profoundly complex human activity. We celebrate the developments in teaching and researching reflection in education, yet have identified flaws in the way reflection has been operationalized: medical education has translated the age-old concept into a teachable and measureable construct. We fear that in this process of operationalization, the philosophical underpinnings of reflection have been discarded. We illustrate this with a thought experiment about a ‘reflective zombie’: students who have been conditioned to follow prescribed thought steps rather than engaging in truly reflective behaviour. In research and assessment of reflection, measuring tools might be unable to distinguish reflective zombies from students who authentically reflect. We argue that the instrumental approach lies at the root of this problem as it limits the rich concept of reflection and illustrate our point by describing problems related to paradigm (we are looking at reflection in the wrong way), methods (we are using the wrong tools), and epistemics (can we even know what we want to know?). We offer three suggestions for implementing reflection into the curriculum and for research into reflection. First, acknowledge the diversity of reflection and let go of the ‘checklist approach’. Second, embrace the personal nature of reflection by stimulating awareness of one’s personal reflection styles as part of the reflective process. Third, shift the focus of research to the practice of reflection. We believe that a strong vision on reflection can lead to a balanced curriculum, setting students up for a lifelong learning as a reflective practitioner.

Reflection for medical undergraduate: learning to take the initiative to look back to go forward

Perhaps reflection can be dated to early days of the appearance of humanity in this universe. This can be seen in the Egyptian and Sudanese Nubian pyramids, which contain a lot of photos and stories of events that have significant and meaningful messages. Different definitions of reflection can be found in the literature. Perhaps all these definitions aim to encourage health professionals to use reflection to make sense of the entire situation of events in their daily practice. Reflection as a subject needs to be taught not only for undergraduate medical students but also for basic scientists and clinical staff. This because reflection was shown to promote deep learning, increase core medical knowledge and enhance the therapeutic relationship with patients. Also, reflection represents a core part of many learning theories like transforming learning theory, motivational models, reflective models, Bloom’s taxonomy, Miller’s pyramid and the adult learning model. Despite all these benefits of reflection, one problem with reflection is the low engagement of medical undergraduates in reflection. This narrative review will discuss the following (I) different definitions of reflection; (II) the importance of reflection in medical education; (III) common problems with implementations of reflection; and (IV) how to encourage undergraduate medical students to engage in reflection.

Scope of reflection in medical education

Scope of reflection in medical education

The Role of Feedback and Reflection in Medical Education

The Role of Feedback and Reflection in Medical Education

Reflection in Medical Education: a Review of Concepts, Models, Principles and Methods of Teaching Reflection in Medical Education

Reflection in Medical Education: a Review of Concepts, Models, Principles and Methods of Teaching Reflection in Medical Education

Mindful EM

Mindful EM

The swamplands of reflection: using conversation analysis to reveal the architecture of group reflection sessions.

Many medical schools include group reflection in their curriculum, and many researchers have considered both the concept and the outcomes of reflection. However, no research has been carried out on how 'reflective talk' is structured in the classroom. This paper describes how tutors and residents organise group reflection sessions insitu by describing an example of group reflection in medical education. Our aim is to provide an evidence base that can be used by medical educators to think about the way reflection should be included in their curriculum. We video-recorded 47 group reflection sessions of the general practice postgraduate training course at Erasmus University Medical School, Rotterdam. We used conversation analysis to unravel their overall structural organisation: the way participants organise and structurea conversation. Through micro-analysis of the moment-to-moment unfolding of group reflection, we distinguished the main building blocks that form the architecture of these sessions. We found that participants consistently oriented towards the following activity types: significant event, reason for sharing, learning issue and learning uptake. There was variation in the order of the activity types, the amount of time spent on each of them, and how they were accomplished. By studying reflection in its messy social context, we found order, commonalities and patterns that were typical of the architecture of group reflection in this setting, even if no formal structure is prescribed. In 'Exchange of Experience', the overall structural organisation consisted of activity types through which a case becomes shared, reflectable, learnable and valuable. There are essential discrepancies between cognitive reflection models and the reality of the classroom. Being conscious of this overall structural organisation can be a tool for tutors of these groups to help them navigate from one activity to another or to diagnose what is not working in the group discussion.

Reflection in Medical Education

This paper offers a medical-education perspective that I will hope complement other disciplinary perspectives in examining the value of reflection for learning in tertiary education. The paper outlines some of the theoretical strands of reflective practice facilitated in a unique course subject for professionalism and patient safety, within the new spiral curriculum at Leeds University School of Medicine. The material presented in this paper outlines some of what is delivered during the medical students’ interactive sessions; this material is continually modified based on feedback from both students and learning facilitators. The paper discusses why both students and clinicians need to reflect, some of the theoretical dimensions and models and examples from the Leeds context of how reflective competence can be progressively developed over the course of an undergraduate program. The focus of the final section suggests directions for reflective practice in the future, where reflexivity takes the form of more collective endeavours requiring some change in culture and perceptions of professional identity. The paper concludes with the proposition that collaborative forms of reflection need to include more involvement of patients, interprofessional communities of practice and the use of learning from other disciplines; all of these require different levels of thinking and different ways of working. This journal article is available in Journal of University Teaching & Learning Practice: http://ro.uow.edu.au/jutlp/vol13/iss2/6 Reflection in Medical Education Ken Hargreaves, University of Leeds, lkmhargreaves@btinternet.com Medical Education’s ultimate aim is to supply society with a knowledgeable, skilled and up-to-date cadre of professionals who put patient care above self interest, and undertake to maintain and develop their expertise over the course of a lifelong career. Swanwick and Buckley (2010, p.xv)

Reflection in Medical Education

This paper offers a medical-education perspective that I will hope complement other disciplinary perspectives in examining the value of reflection for learning in tertiary education. The paper outlines some of the theoretical strands of reflective practice facilitated in a unique course subject for professionalism and patient safety, within the new spiral curriculum at Leeds University School of Medicine. The material presented in this paper outlines some of what is delivered during the medical students’ interactive sessions; this material is continually modified based on feedback from both students and learning facilitators. The paper discusses why both students and clinicians need to reflect, some of the theoretical dimensions and models and examples from the Leeds context of how reflective competence can be progressively developed over the course of an undergraduate program. The focus of the final section suggests directions for reflective practice in the future, where reflexivity takes the form of more collective endeavours requiring some change in culture and perceptions of professional identity. The paper concludes with the proposition that collaborative forms of reflection need to include more involvement of patients, interprofessional communities of practice and the use of learning from other disciplines; all of these require different levels of thinking and different ways of working.

The Hardest Thing about Professional Reflection in Medical Education is Actually Doing It

While requirements for successful completion of graduate and post-graduate training programs in the physical and psychological sciences have increased, there is seldom any structured time for individuals to become self-aware, to emotionally evaluate, and to reflect on their experiences. Lack of reflective learning can contribute to an under-experienced and therefore a less-than-optimal and non-integrated education for physicians; non-reflective practitioners are, so to speak, “under-practiced.”

Physician, know thyself: the role of reflection in bioethics and professionalism education.

Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co-curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three-year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co-curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician's Vocation Program (PVP).

Sea monsters & whirlpools: Navigating between examination and reflection in medical education

The 16th International Ottawa Conference/Canadian Conference on Medical Education (2014) featured a keynote deconstructing the rising discourse of competence-as-reflection in medical education. This paper, an elaborated version of the presentation, is an investigation into the theoretical roots of the diverse forms of reflective practice that are being employed by medical educators. It also raises questions about the degree to which any of these practices is compatible with assessment.

“Safe Harbor” Forum: Professionalism Reflection Sessions for First Year Medical Students in the Gross Anatomy Course

Use of reflection in medical education has been shown to enhance health care practitioner competency and enable a transformation from passive learning of theoretical constructs to a more active acquisition of core competences. Implementation of reflection in medical curriculum is a challenge, and a deficiency of reflective practice has been noted by residency directors. This highlights a need to develop reflective skills within the medical curriculum. In the anatomy course, reflection facilitates deeper learning and gives meaning to a student's dissection experience. During the 7 week gross anatomy course, we implemented four reflection sessions (“Safe Harbor”) aimed at fostering reflective capacity through encouraging student reflection on elements of professionalism including teamwork, ethics, and work‐life balance. Approximately two‐thirds of the class voluntarily participated in sessions lead by near‐peer facilitators. Reflection in professionalism index scores were analyzed at the beginning and end of the course. Preliminary results suggest first year students appreciate the “Safe Harbor” forum to reflect on anatomy course experience, professionalism, and personal challenges. Facilitators report positively on students personally adopting and integrating the reflection framework during Safe Harbor sessions, thereby suggesting an increased capacity to reflect on professionalism.Grant Funding Source: Dept of Anatomy, Mayo Clinic, Rochester, MN