Article

Between two worlds: a multi-institutional qualitative analysis of students' reflections on joining the medical profession.

University of Massachusetts Medical School, Worcester, MA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 07/2008; 23(7):958-63. DOI: 10.1007/s11606-008-0508-1
Source: PubMed

ABSTRACT Recent changes in healthcare system and training mandates have altered the clinical learning environment. We incorporated reflective writing into Internal Medicine clerkships (IMcs) in multiple institutions so students could consider the impact of clerkship experiences on their personal and professional development. We analyzed student reflections to inform curricula and support learning.
We qualitatively analyzed the reflections of students at 3 US medical schools during IMcs (N = 292) to identify themes, tone, and reflective quality using an iterative approach. Chi-square tests assessed differences between these factors and across institutions.
Students openly described powerful experiences. Major themes focused on 4 categories: personal issues (PI), professional development (PD), relational issues (RI), and medical care (MC). Each major theme was represented at each institution, although with significant variability between institutions in many of the subcategories including student role (PI), development-as-a-physician (PD), professionalism (PD) (p < 0.001). Students used positive tones to describe student role, development-as-a-physician and physician-patient relationship (PD) (p < 0.01-0.001), and negative tones for quality and safety (MC) (p < 0.05). Only 4% of writings coded as professionalism had a positive tone. Students employed a "reporting" voice in writing about clinical problem-solving, healthcare systems, and quality/safety (MC).
Reflection is considered important to professional development. Our analysis suggests that students at 3 institutions reflect on similar experiences. Theme variability across institutions implies curricula should be tailored to local culture. Reflective quality analysis suggests students are better equipped to reflect on certain experiences over others, which may impact learning. Student reflections can function as a mirror for our organizations, offer institutional feedback for support and improvement, and inform curricula for learners and faculty.

0 Bookmarks
 · 
82 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Medical education leaders have called for a curriculum that proactively teaches knowledge, skills, and attitudes required for professional practice and have identified professionalism as a competency domain for medical students. Exposure to palliative care (PC), an often deeply moving clinical experience, is an optimal trigger for rich student reflection, and students' reflective writings can be explored for professional attitudes. Objective: Our aim was to evaluate the merit of using student reflective writing about a PC clinical experience to teach and assess professionalism. Methods: After a PC patient visit, students wrote a brief reflective essay. We explored qualitatively if/how evidence of students' professionalism was reflected in their writing. Five essays were randomly chosen to develop a preliminary thematic structure, which then guided analysis of 30 additional, randomly chosen essays. Analysts coded transcripts independently, then collaboratively, developed thematic categories, and selected illustrative quotes for each theme and subtheme. Results: Essays revealed content reflecting more rich information about students' progress toward achieving two professionalism competencies (demonstrating awareness of one's own perspectives and biases; demonstrating caring, compassion, empathy, and respect) than two others (displaying self-awareness of performance; recognizing and taking actions to correct deficiencies in one's own behavior, knowledge, and skill). Conclusions: Professional attitudes were evident in all essays. The essays had limited use for formal summative assessment of professionalism competencies. However, given the increasing presence of PC clinical experiences at medical schools nationwide, we believe this assessment strategy for professionalism has merit and deserves further investigation.
    Journal of palliative medicine 08/2013; DOI:10.1089/jpm.2012.0462 · 1.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To use reflective writing to evaluate a new required palliative care experience for third year medical students. The authors used a constant comparison method based on grounded theory to conduct a thematic analysis of reflective writings produced by third-year medical students completing a mandatory week-long clinical rotation in palliative care during academic year 2010 at the University of Louisville. Two broad thematic categories were identified: what the students learned and what the students experienced. Student writings revealed learning about palliative care (pain management, family meetings, goals of care, patient-family centered care, timing of palliative care, and delivering bad news); being a doctor (knowledge, communication, presence, empathy, not giving false hope, and person-focused care); the patient (importance of family, the experience of dying, and the uniqueness of each patient); and themselves (need to be non-judgmental, ability to do palliative care, self-limitations, becoming a better physician, and dealing with death). Student reflections centered on encounters with patients and families, internal emotional responses, and self-transformation. Systematic analysis of reflective writing provides educators with valuable data about students' learning experiences. These results may inform the design and modification of the curriculum.
    Journal of palliative medicine 03/2012; 15(5):535-41. DOI:10.1089/jpm.2011.0391 · 1.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The teaching of reflection and the use of reflective writing assignments is commonplace in medical school education. There is a preponderance of research in medical education, which appraises and discusses new ways of teaching reflection. Aims: Students often complain about having to write about their experience with that patient. This work explores some of the reasoning between the variability of student acceptance of reflection in medical education. Methods: The method is based on available literature as well as a personal perspective regarding reflective writing in medical education. Results: Reflection is a skill that requires teaching and practice. It is within the explicit process of teaching reflection in medical education that reflective learners can be developed. Conclusions: Reflection includes the take-home lesson from patient encounters. Its use can help learners become better physicians in terms of medical and humanistic effectiveness and support personal growth.
    Medical Teacher 08/2012; 34(11). DOI:10.3109/0142159X.2012.716552 · 2.05 Impact Factor

Full-text (2 Sources)

Download
25 Downloads
Available from
Jun 2, 2014