Reflective Practice Enriches Clerkship Students' Cross-Cultural Experiences

UCI - Department of Family Medicine, University of California, Irvine, School of Medicine, Orange, CA 92868, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 05/2010; 25 Suppl 2(S2):S119-25. DOI: 10.1007/s11606-009-1205-4
Source: PubMed


To describe a curriculum incorporating written reflection followed by reflective discussion with the goal of enhancing students' recognition and handling of cross-cultural and health disparity issues in different healthcare delivery settings. PROGRAM AND SETTING: This required curriculum was implemented within a 4-week family medicine clerkship (n = 188 students, 6 to 12 per rotation) in 23 successive rotations over 2 years. Electronic submission of a written assignment in response to structured questions was followed by in-class discussion in week 4.
Outcomes were students' session evaluations, thematic analysis of student responses, and analysis of faculty facilitators' reflections about discussion sessions. Students' cultural knowledge about their patients' health beliefs around diabetes was assessed using multiple choice questions at the beginning and end of the clerkship.
One hundred percent of students submitted narratives. Student evaluations demonstrated high acceptance, appreciation of sessions and faculty. Analyses of written assignments and in-class discussions identified recurring themes. Students achieved greater synthesis and more nuanced understanding of cross-cultural encounters after discussion. Self-rating of confidence in addressing cultural issues after the curriculum was high at 3.17 +/- SD 0.57 (1-4). Cultural knowledge scores improved significantly. Core components for success were clerkship director support, required participation, experienced faculty facilitators without evaluative roles, a structured assignment and formal forum for trigger question discussion.
Written reflection followed by facilitated peer discussion adds value to simple 'exposure' to cross-cultural clinical experiences for medical students.

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Available from: Désirée Lie
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    • "Reflection is used as a means of promoting the professional development of both student and practice nurses (Paget, 2001). Reflection assists student nurses to: develop skills in dealing with personal emotions that occur during clinical practice (O'sullivan et al., 2012), better understand and increase their ability to solve problems in the clinical setting (Lie et al., 2010), and develop critical thinking analysis skills (Asselin, 2011). Reflective practice also provides a framework for designing graduate nursing curricula (Horton-Deutsch et al., 2011). "
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    ABSTRACT: This paper addresses the importance of considering cultural characteristics prior to implementing reflective practice into nursing courses. Reflective practice implementation in Eastern countries raises challenges related to differences in the cultural characteristics between Eastern and Western countries. This paper will use Hofstede’s framework to explore and identify the influence of culture on reflective practice in Western and Eastern nursing education and the implications this has for the future implementation of reflective practice in Eastern nursing education.
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    • "It is a powerful method for students to express their emotions based on good and bad experiences during practice [2,3]. Furthermore, students are prompted to share their learning moments through writing, discovering themselves deeply by looking through their own written reflections [4]. In writing reflective diaries, the students pick up self-reflective assessment skills during their clinical posting to develop their critical thinking by identifying their own limitations, reflecting upon learning incidents, and thereby creating changes among themselves [5]. "
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    • "A further valuable tool to stimulate reflective processes, which has not been mentioned yet, is reflective writing (cf. Lie et al. 2009). In my experience, reflective writing proved very useful e.g. for seeing ''the 'different other' beyond stereotypes'' and improving ''cultural awareness'', as Llerena-Quinn (2013) pointed out. "

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