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Final Assignment Lavjay

Page history last edited by Lavjay Butani 8 years, 6 months ago


Title: Longitudinal course to build skills for reflective practice in preclinical medical students


Learner level: 1st and 2nd year medical students


Goals: To build the cognitive base to promote use of reflective practice in preclinical medical students


Objectives: At the end of the curriculum, learners should be able to


1)      Explain in their own words the benefits of reflective practice

2)      Define critical reflection as it applies to an educational context,

3)      Demonstrate skill in perspective taking, and

4)      Demonstrate longitudinal growth in depth of reflective writings


Content, teaching strategies:


Pre-assignment: All 1st year medical students will be asked to write a one page reflection on their emotions, feelings or fears, related to their 1st day in medical school. No further specific structure or additional instructions will be provided to them. They will be asked to bring these to the 1st session


Session 1 (early 1st year)-1 hour

  • ·              5 question multiple choice quiz on knowledge of reflective practice and its benefits in medicine
  • ·              Voluntary sharing of few learner reflections (facilitator to share his/her own to start discussion)
  • ·              Brief didactic on the meaning of reflection in an educational context
  • ·              Large group debriefing and discussion on benefits of reflective writing and sharing/reading with respect to shared vulnerabilities, narrative competence and ultimately to pedagogical outcomes of professional identity development, provider well being and improved patient care (Shapiro J et al- Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education, J Med Humanit 2006, 231)


Home work: Read Shapiro article and pre-assignment for session 2 to read: Garden R -Expanding Clinical Empathy: An Activist Perspective, J Gen Intern Med, 2008: 122


Session 2 (mid 1st year)- 1 hour

  • ·        Facilitator to read aloud poem ‘Maria’ (attached). Each learner will then be given 10 minutes to write a 1 paragraph narrative; half will be asked to describe the scene from Maria’s perspective and half from the physician. Facilitator to go last and share his/her narrative (play the Devil’s advocate)   
  • ·        Large group debriefing and discussion on empathy and importance of perspective taking. Discussion of difference between empathy and sympathy and pros and cons of emotional ‘involvement’ with patients



Session 3 (end of 1st year)- 1 hour

  • ·        Brief didactic on levels of reflection and its benefits in clinical reasoning. Discussion of critical reflection 
  • ·        Small group activity- analyzing sample reflective writings using a worksheet adapted from the REFLECT rubric (Wald et al-Fostering and Evaluating Reflective Capacity in Medical Education: Developing the REFLECT Rubric for Assessing Reflective Writing. Acad Med 2012, 41) Learners in groups of 5-10 will analyze sample reflective writings and critique them
  • ·        Large group debriefing- sharing of activity and final thoughts on reflection and critical reflection.
  • ·        Repeat 5 question multiple choice quiz on knowledge of reflective practice and its benefits in medicine
  • ·        Retrospective pre and post test, learner survey on confidence in skills of reflection and reflective practice.


Year 2 of medical school: Learners to keep an on-line reflective portfolio. Submit 3 reflective writings (1 paragraph each) within the 1st 3 months, 6 months and 9 months of start of 2nd year. Instructions- think about a time when you were most engaged or least engaged in the practice of medicine, or when an event surprised you or caught you off guard. Reflect on this and submit a one page assignment describing this.  Feedback to be given to each learner electronically on their reflection to stretch them.


Learner evaluation:


1)      Change in quiz scores from pre to post curriculum

2)      Learner confidence survey

3)      Reflective portfolio- to be evaluated (formatively) using the REFLECT rubric. Change in each learner’s depth of reflection will be assessed.


Course evaluation:


1)      Learner satisfaction survey at the end of the 1st year and end of 2nd year

2)      Change in depth of reflection of writings from the pre-assignment to the 2nd year reflective writings




Maria by Rafael Campos


This G2, P1 gives us a confusing
history.  It sounds like she's been pregnant
approximately thirty weeks, although
she can't recall her LMP.  No pain,
but bleeding for about two days.  Of course
she hasn't had prenatal care, and God
only knows where the father is.  She works
two jobs that keep her on her feet all day.
She's been in the United States six months,
and doesn't speak a word of English.  Bet
you she's illegal.  Cervical exam
is unremarkable, the os is closed.
I think we need an ultrasound to tell
us more.  Besides a look at the placenta,
we need some confirmation of her dates.
Her uterus can tell us more than she can.

Comments (4)

Mitzi D'Aquila said

at 9:16 pm on Mar 25, 2012

Great idea Lavjay. This implementation of reflective writing into the preclinical medical school curriculum is done in a very creative way. The compentency being covered in this longitudinal course is interpersonal and communication skills, I believe. The goal and learning objectives are clear and concise. The content appears complete with reasonable teaching and learning strategies. The evaluation of learners as well as of the course appears plausible, and could easily be achieved. The question I have is with the online reflective portfolio: do the topics remain the same? The students are submitting three reflections, but will they differ not only by more expereince of reflection but by the idea and content? Just something to consider when evaluating their progression-students may naturally reflect more on a topic compared to another. Great job!

Bev Wood said

at 6:49 am on Mar 27, 2012

A nice overview of reflection as taught to medical students. The case is a stunning one, but may be more accurate than we think.
Goal and objectives well stated.
I agree with Mitzi, what are the details of the reflective portfolio.
Seems like an excellent introduction for the students.

ctanders@uci.edu said

at 4:12 pm on Apr 3, 2012

Really nice job. I hope to "steal" some ideas from you if OK! Cindy

Win May said

at 9:28 pm on Apr 9, 2012

Very good work - thank you.
I like the way you have created increasing levels of the use of reflection in medicine. Will you determine whether you can identify improvements in knowledge and understanding, increased self-awareness and engagement in reflection and improved student-tutor relationships through portfolio use as you follow them longitudinally?

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