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

Learner level: 1^st and 2^nd 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 1^st year medical students will be asked to write a one page reflection on their emotions, feelings or fears, related to their 1^st 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 1^st session

Session 1 (early 1^st 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 1^st 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 1^st 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 1^st 3 months, 6 months and 9 months of start of 2^nd 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 1^st year and end of 2^nd year

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

Addendum

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.