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.
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References
1.
GaiserRR. The teaching of professionalism during residency: Why it is failing and a suggestion to improve its success. Anesth Analg, 2009; 108:953.
2.
Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Washington, DC: Association of American Medical Colleges, 2008; 20.
3.
CohnF, LieD. Mediating the gap between the white coat ceremony and the ethics and professionalism curriculum. Acad Med, 2002; 77:1168.
4.
RhodesR. Enriching the white coat ceremony with a module on professional responsibilities. Acad Med, 2001; 76:504–505.
5.
KennyNP, MannKV, MacLeodH. Role modelling in physicians' professional formation: Reconsidering an essential but untapped educational strategy. Acad Med, 2003; 78:1203–1210.
6.
StevensonA, HiggsR, SugarmanJ. Teaching professional development in medical schools. Lancet, 2001; 357:867–870.
7.
ReissM. The importance of affect in science education. AlsopS. Beyond Cartesian Dualism, Science and Technology Education, 29,Part 1Dordrecht: Springer, 2005; 17–25.
8.
WhiteJ. The use of reflective writing in exploring student experiences in surgery. J Surg Educ, 2008; 65:518–520.
9.
AshburyJE, FletcherBM, BirtwhistleRV. Personal journal writing in a communication skills course for first-year students. Med Educ, 1993; 27:196–204.
10.
CohnFG, ShapiroJ, LieDA, BokerJ, StephensF, LeungLA. Interpreting values conflicts experienced by obstetrics–gynecology clerkship students using reflective writing. Acad Med, 2009; 84:587–596.
11.
PlackMM, DriscollM, MarquezJ, CuppernalL, MaringJ, GreenbergL. Assessing reflective writing on a pediatric clerkship by using a modified Bloom's taxonomy. Ambul Pediatr, 2007; 7:285–291.
12.
ClandininDJ, CaveMT. Creating pedagogical spaces for developing doctor professional identity. Med Educ, 2008; 42:765–770.
13.
CarrS, CarmodyD. Experiential learning in women's health: Medical student reflections. Med Educ, 2006; 40:768–774.
14.
AronsonL, NiehausB, LindowJ, RobertsonPA, O'SullivanPS. Development and pilot testing of a reflective learning guide for medical education. Med Teach, 2011; 33:e515–e521.
15.
WaldHS, ReisSP, MonroeAD, BorkanJM. 'The Loss of My Elderly Patient:' Interactive reflective writing to support medical students' rites of passage. Med Teach, 2010; 32:e178–e184.
16.
WearD, ZarconiJ, GardenR, JonesT. Reflection in/and writing: Pedagogy, practice in medical education. Acad Med, 2012May87:603–609.
17.
ChretienKC, ChhedaSG, TorreD, PappKK. Reflective writing in the internal medicine clerkship: A national survey of clerkship directors in internal medicine. Teach Learn Med, 2012; 24:42–48.
18.
HallP, ByszewskiA, SutherlandS, StodelEJ. Developing a sustainable electronic portfolio (ePortfolio) program that fosters reflective practice and incorporates CanMEDS competencies into the undergraduate medical curriculum. Acad Med, 2012; 87:744–751.
19.
LevineRB, KernDE, WrightSM. The impact of prompted narrative writing during internship on reflective practice: A qualitative study. Adv Health Sci Educ, 2008; 13:723–733.
20.
BradyDW, Corbie-SmithG, BranchWT. “What's important to you?”: The use of narratives to promote self-reflection and to understand the experiences of medical residents. Ann Intern Med, 2002; 137:220–223.
21.
LevineRB, HaidetP, KernDEet al.Personal growth during internship: A qualitative analysis of interns' responses to key questions. J Gen Intern Med, 2006; 21:564–569.
22.
FrankelRM. Professionalism. FeldmanM. ChristensenJ. Behavioral Medicine: A Guide for Clinical Practice, 3rd. New York: McGraw Hill, 2008; 424–430.
23.
WaldHS, ReisSP. Beyond the margins: Reflective writing and development of reflective capacity in medical education. J Gen Intern Med, 2010; 25:746–749.
24.
WaldHS, DavisSW, ReisSP, MonroeAD, BorkanJM. Reflecting on reflections: Enhancement of medical education curriculum with structured field notes and guided feedback. Acad Med, 2009; 84:830–837.
25.
AronsonL, NiehausB, DeVriesC, SiegelJ, O'SullivanP. Do writing and storytelling skill influence assessment of reflective ability in Medical students' written reflections?Acad Med, 2010; 85:S29–S32.
26.
FischerMA, HarrellHE, HaleyHL, CifuAS, AlperE, JohnsonKM, HatemD. Between two worlds: A multi-institutional qualitative analysis of students' reflections on joining the medical profession. J Gen Intern Med, 2008; 23:958–963.
27.
GaneshA, GaneshG. Reflective writing by final year medical students: Lessons for curricular change. Natl Med J India, 2010; 23:226–230.
DasGuptaS, CharonR. Personal illness narratives: Using reflective writing to teach empathy. Acad Med, 2004; 79:351–356.
30.
GardenR. Expanding clinical empathy: An activist perspective. J Gen Intern Med, 2009; 24:122–125.
31.
CharonR. The patient–physician relationship. Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA, 2001; 286:1897–1902.
32.
DeenSR, MangurianC, CabanissDL. Points of contact: Using first-person narratives to help foster empathy in psychiatric residents. Acad Psychiatry, 2010; 34:438–441.
33.
MorrisonLJ, ScottJO, BlockSD. members of the ABHPM Competencies Workgroup. Developing initial competency-based outcomes for the hospice and palliative medicine subspecialist: Phase 1 of the hospice and palliative medicine competencies project. J Palliat Med, 2007; 10:313–330.
34.
WelchK. Interdisciplinary communication in a literature and medicine course: Personalizing the discourse of medicine. Tech Commun Q, 2000; 9:311–328.
35.
MorrisonLJ, ThompsonBM, GillAC. A required third-year medical student palliative care curriculum impacts knowledge and attitudes. J Palliat Med, 2012; 15:784–789.
SaldanaJ. The Coding Manual for Qualitative Researchers. London: Sage Publications, 2009.
38.
WeissmanDE, QuillTE, BlockSD. Missed opportunities in medical student education. J Palliat Med, 2010; 13:489–490.
39.
RadwanySM, StovskyEJ, FrateDM, DieterK, FriebertS, PalmisanoBet al.A 4-year integrated curriculum in palliative care for medical undergraduates. Am J Hosp Palliat Med, 2011; 28:528–535.
40.
JacobyLH, BeehlerCJ, BalintJA. The impact of a clinical rotation in hospice: Medical students' perspectives. J Palliat Med, 2011; 14:59–64.
41.
HeadBA, EarnshawLA, GreenbergRB, MoreheadRC, PfeiferMP, ShawMA. “I will never forget”: What we learned from medical student reflections on a palliative care experience. J Palliat Med, 2012; 15:1–7.
42.
BorgstromE, CohnS, BarclayS. Medical professionalism: Conflicting values for tomorrow's doctors. J Gen Intern Med, 2010; 25:1330–1336.
43.
FinsJJ, GentilescoBJ, CarverA, ListerP, AcresCA, PayneR, Storey-JohnsonC. Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula. Acad Med, 2003; 78:307–312.
44.
SullivanC, ArnoldL. Assessment, remediation in programs of teaching professionalism. CruessR, CruessS, SteinertY. Teaching Medical Professionalism. New York: Cambridge University Press, 2009.
