Friday, December 18, 2015

Reflective Writing During a Pediatrics Clerkship

Jamie Sutherell, MD, MEd
Cardinal Glennon Children’s Medical Center

Background: Reflective practice has become commonplace in medical education, with a myriad of published educational programs designed to teach and facilitate the concept of critical reflection as part of the development of introspective, self-aware physicians. Yet what is not well understood is the nature of basal reflection at the beginning of clinical training, including both topical themes upon which students engage in reflection when given an undifferentiated prompt, as well as the depth with which intro-level learners engage in reflection. Understanding the answers to these questions would provide insight upon which future reflection-based educational programs can be constructed. 

Aims: The research presented in this paper seeks to analyze reflection essays written by introductory-level learners (third year medical students) during their pediatrics clerkship in order to better understand the themes these learners choose to reflect on, as well as their depth of reflection. 

Methods: Third year medical students were provided with an undifferentiated critical reflection prompt during their pediatrics clerkship. Submitted essays were evaluated for topical thematic analysis using qualitative methodology, as well as establishing depth of reflection for entry level learners using a previously published modification of Bloom’s taxonomy.

Results: A total of 95 critical reflection essays written by third year medical students during their pediatrics clerkship, representing one academic year (July 2013-June 2014), were included in the analysis. Thematic analysis yielded four common themes: internal career considerations (14.6% of all topics submitted), the doctor-patient relationship (36.8% of all topics submitted), bias (8.2% if all topics submitted), and aspects of patient care (40.4% of all topics submitted). Subthemes were identified within each theme; the subtheme of communication was the largest subtheme identified (within the theme of the doctor-patient relationship). Student topics were further stratified by whether they were internal (inward orientation focused on the self) or external (outward orientation such as to patients or society), and whether students explicitly included emotion in their reflection. These themes were further stratified by gender. There were differences in themes across the academic year, in that students were more likely to reflect on internal career considerations early in the academic year, and bias later in the academic year. 100% of students engaged in critical reflection to a level deeper than simple narrative, while 60% of students engaged in the deepest level of reflection.

Conclusions: This study provides insight into the topics that impact third year medical students during a pediatrics clerkship based students choose to reflect on, with insight into the evolution of topics over the course of the academic year. It is also apparent that when given a minimal prompt, entry level clinical students universally engage in reflection beyond simple narrative, with a significant percentage taking their critical reflection to the deepest level. This provides basal data for entry level learners, and serves as a springboard for further development of critical reflection educational activities.