Wald Hedy S, Davis Stephen W, Reis Shmuel P, Monroe Alicia D, Borkan Jeffrey M
Department of Family Medicine, Warren Alpert Medical School of Brown University, Biomedical Center, Providence, Rhode Island 02912, USA.
Acad Med. 2009 Jul;84(7):830-7. doi: 10.1097/ACM.0b013e3181a8592f.
The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format. Students generated multiple e-mail field notes in response to structured questions on course topics. Individualized feedback from a physician-behavioral scientist dyad supported the students' reflective process by fostering critical-thinking skills, highlighting appreciation of the affective domain, and providing concrete recommendations. The development and implementation of this innovation are presented, as is an analysis of the written evaluative comments of students taking the Doctoring course. Theoretical and clinical rationales for features of the innovation and supporting evidence of their effectiveness are presented. Qualitative analyses of students' evaluations yielded four themes of beneficial contributions to their learning experience: promoting deeper and more purposeful reflection, the value of (interdisciplinary) feedback, the enhancement of group process, and personal and professional development. Evaluation of the innovation was the fifth theme; some limitations are described, and suggestions for improvement are provided. Issues of the quality of the educational paradigm, generalizability, and sustainability are addressed.
在临床技能和职业素养教学中提升反思能力被认为有助于培养合格的医疗从业者。一种创新方法将医学生的结构化反思写作与教师针对这些学生的个性化反馈相结合,以加强反思实践的教学。布朗大学沃伦·阿尔珀特医学院为临床前学生开设的一门名为“行医之道”的课程,将反思写作作业(实地记录)与临床技能和职业素养教学以及以小组形式进行的早期临床接触相结合。学生们针对课程主题的结构化问题撰写了多封电子邮件实地记录。由医生 - 行为科学家组成的二人组提供的个性化反馈,通过培养批判性思维技能、强调对情感领域的认识以及提供具体建议,支持了学生的反思过程。本文介绍了这一创新的开发与实施情况,以及对参加“行医之道”课程的学生书面评价意见的分析。还阐述了该创新特点的理论和临床依据以及其有效性的支持证据。对学生评价的定性分析得出了对他们学习体验有有益贡献的四个主题:促进更深入、更有目的的反思、(跨学科)反馈的价值、小组过程的强化以及个人和职业发展。对该创新的评价是第五个主题;文中描述了一些局限性,并提供了改进建议。文中还探讨了教育范式的质量、可推广性和可持续性等问题。