Ganesh Alka, Ganesh Gayatri
Department of Family Medicine, Christian Medical College, Community Health and Training Centre, Bagayam, Vellore 632002, Tamil Nadu.
Natl Med J India. 2010 Jul-Aug;23(4):226-30.
Reflective writinghas been used in undergraduate medical curricula to inculcate empathetic attitudes in medical students. Journal writing has been used to enhance reflection in a confidential space. We aimed to introduce our medical students to reflective writing of their daily experiences, both to enhance empathetic attitudes as well as to use the entries to Inform curricular changes.
We invited 16 final year medical students posted in the Department of Medicine to record their emotional experiences during a 6-week posting. Freedom to abstain without prejudice was emphasized, yet all 16 students complied.
According to the principle of grounded theory, the entries were grouped into 8 themes: (i) doctor-patient relationship; (ii) personal inadequacy; (iii) empathy; (iv) communication skills; (v) doctor's competence; (vi) patient behaviour; (vii) hospital practices; and (viii) personal feelings. There were 179 entries which were evaluable under the above categories, with no significant gender differences. Based on the entries, the following curricular suggestions were made: (i) use of diaries by medical students to express their emotional reactions and make value judgements, followed by guided discussion by experienced facilitators; (ii) introduction of communication skills courses at appropriate points to enhance Interview skills, empathetic listening, conflict resolution and breaking bad news; (iii) encourage reflection on healthcare delivery and its inequities and suggest methods of dealing with individual patients; and (iv) use of positive feedback and encouragement by faculty. Conclusions. Reflective journal writing by medical students in India gives valuable insights into improving communication skills and professionalism. Appropriate curricular changes should be made to meet the challenges posed by the existing healthcare system.
反思性写作已被应用于本科医学课程中，以培养医学生的同理心态度。日志写作被用于在一个私密空间中增强反思。我们旨在引导医学生对日常经历进行反思性写作，既增强同理心态度，又利用这些记录为课程改革提供信息。
我们邀请了16名在医学系实习的最后一年医学生记录他们在为期6周实习期间的情感经历。强调了可自由选择退出且不会受到不利影响，但所有16名学生都照做了。
根据扎根理论原则，这些记录被归纳为8个主题：（i）医患关系；（ii）个人不足；（iii）同理心；（iv）沟通技巧；（v）医生能力；（vi）患者行为；（vii）医院实践；以及（viii）个人感受。在上述类别下有179条记录可进行评估，且无显著性别差异。基于这些记录，提出了以下课程建议：（i）医学生使用日记来表达他们的情感反应并进行价值判断，随后由经验丰富的引导者进行引导讨论；（ii）在适当的时候引入沟通技巧课程，以提高访谈技巧、同理心倾听、冲突解决和告知坏消息的能力；（iii）鼓励对医疗服务及其不平等现象进行反思，并提出处理个体患者的方法；以及（iv）教师使用积极反馈和鼓励。结论。印度医学生的反思性日志写作能为提高沟通技巧和专业素养提供宝贵见解。应进行适当的课程改革，以应对现有医疗体系带来的挑战。
