T. Naidu is lecturer, Department of Behavioral Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, and head of clinical psychology, King Dinuzulu Hospital Complex, Durban, South Africa. A.K. Kumagai is professor of internal medicine and medical education and director, Family-Centered Experience Program and Longitudinal Case Studies Program, University of Michigan Medical School, Ann Arbor, Michigan.
Acad Med. 2016 Mar;91(3):317-21. doi: 10.1097/ACM.0000000000001019.
The idea of exporting the concept of reflective practice for a global medical education audience is growing. However, the uncritical export and adoption of Western concepts of reflection may be inappropriate in non-Western societies. The emphasis in Western medical education on the use of reflection for a specific end--that is, the improvement of individual clinical practice--tends to ignore the range of reflective practice, concentrating on reflection alone while overlooking critical reflection and reflexivity. This Perspective places the concept of reflective practice under a critical lens to explore a broader view for its application in medical education outside the West. The authors suggest that ideas about reflection in medicine and medical education may not be as easily transferable from Western to non-Western contexts as concepts from biomedical science are. The authors pose the question, When "exporting" Western medical education strategies and principles, how often do Western-trained educators authentically open up to the possibility that there are alternative ways of seeing and knowing that may be valuable in educating Western physicians? One answer lies in the assertion that educators should aspire to turn exportation of educational theory into a truly bidirectional, collaborative exchange in which culturally conscious views of reflective practice contribute to humanistic, equitable patient care. This discussion engages in troubling the already-muddy waters of reflective practice by exploring the global applicability of reflective practice as it is currently applied in medical education. The globalization of medical education demands critical reflection on reflection itself.
将反思实践的概念出口到全球医学教育受众的想法正在增加。然而，在非西方社会，不加批判地出口和采用西方的反思观念可能并不合适。西方医学教育中强调反思是为了达到一个特定的目的，即改善个体的临床实践，这往往忽视了反思实践的范围，只关注反思本身，而忽略了批判性反思和反思性。本观点从批判的角度探讨了反思实践在西方以外的医学教育中的更广泛应用。作者认为，医学和医学教育中的反思观念可能不像生物医学科学的概念那样容易从西方转移到非西方背景。作者提出了这样一个问题：在“出口”西方医学教育策略和原则时，西方培养的教育者有多少次真正接受了这样一种可能性，即可能存在其他有价值的看待和了解问题的方式，这些方式可能对培养西方医生有益？一个答案在于这样一种主张，即教育者应该努力将教育理论的出口转变为一种真正的双向、协作交流，在这种交流中，对反思实践的文化意识观点有助于人文、公平的患者护理。本讨论通过探讨当前在医学教育中应用的反思实践的全球适用性，困扰了已经混乱的反思实践。医学教育的全球化要求对反思本身进行批判性反思。
