Veen Mario, de la Croix Anne
Erasmus University Medical Center, Rotterdam, the Netherlands.
VU University, Amsterdam, the Netherlands.
Med Educ. 2017 Mar;51(3):324-336. doi: 10.1111/medu.13154. Epub 2017 Jan 18.
Many medical schools include group reflection in their curriculum, and many researchers have considered both the concept and the outcomes of reflection. However, no research has been carried out on how 'reflective talk' is structured in the classroom. This paper describes how tutors and residents organise group reflection sessions in situ by describing an example of group reflection in medical education. Our aim is to provide an evidence base that can be used by medical educators to think about the way reflection should be included in their curriculum.
We video-recorded 47 group reflection sessions of the general practice postgraduate training course at Erasmus University Medical School, Rotterdam. We used conversation analysis to unravel their overall structural organisation: the way participants organise and structure a conversation. Through micro-analysis of the moment-to-moment unfolding of group reflection, we distinguished the main building blocks that form the architecture of these sessions.
We found that participants consistently oriented towards the following activity types: significant event, reason for sharing, learning issue and learning uptake. There was variation in the order of the activity types, the amount of time spent on each of them, and how they were accomplished. By studying reflection in its messy social context, we found order, commonalities and patterns that were typical of the architecture of group reflection in this setting, even if no formal structure is prescribed.
In 'Exchange of Experience', the overall structural organisation consisted of activity types through which a case becomes shared, reflectable, learnable and valuable. There are essential discrepancies between cognitive reflection models and the reality of the classroom. Being conscious of this overall structural organisation can be a tool for tutors of these groups to help them navigate from one activity to another or to diagnose what is not working in the group discussion.
许多医学院校在其课程中纳入了小组反思，许多研究人员也对反思的概念和结果进行了探讨。然而，尚未有研究关注课堂上“反思性对话”是如何构建的。本文通过描述医学教育中小组反思的一个实例，阐述了教师和住院医师如何在实际中组织小组反思会议。我们的目的是提供一个证据基础，供医学教育工作者思考应如何将反思纳入其课程。
我们对鹿特丹伊拉斯姆斯大学医学院全科医学研究生培训课程的47次小组反思会议进行了录像。我们运用会话分析来剖析其整体结构组织：参与者组织和构建对话的方式。通过对小组反思即时展开情况的微观分析，我们辨别出构成这些会议架构的主要组成部分。
我们发现参与者始终围绕以下活动类型展开：重大事件、分享原因、学习问题和学习收获。活动类型的顺序、在每种活动类型上花费的时间以及完成方式存在差异。通过在复杂的社会背景中研究反思，我们发现了这种情境下小组反思架构所特有的秩序、共性和模式，即便没有规定正式的结构。
在“经验交流”中，整体结构组织由各种活动类型构成，通过这些活动，一个案例得以分享、可反思、可学习并具有价值。认知反思模型与课堂实际情况存在本质差异。意识到这种整体结构组织可以成为这些小组教师的一种工具，帮助他们从一项活动过渡到另一项活动，或者诊断小组讨论中存在的问题。
