a Department of Family Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA.
b Department of Medical Education , Hebrew University/Hadassah , Jerusalem , NY , USA.
Med Teach. 2019 Feb;41(2):152-160. doi: 10.1080/0142159X.2018.1475727. Epub 2018 Jun 26.
Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been understudied.
The authors developed an IRW curriculum within a Family Medicine Clerkship (FMC) and analyzed students? reflections about challenging/difficult patient encounters using immersion-crystallization qualitative analysis.
The qualitative analysis identified 26 unique emergent themes and five distinct thematic categories (1. Role of emotions, 2. Role of cognition, 3. Behaviorally responding to situational context, 4. Patient factors, and 5. External factors) as well as an emergent PIF model from a directed content analysis. The model describes students? backgrounds, emotions and previous experiences in medicine merging with external factors and processed during student?patient interactions. The RWs also revealed that processing often involves polarities (e.g. empathy/lack of empathy or encouragement/disillusionment) as well as dissonance between idealized visions and lived reality.
IRW facilitates and ideally supports grappling with the lived reality of medicine; uncovering a "positive hidden curriculum" within medical education. The authors propose engaging learners in guided critical reflection about complex experiences for meaning-making within a safe learning climate as a valuable way to cultivate reflective, resilient professionals with "prepared" minds and hearts for inevitable challenges of healthcare practice.
以实习为特定对象的互动式反思性写作（IRW）增强式反思可能会促进医学教育的一个基本目标——专业身份形成（PIF）。学生反思写作（RW）中揭示的 PIF 过程还没有得到充分研究。
作者在家庭医学实习（FMC）中开发了一个 IRW 课程，并使用沉浸结晶定性分析方法分析了学生对具有挑战性/困难的患者遭遇的反思。
定性分析确定了 26 个独特的新兴主题和五个不同的主题类别（1.情感角色，2.认知角色，3.对情境上下文的行为反应，4.患者因素，5.外部因素），以及从定向内容分析中得出的新兴 PIF 模型。该模型描述了学生的背景、在医学中的情感和先前经历与外部因素融合，并在学生与患者的互动中进行处理。RW 还表明，处理过程通常涉及两极化（例如，同理心/缺乏同理心或鼓励/幻灭）以及理想化愿景与现实生活之间的不和谐。
IRW 促进并理想地支持了对医学现实生活的应对；在医学教育中揭示了“积极的隐性课程”。作者建议让学习者参与到对复杂经验的引导性批判性反思中，以在安全的学习环境中进行意义建构，这是培养具有“预备”心态和心灵的反思性、有弹性的专业人员的一种有价值的方法，以应对医疗实践中不可避免的挑战。
