Herrick-Reynolds Kayleigh, Sewanan Lorenzo R, Zheng Daniel J, Wang Priscilla, Encandela John, Shahu Andi, Reisman Anna
Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
Yale University School of Medicine, New Haven, CT.
Clin Teach. 2019 Aug;16(4):339-344. doi: 10.1111/tct.13057.
Training in clinical medicine involves exposure to complex ethical and emotional situations. Reflection aids in the development of personal belief systems and improves self-awareness. Students may be reluctant to participate when reflection is mandatory and may be concerned about retaliation when the facilitator has a role in evaluations. Near-peers are institutional equals with more experience than the participants and may be well suited to facilitate reflection.
A quarterly near-peer-facilitated reflective writing workshop (RWW) was implemented in the mandatory clinical curriculum at a single institution. Qualitative feedback forms were solicited and were analysed through an iterative and inductive consensus process. An end-of-year web-based survey was distributed to test the hypotheses generated from our analysis of the feedback forms.
There were 82 responses (80%) to the web-based survey and 266 (65%) feedback forms were collected. Although few students reported using writing as a coping mechanism, the RWW was viewed favourably, with 62% indicating that they would attend if optional. The structured prompts aided reflection. Students reported a higher likelihood of discussing difficult topics (doubts about medicine as a career, personal shortcomings, harassment and burnout) in sessions led by a near-peer than by a faculty member. The workshop created a safe space to reflect, increased a sense of camaraderie and helped normalise experiences. [The workshop] humanised the clinical experience, gave new perspective and reminded students of their positive personal accomplishments DISCUSSION: The near-peer-facilitated RWW is a novel intervention aimed at developing reflective practice and coping with the challenges of entering clinical medicine. It is highly structured and has been incorporated into the mandatory curriculum. It was well received by students, is generalisable and is easily implementable.
临床医学培训涉及接触复杂的伦理和情感状况。反思有助于个人信念体系的发展并提高自我认知。当反思是强制性的时候，学生可能不愿意参与，并且当促进者在评估中起作用时，他们可能会担心遭到报复。近伴是在机构中与参与者地位平等但经验更丰富的人，可能非常适合促进反思。
在一所机构的必修临床课程中实施了每季度一次的由近伴主持的反思性写作工作坊（RWW）。收集了定性反馈表，并通过迭代和归纳的共识过程进行分析。发放了一项基于网络的年终调查，以检验从我们对反馈表的分析中得出的假设。
基于网络的调查收到了82份回复（80%），收集到266份（65%）反馈表。尽管很少有学生报告将写作作为一种应对机制，但RWW受到了好评，62%的学生表示如果是选修的话他们会参加。结构化的提示有助于反思。学生们报告说，在由近伴主持的课程中比在由教员主持的课程中更有可能讨论困难的话题（对医学职业的怀疑、个人缺点、骚扰和职业倦怠）。这个工作坊创造了一个安全的反思空间，增强了同志情谊，并有助于使经历正常化。[这个工作坊]使临床体验更具人性化，提供了新的视角，并让学生想起他们积极的个人成就。
由近伴主持的RWW是一种旨在培养反思性实践并应对进入临床医学挑战的新型干预措施。它结构高度严谨，并已纳入必修课程。它受到了学生的好评，具有普遍性且易于实施。
