Pandit Kiran, Chu David L, Russell Roxanne, Wright Melissa, Titone Lauren, Diaz Tomas, Truong Jimmy, Murano Tiffany, Egan Daniel J
Department of Emergency Medicine Albert Einstein College of Medicine Bronx New York USA.
New York-Presbyterian Hospital Center New York New York USA.
AEM Educ Train. 2023 Jul 30;7(4):e10899. doi: 10.1002/aet2.10899. eCollection 2023 Aug.
Narrative analysis and reflection have been found to support professional identity formation (PIF) and resilience among medical students. In the emergency department, students have used reflective practice to process challenging clinical experiences, such as ethical dilemmas or moral distress. An online discussion board, however, has not been described as a curricular component of emergency medicine (EM) rotations. The objective of this educational innovation was to support medical students in an EM clinical rotation via an online discussion board for reflecting on and debriefing clinical experiences with faculty and peers.
Fifty-two medical students enrolled in the pass/fail EM elective between May 13, 2019, and October 30, 2020. Each cohort of six students took part in a cohort-specific discussion using the Canvas learning management system. Students were encouraged to post about any observations, reflections, or emotions after their shifts. Faculty course directors responded to each post using concepts of debriefing, coaching, and trauma-informed teaching.
Over 18 months, 49 of 52 (94%) students participated in the discussion board. Of 346 total posts, half were by students, and the other half were faculty responses. Students posted 3.27 times each, on average. Students rarely raised questions about scientific knowledge content, fact-based aspects of patient care, or specific skills. Rather, they often posted about intensely affective reactions to experiences that left them with complex emotions. Upon review of posts by the course directors, the majority (54%) of students' posts contained a range of affective responses. Students appreciated faculty responses and supported each other in their written responses to peers.
An online discussion board can be used successfully for asynchronous reflective practice to debrief clinical experiences during an EM rotation, if designed incorporating faculty and peer support using trauma-informed teaching principles to bolster well-being and PIF.
叙事分析和反思已被证明有助于医学生形成职业身份认同（PIF）并增强适应能力。在急诊科，学生们通过反思性实践来处理具有挑战性的临床经历，如伦理困境或道德困扰。然而，在线讨论板尚未被描述为急诊医学（EM）轮转课程的一个组成部分。这项教育创新的目的是通过一个在线讨论板，支持医学生在EM临床轮转期间反思并汇报临床经历，与教师和同龄人进行交流。
2019年5月13日至2020年10月30日期间，52名医学生参加了及格/不及格的EM选修课。每组六名学生使用Canvas学习管理系统参加特定小组的讨论。鼓励学生在轮班后发布任何观察结果、反思或感受。教师课程主任运用汇报、指导和创伤知情教学的概念对每一篇帖子进行回复。
在18个月的时间里，52名学生中有49名（94%）参与了讨论板。在总共346篇帖子中，一半是学生发布的，另一半是教师的回复。学生平均每人发布3.27次。学生很少提出关于科学知识内容、基于事实的患者护理方面或特定技能的问题。相反，他们经常发布对那些让他们产生复杂情绪的经历的强烈情感反应。在课程主任查看帖子时，大多数（54%）学生的帖子包含了一系列情感反应。学生们感谢教师的回复，并在对同龄人的书面回复中相互支持。
如果按照创伤知情教学原则设计，纳入教师和同伴支持以促进幸福感和职业身份认同形成，在线讨论板可以成功用于异步反思性实践，以在EM轮转期间汇报临床经历。
