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clinical reflective practice lutz icch2011

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Qualitative evaluation of a group-based situative reflective practice format for medical students entering the clinical field.

Publié dans : Formation, Santé & Médecine
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clinical reflective practice lutz icch2011

  1. 1. Clinical reflective practice A group-based, situative approach to promote personal professional development A qualitative developmental evaluation
  2. 2. Background Aim of the study Setting Method Results Discussion Future research Structure of the presentation
  3. 3. Background <ul><li>Communication skills are mainly taught in an additive manner in the </li></ul><ul><ul><li>preclinical phase and in general techniques </li></ul></ul><ul><li>Even with proper preparation in communication skills, there is a decline in patient-centeredness, moral judgement and empathy in medical students * </li></ul><ul><li>Especially when entering clinical phase or residency </li></ul>* Neumann M et al 2011: Empathy decline and its reasons: A systematic review of studies with medical students and residents Katrien Bombeke et al 2010: Help, I’m losing patient-centredness! Experiences of medical students and their teachers
  4. 4. Aim: <ul><ul><li>Aim of the intervention : </li></ul></ul><ul><ul><ul><li>Is a group-based situated clinical reflective practice (CRP) helpful in preventing this decline in this vulnerable phase? </li></ul></ul></ul><ul><ul><li>Aim of the developmental qualitative evaluation : </li></ul></ul><ul><ul><ul><li>To learn about the students‘ perspectives on </li></ul></ul></ul><ul><ul><ul><ul><li>how they experience their educational </li></ul></ul></ul></ul><ul><ul><ul><ul><li>situation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>whether CRP helps </li></ul></ul></ul></ul><ul><ul><ul><ul><li>and if so, how and where it helps. </li></ul></ul></ul></ul>
  5. 5. <ul><ul><li>Clinical education ward </li></ul></ul><ul><ul><ul><li>German system: 6 th year - 3 4months rotations </li></ul></ul></ul><ul><ul><ul><li>Internal medicine, 3-5 students </li></ul></ul></ul><ul><ul><ul><li>In groups, acting interns, individualized increase in number of patients </li></ul></ul></ul><ul><ul><li>Clinical reflective practice </li></ul></ul><ul><ul><ul><li>1 session every two weeks for 1 ½ hours, 5-6 total </li></ul></ul></ul>Setting
  6. 6. Kolb A, Kolb D (2005). Learning Styles and Learning Spaces: Enhancing Experiential Learning in Higher Education .Academy of Management Learning & Education, 2:193–212 Kolb‘s learning cycle
  7. 7. Intervention: <ul><li>Process sequence – Core sessions </li></ul><ul><li>Stop and perceive </li></ul><ul><li>Brief sharing of observations and selection of </li></ul><ul><li>situation </li></ul><ul><li>Sharing of the situation of the day </li></ul><ul><li>Collection of impressions of the group </li></ul><ul><li>Naming and framing of most important issues </li></ul><ul><li>Individual possible solutions and their possible </li></ul><ul><li>consequences </li></ul>
  8. 8. Method I <ul><li>Use of „developmental evaluation“ in the </li></ul><ul><li>initial test phase as it allows for </li></ul><ul><ul><li>„ conceptualizing, designing and testing new approaches in a long-term, on-going process of continuous improvement, adaptation and intentional change” * </li></ul></ul>* Patton, MQ (2010). Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use . Guilford Press
  9. 9. Method II <ul><ul><li>In 2011 11 in depth interviews with students using open-ended questions were conducted </li></ul></ul><ul><ul><li>Findings were analysed using thematic content analysis seeking to categorise explicit and implicit experiences of participants </li></ul></ul><ul><ul><li>The content of the data was coded, compared and categorized </li></ul></ul><ul><ul><li>Possible relationships between emerging themes were analysed </li></ul></ul>
  10. 10. Method III: <ul><ul><li>The questions of the evaluation covered the following areas: </li></ul></ul><ul><ul><ul><li>how did students experience their </li></ul></ul></ul><ul><ul><ul><li>clinical situation? </li></ul></ul></ul><ul><ul><ul><li>which factors were important to them </li></ul></ul></ul><ul><ul><ul><li>within the CRP-process? </li></ul></ul></ul><ul><ul><ul><li>which short term </li></ul></ul></ul><ul><ul><ul><li>and longterm effects were described? </li></ul></ul></ul>
  11. 11. Reality: „Breakers“, „Vortex“ Results: Ward experience * Motivation: Intention to help Openness <ul><li>Medical: </li></ul><ul><li>Application of </li></ul><ul><li>general medical </li></ul><ul><li>knowledge onto </li></ul><ul><li>individual cases, </li></ul><ul><li>work management </li></ul><ul><li>Help through </li></ul><ul><li>clinical supervisor </li></ul><ul><li>Effort to fit in </li></ul><ul><li>Attention outside </li></ul><ul><li>Psychosocial: </li></ul><ul><li>Overwhelming complexity </li></ul><ul><li>„ constant nonverbal </li></ul><ul><li>communication thunderstorm“ </li></ul><ul><li>Effort to meet expectations </li></ul><ul><li>Higher impact </li></ul><ul><li>Insecure, left alone </li></ul><ul><li>Protection - Withdrawal („crept </li></ul><ul><li>through it like a mole“) </li></ul>
  12. 12. Results: Process of reflection <ul><li>Which elements were stated as essential regarding CRP? </li></ul><ul><li>„ Rock in the midst of breakers“ </li></ul><ul><ul><li>Step back, adequate distance </li></ul></ul><ul><ul><li>Sorting of „situational emotional mess“ </li></ul></ul><ul><ul><li>Zoom, slow-motion </li></ul></ul><ul><li>Change in view-direction </li></ul><ul><li>Help for self-help </li></ul><ul><li>Developing individual solutions </li></ul><ul><li>Suitability for daily use </li></ul><ul><li>Group </li></ul><ul><ul><li>Support, multiperspectivity, mirroring </li></ul></ul>
  13. 13. Results: Short term effects <ul><li>… on the student: - „ go upright again“ </li></ul><ul><ul><li>Stress-reduction („little mental pot“) </li></ul></ul><ul><ul><li>positive change in perception of pitfalls, </li></ul></ul><ul><ul><li>comprehensability of self and other, experience of </li></ul></ul><ul><ul><li>meaning, options to act, capacity to provide </li></ul></ul><ul><ul><li>feedback, tolerance for ambiguity and complexity, </li></ul></ul><ul><ul><li>openness </li></ul></ul><ul><li>… on the patient: - „more open again“ </li></ul><ul><li>… on team-work: - „we laughed again“ </li></ul><ul><ul><li>improved ability for conflict management, </li></ul></ul><ul><ul><li>willingness to help, feedback culture </li></ul></ul>
  14. 14. Results: Long term effects „… to realize that looking quietly back on a situation, in which you felt terribly uneasy and reflecting then on what you could have done to prevent such an uneasy situation, … opens up many more options for the next ten situations“. „… I developped a higher sensibility, an internal warning system, which whenever I have an encounter with a difficult patient starts blinking in my head and tells me to step back from my primary feelings, from quick judgment … and therefore developped a higher inner flexibility and openness towards my patients…“
  15. 15. Results: CRP process Perception of misfits Active experimentation Problem definition Individual Plans Trial action Distanced empathy Personal aspects Multiperspectivity Emotional Reg: Suppression or Learning experience Group-perspective Delegation
  16. 16. Discussion: <ul><li>Medical students and residents in the present study describe substantial benefit from this CRP format </li></ul><ul><ul><li>short term and </li></ul></ul><ul><ul><li>in the long run regarding </li></ul></ul><ul><ul><ul><li>the handling of psychosocial and clinical complex situations </li></ul></ul></ul><ul><ul><ul><li>professional communication and </li></ul></ul></ul><ul><ul><ul><li>personal development </li></ul></ul></ul>
  17. 17. Future research and limitations <ul><li>Qualitative findings cannot be generalized </li></ul><ul><li>Subjectively reported “effect” needs further scientific substantiation </li></ul><ul><li>Experiential learning as a major factor for professional development – barely taught in medical education </li></ul><ul><li>The experience of successful learning through reflective practice could have high impact on patient satisfaction and outcome and professional development. </li></ul>
  18. 18. Questions for discussion <ul><li>Your reflection? </li></ul>
  19. 19. Contact Gabriele Lutz, neurologist and specialist in psychosomatic medicine Witten/Herdecke University, Faculty of Health, School of Medicine, Integrated Curriculum for Anthroposophic Medicine, Germany Email: Gabriele.Lutz@gmx.net Thank you very much for your attention!
  20. 21. Organizational background <ul><li>specialized in Integrative </li></ul><ul><li>Medicine </li></ul>University Hospital Evaluation setting <ul><li>Clinical Education Ward </li></ul><ul><li>for Integrative Medicine </li></ul><ul><li>group of final (6th) year </li></ul><ul><li>stud. cover 1 – 5 pts </li></ul><ul><li>and are primary </li></ul><ul><li>caregivers for the pts </li></ul><ul><li>internal medicine ward </li></ul><ul><li>close clinical supervision </li></ul><ul><li>Witten/Herdecke </li></ul><ul><li>Faculty of Health, </li></ul><ul><li>Germany </li></ul><ul><li>only private medical </li></ul><ul><li>school in Germany </li></ul><ul><li>very practice-oriented </li></ul><ul><li>Strong emphasis on </li></ul><ul><li>“ fundamental studies” </li></ul>Gemeinschaftskrankenhaus Herdecke, University’s academic hospital