Evaluation of a compulsory reflective group for medical students
Liza Lack 1 , Jill Yielder 2 , Felicity Goodyear-Smith 1 3
+ Author Affiliations
- Author Affiliations
1 Department of General Practice & Primary Health Care, Faculty of Medical and Health Science, University of Auckland, PB 92019 Auckland 1142, New Zealand
2 Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland 1142, New Zealand
3 Corresponding author. Email: f.goodyear-smith@auckland.ac.nz
Journal of Primary Health Care 11(3) 227-234 https://doi.org/10.1071/HC18030
Published: 23 September 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: The ability to reflect – reflection – taking time to stop, think and evaluate is an important professional skill to develop.
AIM: To evaluate a compulsory reflective group activity to determine whether compulsory participation enabled students to constructively share emotional clinical experiences and develop ethical and professional behaviour.
METHODS: This was a case study with mixed methodology. Participants were Years 5 and 6 medical students at the University of Auckland, New Zealand. Data collection included pre- and post-reflective group questionnaires with Year 5 and 6 students, questionnaires with general practice academic facilitators, and audiotapes of the reflection group discussions.
RESULTS: Students shared emotional experiences that were organised into three themes: (i) witnessing unprofessional behaviour; (ii) meeting difficult clinical scenarios for the first time; and (iii) the hierarchy of medicine. They reported positive learning experiences relevant to their future practice and valued the opportunity to share their experiences safely. Facilitators thought the groups provided unique educational opportunities that students appreciated. Eighty-two percent of participants would like to repeat the activity during their medical school training.
CONCLUSION: Self-reflection is an essential condition for professionalism. Use of reflective groups can help students become ethical and professional doctors.
KEYwords: Balint group; case study; medical students; mixed methods; professionalism; reflective groups
References
[1] Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002; 287 226–35.| Defining and assessing professional competence.Crossref | GoogleScholarGoogle Scholar | 11779266PubMed |
[2] Birden H, Glass N, Wilson I, et al. Defining professionalism in medical education: a systematic review. Med Teach. 2014; 36 47–61.
| Defining professionalism in medical education: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24252073PubMed |
[3] Fernando AT, Consedine NS. Beyond Compassion Fatigue: the transactional model of physician compassion. J Pain Symptom Manage. 2014; 48 289–98.
| Beyond Compassion Fatigue: the transactional model of physician compassion.Crossref | GoogleScholarGoogle Scholar | 24417804PubMed |
[4] Cohen JJ. Viewpoint: linking professionalism to humanism: what it means, why it matters. Acad Med. 2007; 82 1029–32.
| Viewpoint: linking professionalism to humanism: what it means, why it matters.Crossref | GoogleScholarGoogle Scholar | 17971686PubMed |
[5] Rogers CR. The necessary and sufficient conditions of therapeutic personality change. J Consult Psychol. 1957; 21 95–103.
| The necessary and sufficient conditions of therapeutic personality change.Crossref | GoogleScholarGoogle Scholar | 13416422PubMed |
[6] Epstein RM. Mindful practice in action (I): technical competence, evidence-based medicine, and relationship-centered care. Fam Syst Health. 2003; 21 1–9.
| Mindful practice in action (I): technical competence, evidence-based medicine, and relationship-centered care.Crossref | GoogleScholarGoogle Scholar |
[7] Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. 2nd ed. Upper Saddle River, NJ: Pearson Education Ltd.; 2015.
[8] Cavenagh P, Dewberry C, Jones P. Becoming professional: when and how does it start? A comparative study of first‐year medical and law students in the UK. Med Educ. 2000; 34 897–902.
| Becoming professional: when and how does it start? A comparative study of first‐year medical and law students in the UK.Crossref | GoogleScholarGoogle Scholar | 11107013PubMed |
[9] Scott J, Blanshard C, Child S. Workplace bullying of junior doctors: a cross-sectional questionnaire survey. N Z Med J. 2008; 121 10–4.
| 18815599PubMed |
[10] Robinson D. Six minutes for the patient: interactions in general practice consultation. J Soc Pol. 1975; 4 208–09.
| Six minutes for the patient: interactions in general practice consultation.Crossref | GoogleScholarGoogle Scholar |
[11] Balint M. The Doctor, His Patient and the Illness. London: Pitman Medical; 1957.
[12] Benson J, Magraith K. Compassion fatigue and burnout: the role of Balint groups. Aust Fam Physician. 2005; 34 497–8.
| 15931410PubMed |
[13] Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001; 286 3007
| The inner life of physicians and care of the seriously ill.Crossref | GoogleScholarGoogle Scholar | 11743845PubMed |
[14] Parker S, Leggett A. Teaching the clinical encounter in psychiatry: a trial of Balint groups for medical students. Australas Psychiatry. 2012; 20 343–7.
| Teaching the clinical encounter in psychiatry: a trial of Balint groups for medical students.Crossref | GoogleScholarGoogle Scholar | 22767937PubMed |
[15] Leggett A. Transcultural issues in the dynamics of a Balint clinical reflection group for community mental health workers. Transcult Psychiatry. 2012; 49 366–76.
| Transcultural issues in the dynamics of a Balint clinical reflection group for community mental health workers.Crossref | GoogleScholarGoogle Scholar | 22222617PubMed |
[16] Allison CJ, Pullen GP. Student discussion groups on doctor-patient relationships: a critical assessment. Med Educ. 1981; 15 392–7.
| Student discussion groups on doctor-patient relationships: a critical assessment.Crossref | GoogleScholarGoogle Scholar | 7329366PubMed |
[17] Van Der Vleuten CPM. The assessment of professional competence: developments, research and practical implications. Adv Health Sci Educ Theory Pract. 1996; 1 41–67.
| The assessment of professional competence: developments, research and practical implications.Crossref | GoogleScholarGoogle Scholar |
[18] Birden HH, Usherwood T. “They like it if you said you cried”: how medical students perceive the teaching of professionalism. Med J Aust. 2013; 199 406–9.
| “They like it if you said you cried”: how medical students perceive the teaching of professionalism.Crossref | GoogleScholarGoogle Scholar | 24033214PubMed |
[19] Wen CC, Lin MJ, Lin CW, et al. Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship. Med Educ Online. 2015; 20 25965
| Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship.Crossref | GoogleScholarGoogle Scholar | 25661500PubMed |
[20] Pololi L, Clay MC, Lipkin M, et al. Reflections on integrating theories of adult education into a medical school faculty development course. Med Teach. 2001; 23 276–83.
| Reflections on integrating theories of adult education into a medical school faculty development course.Crossref | GoogleScholarGoogle Scholar | 12098399PubMed |
[21] Balint M. The Doctor, His Patient and the Illness. 2nd edn. London: Pitman Medical Publishing Co.; 1964.
[22] Chaffey LJ, de Leeuw EJJ, Finnigan GA. Facilitating students’ reflective practice in a medical course: literature review. Educ Health. 2012; 25 198–203.
| Facilitating students’ reflective practice in a medical course: literature review.Crossref | GoogleScholarGoogle Scholar |
[23] Reiser SJ. The ethics of learning and teaching medicine. Acad Med. 1994; 69 872–6.
| The ethics of learning and teaching medicine.Crossref | GoogleScholarGoogle Scholar | 7945682PubMed |
[24] Passi V, Johnson S, Peile E, et al. Doctor role modelling in medical education: BEME Guide No. 27. Med Teach. 2013; 35 e1422–36.
| Doctor role modelling in medical education: BEME Guide No. 27.Crossref | GoogleScholarGoogle Scholar | 23826717PubMed |
[25] Goldie J. AMEE Education Guide no. 29: evaluating educational programmes. Med Teach. 2006; 28 210–24.
| AMEE Education Guide no. 29: evaluating educational programmes.Crossref | GoogleScholarGoogle Scholar | 16753718PubMed |
[26] Stephenson A, Higgs R, Sugarman J. Teaching professional development in medical schools. Lancet. 2001; 357 867–70.
| Teaching professional development in medical schools.Crossref | GoogleScholarGoogle Scholar | 11265967PubMed |
[27] Chambers S, Brosnan C, Hassell A. Introducing medical students to reflective practice. Educ Prim Care. 2011; 22 100
| Introducing medical students to reflective practice.Crossref | GoogleScholarGoogle Scholar | 21439141PubMed |
[28] Radomski N, Russell J. Integrated Case Learning: Teaching Clinical Reasoning. Adv Health Sci Educ Theory Pract. 2010; 15 251–64.
| Integrated Case Learning: Teaching Clinical Reasoning.Crossref | GoogleScholarGoogle Scholar | 19760511PubMed |
[29] Heidari F, Galvin K. Action learning groups: can they help students develop their knowledge and skills? Nurse Educ Pract. 2003; 3 49–55.
| Action learning groups: can they help students develop their knowledge and skills?Crossref | GoogleScholarGoogle Scholar | 19036317PubMed |
[30] Pololi LP, Frankel RM, Clay M, Jobe AC. One year’s experience with a program to facilitate personal and professional development in medical students using reflection groups. Educ Health (Abingdon). 2001; 14 36
| One year’s experience with a program to facilitate personal and professional development in medical students using reflection groups.Crossref | GoogleScholarGoogle Scholar | 14742043PubMed |
[31] Lachmann H, Ponzer S, Johansson U-B, et al. Capturing students’ learning experiences and academic emotions at an interprofessional training ward. J Interprof Care. 2013; 27 137–45.
| Capturing students’ learning experiences and academic emotions at an interprofessional training ward.Crossref | GoogleScholarGoogle Scholar | 23043548PubMed |
[32] Torppa MA, Makkonen E, Mårtenson C, et al. A qualitative analysis of student Balint groups in medical education: contexts and triggers of case presentations and discussion themes. Patient Educ Couns. 2008; 72 5–11.
| A qualitative analysis of student Balint groups in medical education: contexts and triggers of case presentations and discussion themes.Crossref | GoogleScholarGoogle Scholar | 18295432PubMed |
[33] Salander P, Sandström M. A Balint-inspired reflective forum in oncology for medical residents: main themes during seven years. Patient Educ Couns. 2014; 97 47–51.
| A Balint-inspired reflective forum in oncology for medical residents: main themes during seven years.Crossref | GoogleScholarGoogle Scholar | 25034638PubMed |
[34] Forssell J. Has anyone met a patient? Balint groups with young doctors in their foundation years at a county hospital in Sweden. Psychoanal Psychother. 2007; 21 181–91.
| Has anyone met a patient? Balint groups with young doctors in their foundation years at a county hospital in Sweden.Crossref | GoogleScholarGoogle Scholar |
[35] Hafferty FW. Definitions of professionalism: a search for meaning and identity. Clin Orthop Relat Res. 2006; 193–204.
| 16770288PubMed |
[36] Sullivan W. Can professionalism still be a viable ethic? Good Soc PEGS. 2004; 13 15–20.
| Can professionalism still be a viable ethic?Crossref | GoogleScholarGoogle Scholar |
[37] Swick HM. Toward a normative definition of medical professionalism. Acad Med. 2000; 75 612–6.
| Toward a normative definition of medical professionalism.Crossref | GoogleScholarGoogle Scholar | 10875505PubMed |
