Schön (1983) developed the concept of the reflective practitioner based on his studies of how professionals actually worked - by analysing, reflecting and learning from their experiences. Raw et al (2005) describe reflection in medical practice as thoughts or feelings about a situation, a critical analysis of that situation, leading to the development of a new perspective.
The medical students used a short online, interactive presentation to familiarise themselves with reflection and reflective writing. Then they participated in online group discussions of a thought-provoking article on Psychiatry. Each student had to write posts at three, increasingly deep levels of reflection. Tutors gave feedback in the forum. Finally, students wrote a reflective essay. Most of the students’ grade was for this essay. They were assessed for knowledge, communication and reflection. The students received a small grade for participating in the online discussion.
To determine the effectiveness of this approach, usage data from the Blackboard virtual learning environment was analysed. Student participation was measured by counting the number of posts. The number of posts was compared with the grade for the reflective essay and the grade for the reflective component of that essay. Some students were surveyed and interviewed on their motivation for engaging with the resources.
There was a close relationship between the number of posts and high grades in both the essay and the reflective component of the essay. Students had both extrinsic and intrinsic motivation for participation.
Use of the online learning resources helped the students to develop their reflective writing skills. The reasons for little or no participation by a minority of students should be further investigated.
To explore the use of wikis in the development of key health professional skills, including critical appraisal of literature, collaborative work, use of educational technology, peer discussion and reflective practice.
Groups of students in Year 3 of their BSc Physiotherapy programme each created and contributed to a Wiki (Blackboard) regarding exercise for a specific pathology (eg. obesity) over a 12 week university semester. In addition, they documented their ’Wiki learning experience’ using an online reflective journal and these data were coded and analysed for common themes.
Students demonstrated good collaborative creativity, producing user- friendly Wikis which demonstrated a strong ability to appraise, summarise and present literature findings.
The online reflective journals mapped the progressive experiences of an undergraduate cohort with social media and reflect the learning experience. Common themes which emerged from the students’ on line journal data are outlined below.
The introduction of the wiki has led to a modular transformation and enabled an assessment re-design. Overall students engaged well with the process and learning objectives were met. Any negative feedback was based on group dynamic and software issues, the latter which may be remedied via the use of alternative Wiki software.
Wikis were found to be a useful tool in the development of key health professional skills, fostering teamwork and acting as an ongoing learning resource.
Emotional intelligence (EI) has been identified as an important trait for healthcare professionals and several studies have explored the EI of students on health professional programmes and graduates at varying stages of their careers. Emotion-related self-perceptions and dispositions such as emotion regulation, relationship skills, and social competence, along with empathy can vary across different cultures. It has also been suggested that EI may also be influenced by social and cultural learning. This study explores cultural aspects of entry-level EI in radiography and radiation therapy students across three countries.
First year radiography and radiation therapy students from three universities in Hong Kong, Ireland and the UK were invited to participate in an anonymous online survey containing the published and validated short form of the trait EI questionnaire (TEIQue-SF) at the beginning of the 2012/2013 academic year. Demographic data including sex and age was also recorded. Data was analysed using independent sample t-tests with post-hoc Bonferroni for multiple testing and analysis of covariance to correct for the effects of age and gender.
Of the 230 students who completed the survey (Hong Kong, n=123; Ireland, n=33; UK, n=74) 51.3% were female (n=118) and 48.7% (n=112) were male. Hong Kong students scored significantly lower in terms of global EI (mean=4.75) than students in Ireland (mean=5.01) and the UK (mean=5.05) (F (2, 210) = 4.97, p=0.008). Statistically significant differences emerged for the factors of well-being (F= (2, 221) = 4.84, p=0.001) and sociability (F (2, 217) = 6.76, p=0.02).
This survey demonstrated differences between students from Hong Kong and both Ireland and the UK in terms of their EI profiles in terms of global EI, well-being and sociability. It has been suggested that Asian university students tend to show greater humility in their self-estimations of overall, verbal and cultural intelligence compared to American and British students.1 The difference in well-being score could perhaps confirm that individualistic cultures, such as Ireland and the UK, would have higher estimations of their well-being than collectivist cultures, such as China and Hong Kong.
The Medical Practitioners Act 2007 has given formal recognition to the need for clinicians to maintain and develop the knowledge and skills relevant to their professional work (1). In their review of medical schools in Ireland (2007), the Medical Council list the encouragement of ‘reflective practice’ processes as one of the key indicators of good practice in assessment (2). To date in Ireland, no studies have examined medical students' and doctors’ views about reflective practice. This study explores compares and contrasts medical students' and postgraduate’s understanding of, and attitudes to reflective practice.
A case study design was undertaken within the broad paradigm of qualitative research. Final year medical students were interviewed about their understanding of and attitudes to reflective practice at the commencement of their final year module in psychiatry. A further series of interviews examining these same issues were held with postgraduate trainees at various stages of their postgraduate training. Exploratory thematic analysis and an interpretive approach were used. A focus group was undertaken to explore emergent themes.
There were clear deficits in in understanding amongst both medical students and doctors with regard to the concept of reflective practice. The relevance of reflective practice for a career in medicine was more evident amongst postgraduate trainees. The concept of ‘reflection’ was more familiar to medical students who in general demonstrated more negative attitudes towards reflective practice.
This study begins to highlight medical students' and doctors views about reflective practice. It suggests a need for greater attention to how reflective practice techniques are taught and assessed in a structured way in medical school. It suggests that their relevance for a career in medicine or psychiatry needs to be highlighted. Medical educators should be encouraged to consider introducing teaching in reflective practice as a method of formative and summative assessment earlier in the psychiatric undergraduate and postgraduate curriculum.
Empathy can be defined as an ability to identify with and understand another's situation, feelings, and motives – the ability to put oneself in someone else’s shoes. Empathy involves health care professionals being able to communicate that understanding to their patients (Hojat et al, 2009). Empathy is important in dealing with children in hospital. “When patients feel they have been heard and understood, their adherence to medical management plans is increased” (Shore, 2009). An empathetic approach from the radiographer can make the examination less stressful for the child, and can result in greater ease for the radiographer in obtaining diagnostic images. Whether empathy is an inherent personality trait or a skill that can be taught is a moot point in published literature. However, Anderson and Konrath (2011) report that while students have varying inherent ability to empathise, that ability can be developed through teaching and individual effort.
We wanted to provoke radiography students to think about how a child perceives the X-ray department, such that they could better empathise with a child’s anxieties. We developed a simple and fun exercise where each student was asked to sit or lie on the floor or an X-ray table, anywhere in an imaging department, and take a photograph of what a small child would see. The students then had to present the photo and a reflective commentary within group pages of our virtual learning environment. The commentary had to identify how the child’s perspective is different to that of an adult, how that may influence a child’s thoughts and feelings about being in X-ray, and how this knowledge can help a radiographer communicate empathy to the child.
An interesting, imaginative and sometimes terrifying variety of images were presented. The commentaries were thoughtful and well considered, highlighting issues of perspective, scale, and unknown environment as being particularly threatening to a paediatric patient. In a post exercise de-briefing, the students agreed that while the work was fun, they learned a lot, both from their own work, and from the images and commentary of their class mates.
Whether it is possible to teach empathy to the extent that students’ feelings will change is debatable, but this exercise has shown that it is possible to make students more aware of a paediatric patient’s perspective. The images and commentaries have resulted in a useful resource for students, lecturers and radiographers, giving us sight of aspects of the X-ray department that we may have become inured to in our day to day practice. Selected images and commentaries will be presented in the proposed poster.
Emotional intelligence (EI) may be defined as the ability to perceive, appraise and express emotion, access and process emotional information, generate feelings, understand emotional knowledge and regulate emotions for emotional and intellectual growth. The significance of self-awareness and self-regulation of one’s emotions is of high priority in many sectors especially in health settings and students who develop EI may be better able to endure the pressures associated with health professional education and in their postgraduate careers. The aim of this study was to explore entry-level EI across health science programmes.
All entry-level health sciences students (n=613) were invited to participate in an anonymous online survey containing the 30-item validated short form of the trait EI questionnaire (TEIQue-SF) at the beginning of the 2012/2013 academic year. This questionnaire yields scores on global trait EI and its four factors (Well-being, Self-control, Emotionality and Sociability). Demographic data including sex, age and ethnicity was also recorded.
An overall response rate of 38.2% of the population was achieved. Physiotherapy students scored highest in terms of global EI (mean=5.57), well-being (6.05), self-control (5.25) and sociability (5.28) while midwifery students scored highest on emotionality (5.69). Statistically significant differences between programmes were identified in terms of global EI (p=0.050), self-control (p=0.027), emotionality (p=0.008) and sociability (p=0.048). Sex differences were found for self-control (p=0.030; Male>Female) and emotionality (p=0.044; Female>Male).
While the root of some of the above differences between programmes requires further consideration, sex was found to be a factor influencing student EI scores in keeping with other studies. Studies have also demonstrated significant declines in EI scores throughout the course of health professional programmes.
It has also been argued that EI can be enhanced and as students / professionals with higher EI are better able to endure the pressures associated with their studies / career it is important to consider EI in the context of entry-level scores and potential curricular interventions with the aim of trying to produce exceptional health professionals who are more employable and better positioned to enhance the patients’ / clients’ experience.
A positive attitude to patients with mental illness is important in all branches of medicine, as it can impact on the quality of care patients receive from doctors . Attitudes of preclinical medical students is an under researched area.
This study aims to (1) assess the attitudes of preclinical and clinical medical students to patients with mental illness, (2) assess the effect of two modules taught using different teaching methods on students’ attitudes to patients with mental illness.
During the same academic year all students (N= 394) completing the year 3 preclinical psychiatry module and the final year psychiatry module anonymously completed an attitudinal questionnaire at the beginning and following completion of the module.
There was no significant difference in attitudes displayed by preclinical and clinical medical students prior to starting their respective modules. An association was found between female gender and more tolerant attitudes (r=0.20, p=0.02). Students who knew someone with experience of mental illness were associated with more tolerant attitudes (r=0.32, p<0.001). Final year students who completed the clinical module demonstrated a positive attitudinal shift (p< 0.001) and the attitudes of third and final year male students improved significantly following the module (p<0.05).
Given the high rates of physical illness in patients with mental health problems specific educational initiatives to address medical student’s attitudes to patients with mental health problems should be an educational priority in medical school.
Empathy is essential for high quality care but is difficult to define and measure. The Jefferson Scale of Empathy (JSE) is a validated instrument “to measure empathetic qualities”. We designed a learning intervention to promote empathy using a “narrative” approach and measured empathy in final year students using the JSE.
To evaluate the effectiveness of a patient centered “Care Seminar” on student empathy using the JSE and a method of contrasting groups.
The seminar was designed by a multidisciplinary educational team as a 3-hour patient centered discussion of experiences of care with student interaction. All students in final year were asked to complete an online version of the JSE ( Student version). Statistical comparison of scores investigated the role of various factors on JSE scores. Other evaluation included detailed follow up feedback . Statistical comparisons were made using the method of Bonferroni (SPPS) for the following variables
92 of 180 final year students completed the questionnaire. 53 had attended a Care Seminar at the time of completion , 39 had not. KMO and Bartlett's Test were fulfilled and Cronbach’s alpha= 0.803. Empathy scores were normally distributed [mean 113 ( max possible score 140) , sd=10], lower than reported scores in other populations. NO statistical difference in JSE scores was found for any variable tested. Score analysis from the subscale “perspective taking” indicated an unexpected FALL in individual question scores for those who had taken a Care Seminar.
The lack of relationship between empathy scores and gender is not in keeping with international reports and has prompted a full validation of the JSE in the UCD medical student population. We thus draw no conclusions about the efficacy of the “Care Seminar” measured by the JSE, noting that feedback via other methods was strongly positive in relation to empathy and care. We did note statistically significant increases in individual questions on the JSE, and unexpected and paradoxical falls (ns) on ‘perspective taking” questions for seminar attenders.
We postulate that either the seminars offered “too much perspective” or that the instrument is inappropriate for measuring “perspective taking” due to specific item wording in this subscale. We acknowledge that the instrument was neither designed or validated for subscale analysis of this sort and conclude that measuring the educational effectiveness of interventions to engender empathy may require a more sophisticated instrument responsive to a deepening understanding of the patient’s perspective.