MedEdSig

The Utility of Reflective Writing after a Palliative Care Experience: Can

we assess medical students’ professionalism?
Background
• Professionalism as part of medical school curriculum
• Association of American Medical Colleges’ definition: “ability to understand the nature of, and
demonstrate professional and ethical behaviour in, the act of medical care.”
• Baylor College of Medicine (Houston, Texas)
• Longitudinal Ambulatory Care Experience (LACE): 1 year course
• 3-hour palliative care (PC) workshop: didactic basic PC concepts
• Faculty-guided interview with family members of deceased PC patient
• Half-day clinical PC patient experience
• Online pain management module
• Students interviews preselected patient/ relatives (if patients are non-verbal) with intermittent faculty
supervision (standardized PC history/physical form as guidance), presents to faculty for group
discussion and debrief/
• Students complete one-page reflective essay within a week.
• “Students were not explicitly asked about professionalism”
Baylor College of Medicine Competency
GMC’s perspective
Instructions for reflective essay
• Describe your thoughts and feelings about caring for a dying patient
BEFORE your LACE palliative care visit. Describe any changes in your
thoughts and feelings afterwards.
• During the visit, to what degree were you able to have compassion for
the patient and/or family?
• What was the most challenging characteristic of the patient and/ or
family for you? Why was it a challenge?
• What did you learn from this experience that you can use to enhance
your relationship with patients in the future?
Methods
• Qualitative analysis
• Reflective essays written by Year 3 students
• “Randomly sampled” n=30
• Analysts: 2 PC physicians in geriatrics and internal medicine, 1 medical
educator with nursing and public health expertise, 1 research scientist
with background in psychology and qualitative method
Professionalism competencies that were
assessed during qualitative analysis
1. Demonstrate caring, compassion, empathy, and respect.
• Communicates in a polite tone and manner in all exchanges and encounters. Sensitive to the emotional
needs of others.
2. Demonstrate awareness of one’s own perspectives and biases.
• Takes action to identify conscious and nonconscious bias that may impact interactions with patients and
others. Interested and attentive to perspectives and cultural beliefs of others.
3. Display self-awareness of performance and dedication to excellence by continual
improvement of knowledge, skills and attitudes.
• Identifies status of competency achievement. Plans with assistance (as needed) and implements course
of improvement.
4. Recognise and take actions to correct deficiencies in own’s own behaviour, knowledge, and
skill.
• Self assess progress and requests feedback. Acknowledges, reflects upon, and takes action in response
to feedback for improvement.
Qualitative analysis
• Preliminary thematic coding structure: 5 “random” samples (2007-2008)
• Each analyst independently read the essay 4 times (each focusing on one of the
competencies) and recorded the emergent themes
• Analysts meets up, consider analyst differences in coding and finalise a thematic
structure.
• Primary coding : 10 “random” samples (2008-2009)
• Extent of identified themes correspond to the structure
• Any superb exemplars of themes
• Any emergent themes not previously captured
• Repeat step 2 twice when “thematic saturation was achieved”
Results
• 176 coded quotes
• “suggesting students’ progress toward achieving the first three
professionalism competencies”
• Competency 1: 27.8%
• Competency 2: 31.8%
• Competency 3: 23.9%
• Competency 4: 16.4%
• Competencies 1 and 2 are “more rich and detailed” than
competencies 3 and 4.
Discussion
• Sample selection- randomisation process
• Essay instructions (implicit way of instructing professionalism)
• Reflection
• What do we choose to reflect?
• Lesson learnt from reflection (in writing)- does it reflect in action/ change in
future behaviour?
• Does it reflect true behaviour?