clinical reflective practice lutz icch2011
-
Upload
gabrielelutz -
Category
Education
-
view
387 -
download
2
description
Transcript of clinical reflective practice lutz icch2011
Clinical reflective practice
A group-based, situative approach
to promote personal professional development
A qualitative developmental evaluation
Structure of the presentation
Background
Aim of the study
Setting
Method
Results
Discussion
Future research
Background
Communication skills are mainly taught in an additive
manner in the
• preclinical phase and in general techniques
Even with proper preparation in communication skills,
there is a decline in patient-centeredness, moral
judgement and empathy in medical students*
Especially when entering clinical phase or residency
* Neumann M et al 2011: Empathy decline and its reasons: A systematic review of studies with medical students and residentsKatrien Bombeke et al 2010: Help, I’m losing patient-centredness! Experiences of medical students and their teachers
Aim:
Aim of the intervention:
Is a group-based situated clinical reflective practice
(CRP) helpful in preventing this decline in this
vulnerable phase?
Aim of the developmental qualitative evaluation:
To learn about the students‘ perspectives on
• how they experience their educational
situation
• whether CRP helps
• and if so, how and where it helps.
Setting
Clinical education ward
• German system: 6th year - 3 4months rotations
• Internal medicine, 3-5 students
• In groups, acting interns, individualized increase in
number of patients
Clinical reflective practice
• 1 session every two weeks for 1 ½ hours, 5-6 total
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
Intervention:
Process sequence – Core sessions
Stop and perceive
Brief sharing of observations and selection of situation
Sharing of the situation of the day
Collection of impressions of the group
Naming and framing of most important issues
Individual possible solutions and their possible consequences
Method I
Use of „developmental evaluation“ in the
initial test phase as it allows for
„conceptualizing, designing and testing new
approaches in a long-term, on-going process of
continuous improvement, adaptation and
intentional change”*
*Patton, MQ (2010). Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use . Guilford Press
Method II
In 2011 11 in depth interviews with students using
open-ended questions were conducted
Findings were analysed using thematic content analysis
seeking to categorise explicit and implicit experiences
of participants
The content of the data was coded, compared and
categorized
Possible relationships between emerging themes were
analysed
Method III:
The questions of the evaluation covered the
following areas:
how did students experience their
clinical situation?
which factors were important to them
within the CRP-process?
which short term
and longterm effects were described?
Reality: „Breakers“, „Vortex“
Results: Ward experience
*
Motivation:Intention to helpOpenness
Medical:• Application of general medical knowledge onto individual cases, work management• Help through clinical supervisor• Effort to fit in• Attention outside
Psychosocial:• Overwhelming complexity • „constant nonverbal communication thunderstorm“• Effort to meet expectations• Higher impact• Insecure, left alone• Protection - Withdrawal („crept through it like a mole“)
Results: Process of reflection
Which elements were stated as essential regarding CRP?
„Rock in the midst of breakers“
• Step back, adequate distance
• Sorting of „situational emotional mess“
• Zoom, slow-motion
Change in view-direction
Help for self-help
Developing individual solutions
Suitability for daily use
Group
Support, multiperspectivity, mirroring
Results: Short term effects
… on the student: - „ go upright again“
Stress-reduction („little mental pot“)
positive change in perception of pitfalls,
comprehensability of self and other, experience of
meaning, options to act, capacity to provide
feedback, tolerance for ambiguity and complexity,
openness… on the patient: - „more open again“
… on team-work: - „we laughed again“
improved ability for conflict management, willingness to help, feedback culture
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…“
Results: CRP process
Active experimentation
Problem definitionIndividual PlansTrial action
Distanced empathyPersonal aspectsMultiperspectivity
Emotional Reg:Suppression or
Learning experience
Group-perspective
Delegation
Perception of misfits
Discussion:
Medical students and residents in the present study
describe substantial benefit from this CRP format
short term and
in the long run regarding
• the handling of psychosocial and clinical complex
situations
• professional communication and
• personal development
Future research and limitations
Qualitative findings cannot be generalized
Subjectively reported “effect” needs further scientific
substantiation
Experiential learning as a major factor for professional
development – barely taught in medical education
The experience of successful learning through reflective
practice could have high impact on patient satisfaction
and outcome and professional development.
Questions for discussion
Your reflection?
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: [email protected]
Thank you very much for your attention!
| 03/ 09/ 2008 | The qualitative short surveyPage 21
University Hospital Evaluation setting
Clinical Education Wardfor Integrative Medicine
•group of final (6th) year stud. cover 1 – 5 pts and are primary caregivers for the pts• internal medicine ward• close clinical supervision
Witten/Herdecke
Faculty of Health,
Germany
• only private medical
school in Germany
• very practice-oriented
•Strong emphasis on
“fundamental studies”
Gemeinschaftskrankenhaus
Herdecke,
University’s academic hospital
• specialized in Integrative Medicine
Organizational background