An analysis of reflective writing early in the medical curriculum: The relationship between reflective capacity and academic achievement.

OBJECTIVE: To examine the relationship between reflection, gender, residency choice, word count, and academic achievement among medical students. METHODS: A modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) was developed and used for this study (Cronbach's alpha of 0.86 with an intraclass correlation coefficient [ICC] of 0.68). This was applied to writing samples about professionalism in gross anatomy from first-year medical students between 2005 and 2011. Four analysts reviewed and scored written reflections independently. Composite reflection scores were compared with gender, residency choice, length of written reflection, NBME® Gross Anatomy and Embryology Subject Examination scores, and final gross anatomy course. RESULTS: Total of 319 written reflections were evaluated. Female students who pursued medicine specialties had the highest composite reflection scores (87 [27.2%]). Word count frequently correlated with reflection score (p < 0.0001). Students who performed well on the NBME® Gross Anatomy and Embryology Subject Examination tended to achieve high anatomy course grades (p < 0.0001). There was no statistically significant relationship between composite reflection scores and NBME® Gross Anatomy and Embryology Subject Examination scores (p = 0.16) or anatomy course grades (p = 0.90). CONCLUSIONS: This study suggests there are likely no correlations between reflective capacity and academic performance on tests of medical knowledge administered early in the medical curriculum.

Prevalence and Contents of Advance Directives in Patients Receiving Home Parenteral Nutrition.

BACKGROUND: Ethical issues may arise with patients who receive home parenteral nutrition (HPN) and have a change in their overall health status. We sought to determine the extent of advance care planning and the use of advance directives (ADs) by patients receiving HPN. MATERIALS AND METHODS: Retrospective review of the medical records of adult patients newly started on HPN at the Mayo Clinic, Rochester, Minnesota, between January 1, 2003, and December 31, 2012, to determine the prevalence and contents of their ADs. RESULTS: A total of 537 patients met the inclusion criteria. Mean (SD) age at commencement of HPN was 52.8 (15.2) years, and 39% (n = 210) were men. Overall, 159 patients (30%) had ADs. Many mentioned specific life-prolonging treatments: cardiopulmonary resuscitation (44 [28%]), mechanical ventilation (43 [27%]), and hemodialysis (19 [12%]). Almost half mentioned pain control (78 [49%]), comfort measures (65 [41%]), and end-of-life management of HPN (76 [48%]). Many also contained general statements about end-of-life care (no "heroic measures"). The proportion specifically addressing end-of-life management of HPN (48%) was much higher than that previously reported in other populations with other life-supporting care such as cardiac devices. The primary diagnosis or the indication for HPN was not correlated with whether or not the patient had an AD (P = .07 and .46, respectively). CONCLUSION: Although almost one-third of the patients had an AD, less than half specifically mentioned HPN in it, which suggests that such patients should be encouraged to execute an AD that specifically addresses end-of-life management of HPN.