So You Think You're Reflexive? A Modern Approach to Reflexivity in Medical Education.

This article was migrated. The article was marked as recommended. Reflection is now considered a hallmark of good medical practice. The incorporation of reflective student assignments and activities across medical curricula worldwide are a collective nod to the essentiality of reflection in medicine. However, when the link between reflective and clinical practice fails to be established or emphasised, students are sometimes left wondering what purpose their reflection serves. Consequently, superficial engagement, or even outright disengagement can ensue. In this paper, a case is made for reflexivity, reflection's socially oriented cousin, to be introduced as part of formal medical training. The proposed approach utilises the pedagogical value of social media and builds upon the burgeoning social awareness of the latest generation of medical students to incite actionable change. It is suspected that by offering a more timely, challenging, and engaging learning experience, students will begin to understand the necessity of personal introspection, and the duty they have in the delivery of equitable healthcare.

Well-being and uncertainty in health care practice.

BACKGROUND: Well-being and uncertainty are intimately related, although less easily defined from a health care perspective. Uncertainty is intrinsic to both the science and practice of health care, and dealing with uncertainty can bring feelings of stress, avoidance and resistance, all of which are detrimental to an individual's well-being. CONTEXT: Contrary to the majority of the literature, which suggests promoting resilience as a way to improve health care professionals' well-being, our paper argues that a better understanding of the relationship between well-being and uncertainty can support health care professionals in managing the complexity of everyday clinical interactions. INNOVATION: Various strategies and educational exercises around being comfortable in not knowing, preserving uncertainty through effective communication and the use of reflective silence are discussed to support clinical educators in recognising the impact of uncertainty on individual well-being. The relationship between uncertainty and well-being is poorly understood and vaguely defined … IMPLICATIONS: Our paper calls for a broader understanding of the term well-being, recognising the interplay between individual and environmental factors that contribute to maintaining our well-being. The recommended strategies and exercises can be considered in faculty member development sessions and used to promote the incorporation of curriculum initiatives in this area.

Self-management of a musculoskeletal condition for people from harder to reach groups: a qualitative patient interview study.

Background: This study recorded the functional health literacy levels of people with musculoskeletal (MSK) conditions from harder to reach groups and explored their experiences in engaging with health care professionals to self-manage their MSK condition.Methods: We recruited participants, identified by key health and social care contacts as likely to have lower health literacy levels, and used semi-structured interviews to collect data. Thematic analysis was used to identify the main key themes arising from the transcribed interviews.Results: Eighteen participants were identified and recruited from harder to reach community populations, 10 were scored as having inadequate functional health literacy on the Short Form Rapid Estimate of Adult Literacy Measure. Three themes were identified in relation to participants' experiences of MSK self-management approaches: engaging with health care services; interpreting the health care providers' message; and facilitating participation in MSK self-management.Conclusions: Our findings indicate that people with a MSK condition, from harder to reach groups, experience multi-morbidity, find health care systems complicated and hear from health care professionals that their MSK condition cannot be cured. People interpreted that a lack of cure meant that nothing could be done to help their MSK pain. Engaging with self-management strategies was not seen as a priority for our participants. Strategies to simplify health communication, more time to process health information and supportive social networks helped our participants to understand and manage their MSK health on a day-to-day basis. Implications for RehabilitationMSK conditions are long term and prevalent in the UK with substantial impact on people's daily life.Currently self-management strategies for MSK conditions are poorly communicated and many patients believe that nothing can be done to help their MSK pain.Good clinician communication that supports self-management is needed so that key messages can be effectively understood and used by patients with a range of literacy skills.Health services need to be even more accessible to help all individuals from a range of backgrounds better self-manage their MSK conditions.

Effectiveness of musculoskeletal education interventions in people with low literacy levels: a systematic review.

OBJECTIVE: To conduct a systematic review to assess the effectiveness of patient education interventions delivered or directed by health professionals for people with musculoskeletal conditions who also have lower levels of literacy. METHODS: Electronic databases were searched from 1946 to May 2012. Randomized controlled trials with primary interventions designed specifically for individuals with musculoskeletal conditions and lower levels of literacy were eligible for inclusion. The quality of the study was determined by assessing method of randomization, allocation concealment, creation and maintenance of comparable groups, blinding of patients and providers, control of confounding, and the validity and reliability of outcome measures. RESULTS: Of the 2,440 studies located using the search strategy, 6 studies met the inclusion criteria. Three public health community studies and 3 rheumatology clinic-based studies delivered educational programs to people with musculoskeletal conditions who also had lower levels of literacy. Three moderate quality studies suggest that musculoskeletal educational interventions had a small short-term effect on knowledge and 2 moderate quality studies suggest musculoskeletal interventions had a small effect on self-efficacy (although results on self-efficacy were conflicting in 1 of these studies). Only 1 moderate quality study showed a small effect on anxiety and 1 on self-perceived health and well-being in people with lower literacy. CONCLUSION: High quality evidence is lacking on the effectiveness of musculoskeletal education interventions for people with lower literacy levels. Research programs that test the effectiveness of patient education interventions for arthritis must recruit and engage people with lower levels of literacy.

Crohn disease: effect on children's lifestyles.

BACKGROUND AND AIM: Crohn disease (CD) presents a range of physical, social, and psychological challenges, and can adversely affect the quality of life of those affected by it. The present study aimed to investigate the health-related quality of life of paediatric patients with CD in the Wellington region. Measuring health-related quality of life assists with resource allocation decisions and assesses various forms of interventions. METHODS: Patients ages 9 to 18 years with CD in the Wellington region were assessed using the IMPACT-III inflammatory bowel disease-specific questionnaire (n = 16). Eight participants filled it out and returned it by post; the remaining 8 filled it out in a meeting with the researcher and then underwent cognitive debriefing as part of a cross-cultural adaptation of the questionnaire. RESULTS: Of a maximum possible value of 175, the total health-related quality of life score had a mean value of 119.2 (standard deviation 30.7). Using Spearman rank correlation analysis, significant findings included a positive correlation between disease duration and quality of life (ρ = 0.534, sig. <0.05) and a negative correlation between disease activity and quality of life (ρ = -0.596, sig. <0.05). Qualitative information included difficulties in coping with long-term and unpleasant treatments and feelings of isolation. CONCLUSIONS: Children with Crohn disease in the Wellington region may benefit from age-specific social and psychological support. Because there is limited information on quality of life in young patients with CD in New Zealand, the results of the present study may be used as baseline data for future studies.