Lessons from medical students' perceptions of learning reflective skills: a multi-institutional study.

BACKGROUND: A core competency during undergraduate medical training is the development of reflective learning. The current literature is limited to demonstrating how reflective learning has been implemented or the approaches to its development. There is a lack of insight into students' perceptions of reflection and the factors that support development of reflective practice. Bridging this gap may provide insight into how reflective learning within the curriculum can be better developed to increase engagement from learners. METHODS: Eight focus group interviews with second year students from four UK medical schools were held. Results were thematically analysed. KEY FINDINGS: Students have a high level of understanding of the purpose of reflection in practice but they perceive that there is a tension between public and private reflections. Assessment of the reflective process was perceived to be useful for developing reflective skills but grading of their reflective writing was not considered to be useful. Staff who champion the development of reflective skills and mentor students were perceived to play key roles in aiding the development of reflective skills. Appropriate experiences were seen to be a key part of developing reflective skills. CONCLUSION: These findings highlight potential ways to revise and improve engagement with the reflective learning components of undergraduate courses.

What do medical students understand by research and research skills? Identifying research opportunities within undergraduate projects.

BACKGROUND: Undergraduate research exposure leads to increased recruitment into academic medicine, enhanced employability and improved postgraduate research productivity. Uptake of undergraduate research opportunities is reported to be disappointing, and little is known about how students perceive research. AIM: To investigate opportunities for undergraduate participation in research, recognition of such opportunities, and associated skills development. METHOD: A mixed method approach, incorporating student focus and study groups, and documentary analysis at five UK medical schools. RESULTS: Undergraduates recognised the benefits of acquiring research skills, but identified practical difficulties and disadvantages of participating. Analysis of 905 projects in four main research skill areas - (1) research methods; (2) information gathering; (3) critical analysis and review; (4) data processing - indicated 52% of projects provided opportunities for students to develop one or more skills, only 13% offered development in all areas. In 17%, project descriptions provided insufficient information to determine opportunities. Supplied with information from a representative sample of projects (n = 80), there was little consensus in identifying skills among students or between students and researchers. Consensus improved dramatically following guidance on how to identify skills. CONCLUSIONS: Undergraduates recognise the benefits of research experience but need a realistic understanding of the research process. Opportunities for research skill development may not be obvious. Undergraduates require training to recognise the skills required for research and enhanced transparency in potential project outcomes.

Readiness for self-directed change in professional behaviours: factorial validation of the Self-Reflection and Insight Scale.

CONTEXT: Self-reflection, the practice of inspecting and evaluating one's own thoughts, feelings and behaviour, and insight, the ability to understand one's own thoughts, feelings and behaviour, are central to the self-regulation of behaviours. The Self-Reflection and Insight Scale (SRIS) measures three factors in the self-regulation cycle: need for reflection; engagement in reflection, and insight. METHODS: We used structural equation modelling to undertake a confirmatory factor analysis of the SRIS. We re-specified our model to analyse all of the data to explain relationships between the SRIS, medical student characteristics, and responses to issues of teaching and learning in professionalism. RESULTS: The factorial validity of a modified SRIS showed all items loading significantly on their expected factors, with a good fit to the data. Each subscale had good internal reliability (> 0.8). There was a strong relationship between the need for reflection and engagement in reflection (r = 0.77). Insight was related to need for reflection (0.22) and age (0.21), but not to the process of engaging in reflection (0.06). CONCLUSIONS: Validation of the SRIS provides researchers with a new instrument with which to measure and investigate the processes of self-reflection and insight in the context of students' self-regulation of their professionalism. Insight is related to the motive or need for reflection, but the process of reflection does not lead to insight. Attending to feelings is an important and integral aspect of self-reflection and insight. Effective strategies are needed to develop students' insight as they reflect on their professionalism.

Discovering professionalism through guided reflection.

Doctors need to identify and understand the professional behaviours of both themselves and others. In order for students to think critically about these issues we encouraged them to use the tenets of the General Medical Council's Duties of a Doctor as a framework in which to reflect on the actions of healthcare professionals at work. Although the critical incident technique is a well-known process for encouraging reflection, little is known about its usefulness for assessment purposes in this setting. We aimed to discover the validity, feasibility and educational impact of the critical incident as an assessment method for first year students undertaking guided reflection in the context of their first exposure to multi-professional health and social care experiences. First year medical students submitted two critical incidents they had observed during multi-professional health and social care attachments and an evaluation of their experiences. Students engaged in the reflective cycle on the professional behaviours of others providing evidence of a varied range of situations. With adequate preparation, junior students are able to reflect on social and healthcare experiences using the Duties of a Doctor as a framework. Critical incidents are a valid and feasible method for assessing students' reflections on professionalism, with good educational impact.

Developing an education and assessment framework for the Foundation Programme.

AIM: To develop an education and assessment framework for the second year of the Foundation Programme (F2). METHODS: A total of 23 PRHOs were recruited to the F2 pilot in August 2003. The training posts included a variety of specialties at 2 hospital trusts plus primary care. Trainee expectations and satisfaction were evaluated using questionnaires administered before and at the end of the pilot. At the end of the pilot, 10 trainees participated in a focus group and 19 trainers participated in a semistructured telephone interview. RESULTS: The majority of trainees (78%) felt that their expectations of the F2 pilot were met and all felt that they had improved their generic skills. Attendance at the generic education programme was 95%. The majority of trainees found the assessment framework useful. The percentage of undecided trainees in terms of career aspirations dropped from 48% to 13%. Trainees valued the breadth of experience provide by the year and the support provided by the programme directors and each other. A need for better communication, administrative support and time for assessment was highlighted by the trainers. CONCLUSIONS: Early, focused education on generic skills will benefit both doctors and their patients. More varied career experience will help to ensure that doctors make appropriate and timely career decisions. Pilots are identifying good practice and areas that need improvement.

Developing an outcome-focused core curriculum.

BACKGROUND: Many UK medical schools have modified their curricula to meet the requirements of the General Medical Council and other external agencies. In particular, efforts have been focused on increasing integration and reducing factual overload through the definition of a core curriculum. Various approaches to curriculum change have been adopted in an attempt to meet such demands. PURPOSE: This paper describes a curriculum development process, which commences with a clear vision, adopts an outcome-based approach and identifies clear statements of learning outcomes. The process led to the development of an outcome-focused core curriculum structured around clinical problems, which is available to all students and staff. CONCLUSION: A model of curriculum development has evolved which is relatively simple in concept, and appears to be easy to comprehend by students, teaching staff and visitors from other institutions. It provides a practical framework for managing the difficult problems of integration and factual overload. It should be of general interest and applicability to other schools with health professional programmes looking for a realistic and acceptable way of defining a core curriculum.

Student-selected components in the undergraduate medical curriculum: a multi-institutional consensus on assessable key tasks.

This paper describes further progress by the Northern Universities SSC Consortium in achieving consensus on the contribution of the Student Selected Components (SSCs) to undergraduate medical courses. Following the identification of common purposes and outcomes, the group has matched these to assessable key tasks which students may undertake in order to demonstrate competence on a range of attributes not normally fully assessed in the core curriculum. In some schools, SSCs may be the predominant route through which students gain exposure to research methods and reflective practice. In addition to opportunities to acquire knowledge and skills outside the core curriculum, SSCs can contribute towards enhancement of core skills. SSCs may also contribute to the overall longitudinal assessment of personal and professional development. The potential role of portfolios in maximizing student learning from SSCs is discussed, and future areas for development identified.

Learning for real life: patient-focused interprofessional workshops offer added value.

OBJECTIVES: This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes? DESIGN: Pre-registration house officers (PRHOs), student nurses and pre-registration pharmacists attended a series of 3 workshops intended to develop participants' understanding about each other's professional roles, to enhance teamworking and to develop communication skills. Evaluation covered the process of development of the workshops, the delivery of the workshops and their effects on both facilitators and participants. RESULTS: The course was well received by the participants. The learning reported by the participants reflected 2 project objectives. Participants emphasised communication skills--both with other professionals and patients--and the development of increased awareness of others' roles. These 2 aspects were interlinked. CONCLUSIONS: The project aims and 2 of the learning outcomes were achieved. There was a demonstrable value to learning together, particularly with regard to interprofessional communications. This project was effective and can make a contribution towards answering the question 'What types of IPE, under what circumstances, produce what type of outcomes?'

Student-selected components in the undergraduate medical curriculum: a multi-institutional consensus on purpose.

Student-selected components (SSCs) are an established part of undergraduate medical curricula in the UK. Implementation has been against a background of differing educational approaches to curricular change, together with a lack of clarity about their purpose, relationship with the core curriculum and contribution to overall assessment. This has resulted in a diversity of programmes with perceived differing importance between medical schools. This paper documents the approach used by a consortium of medical schools with diverse curricula to develop consensus on the educational purpose and learning outcomes of SSCs. Agreement on common purposes and outcomes was achieved, and consensus documents are reported. These may be valuable for other medical schools implementing any form of student-selected project work. This work will now be the starting point for further work on producing recommendations for assessment of SSCs, which will be applicable across different medical schools.

Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachers.

OBJECTIVE: To describe the perceptions of medical students and clinical teachers of teaching and learning in the clinical setting. DESIGN: Qualitative study of focus groups with undergraduate medical students and semistructured interviews with hospital consultant clinical teachers. SETTING: The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK. PARTICIPANTS: Fourth year medical students and consultant clinical teachers. MAIN OUTCOME MEASURES: Analysis of narratives to identify students' perceptions of clinical teaching and consultants' views of their delivery of undergraduate clinical teaching. RESULTS: Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be 'teaching' by students. CONCLUSIONS: While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills.

Teaching clinical skills in developing countries: are clinical skills centres the answer?

CONTEXT: There is growing international interest in teaching clinical skills in a variety of contexts, one of which is Clinical Skills Centres. The drivers for change making Skills Centres an important adjunct to ward and ambulatory teaching come both from within and outside medical education. Educationally, self-directed learning is becoming the accepted norm, encouraging students to seek and maximize learning opportunities. There are global changes in health care practice, increased consumerism and increasing student numbers. In some countries, professional recommendations influence what is taught. Increasingly, core skills curricula and outcome objectives are being defined. This explicit definition encourages assessment of the core skills. In turn, all students require equal opportunities to learn how to practise the skills safely and competently. The moves towards interprofessional education make joint learning in a"neutral" setting, like a Clinical Skills Centre, appear particularly attractive. OBJECTIVE: To discuss the potential role of Clinical Skills Centres in skills training in developing countries and to consider alternative options. DISCUSSION: Many developing countries seek to establish Clinical Skills Centres to ensure effective and reliable skills teaching. However, the model may not be appropriate,because fully equipped Clinical Skills Centres are expensive to set up, staff; and run. They are not the only way to achieve high quality clinical teaching. Suggested options are based on the philosophy and teaching methods successfully developed in Clinical Skills Centres that may fulfil the local needs to achieve low cost and high quality clinical teaching which is reflective of the local health needs and cultural expectations.