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Teaching Medicine Through Student Self-reflection
"The college student [had been] driving 90 mph and crashed ... ejecting his passenger through the windshield. He reeked of alcohol and he cursed.... I hated him, really hated him, as I looked at his friend who was two bays down in a coma from which he would never awaken." Being able to inspire self-reflection in up-and-coming doctors, like these powerful examples, is an important skill for clinical teachers. Reflection allows learners to consider the meaning and implications of their experience. Reflective skill helps students and physicians develop personal insight, direct their own learning, and attain success as autonomous practitioners.
For the past two years, we have used a new teaching method--sharing and discussing student reflections anonymously--in one of the Patient-Doctor III tutorial sessions. The tutorial includes nine students and two faculty members. We invite Rev. Susan Moran, a Unitarian Universalist minister, to facilitate the session. With the students' permission, we send Rev. Moran their papers with their names removed. She selects quotes from each one and presents them by theme for group discussion. The resulting conversation helps students become more aware of their personal feelings and those that others share. Students express surprise and relief as they hear classmates echo their own feelings and experiences. What Stirs the Students?As the students' written reflections are shared, themes that frequently arise include experiences of inadequacy, professional isolation, feelings of anger and grief, dimensions of caring, and honoring the physician-patient relationship. Following are some examples of the first."At times we are encouraged by the robust part of the learning curve we have already scaled, and at other times, we are humbled and frustrated by the seemingly endless part of the curve we have yet to conquer." "It's hard to feel that for once in your life, you're the dumbest person in the room. You're the one slowing everyone down, you're the one asking questions everyone knows the answer to...." Here are some of the experiences of professional isolation: "When the last day of the month came--the last day the team was to work together--there were no good-byes, no Great-to-work-with-you's. Each finished up their tasks and went home separately without a word." "There's so much emphasis on the science, the lab values, the imaging, and the surgeries that there's no time to focus on the patients." "The group continued to speak of this man as they had in the years prior without a formal recognition of his passing.... I had a sense of some degree of impropriety in not accurately reflecting on this individual's passing." Being Professional and CaringStudents discuss the challenges of medicine as a healing profession and how to remain caring yet professional. They consider ways to talk about their feelings and find adaptive outlets for their grief. They talk about the power of listening and being heard. Students also reflect on their wonder and honor at becoming doctors."Perhaps the most rewarding aspect of third year is the aspect of healing. Surrounded in a world of constant violence and sometimes massive death, one finds comfort knowing it is still possible to make a difference in someone's life no matter how small it may be." "I had caught a glimpse of some of the very purest, rawest moments of life, and I felt privileged for having had that opportunity." Sharing and discussing reflections provides a way of humanizing students' medical school experiences and feelings. Students have unanimously valued this Patient-Doctor session. "It's so comforting to hear the thoughts of other students and know that what you experience on the wards may be a universal experience. Also, it's helpful to have someone objective pick out common threads in our reflections." "It was ... therapeutic to hear my classmates' reflections.... Thank you for reminding me of the power of reflection!" It is evident that the students feel ownership of the insights that come to light from their own contemplation. Their perceptions help teachers focus more accurately on learning needs, and they help students become more aware of assumptions and biases that may interfere with patient care. Reflection also helps students become more attuned to the feelings that emerge during professional encounters, so they can learn to provide compassionate care while attending to their own well-being. --Elizabeth Rider, HMS clinical instructor in pediatrics at Children's Hospital and Massachusetts General Hospital, Patient-Doctor III tutor, and codirector of the Communication Skills Teaching Program, who thanks the students for sharing their reflections The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University. |
