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REVIEW ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 2  |  Page : 57-59

Encouraging reflection among medical undergraduate and postgraduate students for advancement of learning and development of skills


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India

Date of Submission21-Jan-2021
Date of Acceptance30-Mar-2021
Date of Web Publication18-Aug-2021

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_7_21

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  Abstract 


The field of medical education is quite complex and there are lots of unsaid expectations of a medical student to eventually transform into a competent medical professional. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 13 articles were selected based on the suitability with the current review objectives. Apart from the various teaching–learning methods adopted by the teachers in the delivery of information, it is a must that in order to accomplish deep learning, we have to encourage medical students to reflect upon all the learning and clinical interactions. As a matter of fact, most of the regulatory and professional bodies have strongly advocated for the inclusion of reflection in different phases of both undergraduation and postgraduation medical education. In conclusion, the strategy of reflection should be looked upon as a method for advancement in knowledge, shaping the learning in the future, and to improve the competence level to deal with complex and emotionally or ethically challenging situations. It is the need of the hour that all the medical institutions should develop a detailed plan to encourage students to reflect upon and improve their learning.

Keywords: Feedback, medical education, reflection


How to cite this article:
Shrivastava SR, Shrivastava PS. Encouraging reflection among medical undergraduate and postgraduate students for advancement of learning and development of skills. J Sci Soc 2021;48:57-9

How to cite this URL:
Shrivastava SR, Shrivastava PS. Encouraging reflection among medical undergraduate and postgraduate students for advancement of learning and development of skills. J Sci Soc [serial online] 2021 [cited 2021 Nov 30];48:57-9. Available from: https://www.jscisociety.com/text.asp?2021/48/2/57/324081




  Introduction Top


The field of medical education is quite complex and there are lots of unsaid expectations of a medical student to eventually transform into a competent medical professional. A student who completes high school and joins a medical college for further studies takes a lot of time to adjust to the needs of the medical profession, which essentially demands a student to amalgamate the domains of knowledge, skills, values, professionalism, communication skills, empathy, etc.[1],[2] Apart from the various teaching–learning methods adopted by the teachers in the delivery of information, it is a must that in order to accomplish deep learning, we have to inculcate the practice of giving feedback to the students on their performance and also encourage medical students to reflect upon all the learning and clinical interactions.[1],[2],[3]


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on reflection among medical students published in the period 2008–2020 were included in the review. A total of 15 studies similar to the current study objectives were identified initially, of which 2 were excluded due to the unavailability of the complete version of the articles. Overall, 13 articles were selected based on the suitability with the current review objectives and analyzed. Keywords used in the search include reflection and medical students. The collected information is presented under the following subheadings, namely reflection and its need, merits for undergraduate and postgraduate medical student, reflection and teachers, lessons from the field, implications for practice, and implications for research.


  Reflection and its Need Top


In simple words, reflection refers to a metacognitive process which takes place before, during and after various scenarios (viz., theory class, practical demonstration, bedside teaching, and clinical examination) with a solitary aim to enhance the overall understanding of both the self and the settings to enable better performance in similar future settings.[4],[5] As a matter of fact, most of the regulatory and professional bodies have strongly advocated for the inclusion of reflection in different phases of both undergraduation and postgraduation medical education.[4],[5] This is predominantly because of the available evidence which has demonstrated that the practice of reflection significantly enhances learning and performance in core competencies.[3]


  Merits for Undergraduate and Postgraduate Medical Student Top


From the students' perspective, reflection enables students to develop in depth thinking about various issues in terms of what went well and what can be improved further in subsequent occasions. At the same time, the practice of reflection encourages self-directed learning, makes the student motivated, ensures lifelong learning, improves the level of satisfaction, and plays an important role in critical thinking and deep learning.[4],[5],[6] Moreover, it also aids the students to integrate the knowledge and experiences across different specialties and thereby develop concrete understanding.

The findings of the studies carried out under different settings have indicated that reflection plays a significant role in acquiring the skills of empathy, improves learning in complex clinical or ethical situations, deepens professional attributes, and even upgrades the approach to deal with a difficult situation by improving the communication skills.[4],[5],[6] During the process of reflection, the students think about how they approached a specific situation, why they took a specific step, critique the good and bad aspects, and thus revisit the entire situation once again with a newer perspective or newer idea.[4],[5],[7]


  Reflection and Teachers Top


It is a must to note that teachers play an important role in encouraging medical undergraduate and postgraduate students to develop the practice of reflection and create an ample number of opportunities for them to reflect upon and finally follow it up with the periodic assessments of the written reflections.[8] Reflection helps the teachers as well and apart from the above areas, it assists them to develop better teaching, communication, feedback, and interpersonal skills.[3],[5]


  Lessons from the Field Top


At Shri Sathya Sai Medical College and Research Institute, a constituent unit of Sri Balaji Vidyapeeth, Puducherry, the importance and scope of reflection has been recognized and steps have been taken to encourage the medical students to reflect upon their learning. The postgraduate students of the institution are expected to maintain e-portfolio, which is being assessed by a panel of experts on a quarterly basis and an exclusive scoring is being awarded for reflecting upon their daily learning. In fact, in the hope to make students reflect better, each of the postgraduate student has been attached to one of the faculty members of the department, who not only supervises the overall portfolio, but even motivates the student to reflect upon their learning.

For the undergraduate students who are being admitted in the academic year 2019–2020 onward, they have been instructed to maintain a logbook, wherein they are expected to record their learning. It has been envisaged that the students should reflect about each of their sessions for better and deep learning. Further, as a part of faculty educational innovation projects, undergraduate students have been enrolled and motivated to reflect about ethical dilemmas and other significant clinical encounters.


  Implications for Practice Top


Acknowledging the importance of reflection in the making of a lifelong and competent healthcare professional, it is a must that institutions should take steps for its encouragement. Encouraging medical students to take an interview at the time of exit (viz., discharge from hospital or after outpatient consultation) can prove to be an enriching and though-provoking exercise for them.[9],[10] Such interviews will not only make students aware about the social and mental problems faced by the patients and relatives, but also gives an in-depth understanding about the quality of healthcare services offered by the hospital, and thus the areas which require improvement for the well-being of patients.[9],[10],[11]

Another option will be to videotape the clinical encounters, and show the same subsequently to the medical students, so that they are aware about the need to be empathetic, offer compassionate care and the need to strengthen communication skills.[12] This strategy can prove to be an effective one for the medical students to reflect upon and become a better and holistic healthcare professional.[12]


  Implications for Research Top


There is an ample scope for exploring the role of reflection in accomplishing the ultimate goal of the regulatory body to produce a competent medical graduate. In fact, the medical students can be encouraged to reflect in action or after action, and based on their responses, the pattern of assessment can be revised.[13] Further, the professional development of medical students as educators can also be assessed through reflection on their teaching after being trained.[14] In these difficult times of coronavirus disease-2019 pandemic, it will be nice to obtain the reflection of medical students on how their learning was affected once educational institutes were closed and their reflection on online teaching–learning.[15] In other words, reflection in the field of medical education can be researched in different settings for the better delivery of curriculum.


  Conclusion Top


The strategy of reflection should be looked upon as a method for advancement in knowledge, shaping the learning in the future, and to improve the competence level to deal with complex and emotionally or ethically challenging situations. It is the need of the hour that all the medical institutions should develop a detailed plan to encourage students to reflect upon and improve their learning.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ramesh A. A call for reflection: Medical student driven effort to foster empathy and compassion. Med Teach 2013;35:69-70.  Back to cited text no. 1
    
2.
Shemtob L. Reflecting on reflection: A medical student's perspective. Acad Med 2016;91:1190-1.  Back to cited text no. 2
    
3.
Shrivastava SR, Shrivastava PS. Scope of reflection in medical education. Int J Acad Med 2018;4:187-8.  Back to cited text no. 3
    
4.
Schei E, Fuks A, Boudreau JD. Reflection in medical education: Intellectual humility, discovery, and know-how. Med Health Care Philos 2019;22:167-78.  Back to cited text no. 4
    
5.
Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach 2009;31:685-95.  Back to cited text no. 5
    
6.
Winkel AF, Yingling S, Jones AA, Nicholson J. Reflection as a learning tool in graduate medical education: A systematic review. J Grad Med Educ 2017;9:430-9.  Back to cited text no. 6
    
7.
Ahmed WU, Mubashar T. Medical student reflection: Quality over quantity. Clin Teach 2019;16:288-9.  Back to cited text no. 7
    
8.
Aronson L. Twelve tips for teaching reflection at all levels of medical education. Med Teach 2011;33:200-5.  Back to cited text no. 8
    
9.
Chua IS, Bogetz AL, Bhansali P, Long M, Holbreich R, Kind T, et al. The patient experience debrief interview: How conversations with hospitalized families influence medical student learning and reflection. Acad Med 2019;94:S86-94.  Back to cited text no. 9
    
10.
Kalish R, Dawiskiba M, Sung YC, Blanco M. Raising medical student awareness of compassionate care through reflection of annotated videotapes of clinical encounters. Educ Health (Abingdon) 2011;24:490.  Back to cited text no. 10
    
11.
Shiau SJ, Chen CH. Reflection and critical thinking of humanistic care in medical education. Kaohsiung J Med Sci 2008;24:367-72.  Back to cited text no. 11
    
12.
Wear D, Zarconi J, Garden R, Jones T. Reflection in/and writing: Pedagogy and practice in medical education. Acad Med 2012;87:603-9.  Back to cited text no. 12
    
13.
Lane JL, Soep JB, Hanson JL. Narrative derived from medical student reflection in action: Lessons learned and implications for assessment. Acad Pediatr 2018;18:354-6.  Back to cited text no. 13
    
14.
Yoon MH, Blatt BC, Greenberg LW. Medical students' professional development as educators revealed through reflections on their teaching following a students-as-teachers course. Teach Learn Med 2017;29:411-9.  Back to cited text no. 14
    
15.
Levene A, Dinneen C. A letter to the editor: Reflection on medical student volunteer role during the coronavirus pandemic. Med Educ Online 2020;25:1784373.  Back to cited text no. 15
    




 

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