Reflections on reflection on reflection

elbow lake reflection2

Hi all:  I’m back from a few weeks at our family cottage near Sudbury. Now for those of you from north of Parry Sound, you know that it’s not a cottage, it’s a camp, but I’m translating for all the Southerners here at the UGME blog.

I find that there’s nothing like total exhaustion from installing a new water pump, sanding and staining a deck, staining 6 new Muskoka chairs, and bringing water by hand, up a steep hill, to the garden which one has foolishly planted up that hill.  I find total exhaustion quite conducive to reflection.  I simply sit and stare at the water.  After awhile, my brain starts to work again, and after solving basic issues like food and water (shades of Mazlow), I can even start to get creative.  I think about what’s gone wrong, or what needs to be better and I plan.  I can plan a brand new cottage (hah!), a new way to pump water (hah!), and even a new garden location.  I can plan things to say to my husband when he says, “These Muskoka chairs are so cheap—we couldn’t build them for this money.  Let’s get 6.”  And then, furtively, because UG at Queen’s is never far from my thoughts, I can even start to reflect on things at UG, and plan to make things even better.

Now this urge to action based on reflection is my favourite perspective on reflection. Unfortunately, I’ve never been one to meditate, or think about the moment, or think about nothing, or “relax”.  (However, I did take Dr. John Smythe’s 6 week course on mindfulness and just to show you how good he and the course are, by week 6, I found I actually could be mindful, focus on an object and poof!  Gone for 15 minutes! I highly recommend it, and I try very hard to put his precepts into practice!)

But generally, I’m a Kolb-ian.  I like Kolb’s model of experiential learning—it speaks to me as a call to action.  He advises, in essence, to act, reflect on the action, take it to other reference points and then make an action plan.  I think I’ve shown you this before, but just in case…:)

kolb_cycle

 

So, on what did I reflect, in my moments of recovery from projects at the cottage?  (Did I mention my perennial and consistent devotion to ridding the cottage of mice droppings as part of my activities?  I abstractly conceptualize that as draining the ocean with a teaspoon. (See Stage 3 above.)

Well, one thing I did was bring a book that I promised I’d give you some feedback on, up to the cottage.  It’s entitled English and Reflective Writing Skills in Medicine by Clive Handler, Charlotte Handler and Deborah Gill (CRC Press).  I took some great things from this, to share with you.  They are reflections and pieces of reflections, morphed into this article, which is something I strongly advice with reflection.  Reflections are private.  An action or a blog article, for example, is something that can be crafted from reflections into a public piece of writing.

One thing that really spoke to me was the list of areas and experiences that can generate good critical reflection especially for learners in medical education.  I think, too, that even for experienced practitioners these questions can trigger reflection.

About a patient:

  • A patient happy or unhappy with their treatment by you or others
  • A question of confidentiality, consent or inappropriate risk
  • Doing something for the first time
  • Communicating with older or frail people
  • Consultations involving more than one person (for example, a relative)
  • Sudden death or deterioration

About you:

  • An aspect of a patient encounter that revealed gaps in your knowledge or skills
  • An even that caused you anxiety or enjoyment
  • An aspect of care that left you surprised, puzzled or confused
  • A patient that challenged our assumptions or whose actions are at odds with your personal beliefs and values

About the team

  • When you feel an aspect of the treatment or management is wrong
  • A dysfunctional team that affects patient outcomes or experiences
  • The actions of a team under pressure

Good medical practice

  • Times you have exhibited good medical practice or found yourself in a situation that may be at odds with good medical practice
  • Times when you have seen medical practice or behavior that may be at odds with medical practice. (pp. 6-7)

What do you think?

Now the authors also tackle the dicey area of marking and giving feedback on reflective writing.  Medical students are often extremely concerned about who will see their reflective writing, and whether that will impact on the faculty member’s opinion of the student.  This seems to me to be quite understandable, and it’s why I mentioned above, that taking a reflection and crafting it into a set of goals or more concretely, an action plan, with some work already done, is often a very positive spin to put onto a problem area that a student has identified.  I used to tell my education students, “It’s not a question of whether any of us will make a mistake or not. It’s a question of how we recover, and deal with the mistake that makes the good teacher.”  I think that is also true of the good doctor.

So…in order to create an action plan the authors advise using the Kolb cycle but changing it slightly to:

  1. Identify and describe a professional scenario
  2. What are the perceived consequences of these behaviours?
  3. What are the implications for professional practice? [Sheila’s note: at this point I would challenge students to walk the walk and provide some evidence from medical and medical education literature to demonstrate the implications and help provide solutions for 4.]
  4. What evidence can you provide to show how you have used this experience to develop your practice and inform your behavior in professional scenarios? [Sheila’s note again: OR What is your plan of action to change the behavior?] (p. 12)

At this point the book delves into how to assess the writing skills of the students and it’s full of good advice about grammar and tons of examples of reflective essays.

Speaking of assessment, I’ve been hearing that some students don’t feel that receiving feedback on the lack of clarity and the amount of spelling and grammar errors in their med ed writing is within the realm of medical education.   Well, it is one of our Curricular Objectives (CM 1.3a: Provide accurate information… in a clear, non-judgmental and understandable manner.) And I can only imagine what you readers are saying to yourselves right now, about the importance of clear writing in transitions of care, etc.

What I do have for you is a row for a rubric I created for clarity of expression.  So should you ever be assessing student writing, and want to use it, feel free.

10 prompts write reflections

Lastly, here are some ways to write about reflections that give a format or form to the thoughts.  Students may find these more enjoyable, or at least more guided.  What do you think?  Do you have others?

  1. So What? Journal:  Identify the main idea of the lesson or incident. Why is it important? Why is it important to others?
  2. Analogy (or Simile):  Explain the main idea using an analogy. (Has the benefit of making everyone look up “analogy”.) OR could be explain this idea as a simile:  It’s as if, or it’s like… Then, folow the thread of the anaology or simile.
  3. Question Stems
    • I believe that ________ because _______.
    • I was most confused by _______.
    • What surprised me was _______
    • A patient (a nurse, a physiotherapist, etc.) would see this incident as _____________.
    • When I read up on this, here was one interesting solution____________
  4. Muddy Moment:  What frustrates and confuses you about this incident?  What will you do about it?
  1. PAS_Double-Entry-JournalDouble Entry Journal: Jot down main points, questions, etc. in left hand column.  In right hand column write about these, including actions for the future
  2. Twitter Post: encapsulate in under 140 characters.
  3. Praise from your Mother (or Father or other person who loves you):  “My son’s (daughter’s etc.) done this_______” (In other words, have someone else brag about you if you won’t.)
  4. Top Ten List:  What are the most important takeaways, written with humor?
  5. Quickwrite:  Without stopping, write what most confuses you.  Use a concept map or other format to try sorting it out.
  6. If I were writing a blog about this ____(opinion, incident, topic), I would write__________________.
(Adapted from “Dipsticks: Efficient Ways to Check Understanding; http://www.edutopia.org/blog/dipsticks-to-check-for-understanding-todd-finley)

Well, those are some reflections on reflections from my time up North.  I’ve also partially solved the mouse dropping problem (all the dishes are now in bins when we leave!)  And I’ve figured out what to say to my husband when he advises buying 6 chairs we have to build and stain:  “You are right, dear!”  (because he was right, and  they look awesome!).  muskoka 1

I’ve also once again realized how rejuvenating short physical projects can be (they have an end! 🙂 and how much I love to sit by a lake and think.  I just have to figure out how to keep this reflective spirit going all year long!  As for the water pump…well, maybe part of the reflection is that some things you just have to live with!

Any reflection on reflections to share?  Feel free to write in!

One Response to Reflections on reflection on reflection

  1. Thank you for this Sheila. Your time by the lake will translate to the good fortune of the students, I am sure. Wendy

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