Undergraduate medical students' perceptions of reflective learning in the curriculum

N.B. The information below is authored by the mini-project applicants, not by staff of MEDEV. This text represents the views and opinions of the mini-project team only, not those of MEDEV or its affiliates.

Principal investigator

Pirashanthie Vivekananda-Schmidt,

Full list of project partners

Sheffield University: Dr. Patsy Stark, Dr. P.Vivekananda-Schmidt, Dr. Michelle Marshall
Manchester University: Prof. Val Wass
Leeds University: Dr. John Sandars
Durham University: Dr. Jane Roberts
Hull,York Medical School: Dr. Jean McKendree.
Correspondence to: Dr. P.Vivekananda-Schmidt, Academic Unit of Medical Education, 85 Wilkinson Street, S10 3GJ

Background

Background and Rationale
Reflection is a core component of medical professionalism(1) and a key aspect of the foundation training and the revalidation process(2).

Students are taught the skills of reflective practice from year 1 of the undergraduate curriculum(3-8) as part of developing their professionaslim. Reflective practice fosters personal responsibility and accountability. It makes achievements explicit and thereby directs learning illustrating strengths and weaknesses which can be improved upon.(9) When reflection is documented and revisited there can be more impetus for behavioral changes.

Proposed Project:
Explore second year medical students' perceptions of reflective learning in the curriculum to ascertain factors that will help promote reflection in 5 UK medical Schools.

Rationale:
The importance of helping undergraduate students to acquire reflective skills is well recognised by UK university curricula including teaching professionalism through reflective practice (10-13) and in developing clinical reasoning skills(14;15) through reflection.

Students' competency in reflective skills is a result of collaborative effort between the various stakeholders including students. Informal student feedback at the member institutions and content from the academic discussion board at Sheffield University suggest that students are not always enthusiastic about the learning and assessment practices in the curriculum to develop their reflective skills. Even though, work has been done on best ways of incorporating and assessing reflection in the curriculum(11;16-18) work looking at how to increase student engagement with reflection is scarce. The little research looking into student perspective on reflection(9) has not looked into potential barriers in motivating and engaging students in reflection. Without positive engagement, participation in curriculum initiatives per se is unlikely to turn students into reflective practitioners.

This project will look at a multi-institutional perspective to determine whether student perception of reflection is conducive to acquiring reflective learning skills, how reflective learning skills can be facilitated more effectively and whether the type of curriculum is a driver influencing the perception and acquisition of reflective learning.

AIM: To explore the second year medical students' perceptions of reflective learning across five United Kingdom undergraduate curricula

Objectives:
(1)Identify what the participants define as reflective practice
(2)How does the undergraduate curriculum facilitate reflection?
(3)What helps the acquisition of reflective practice?
(4)What factors hinder the acquisition of reflective practice?
(5)Identify whether specific curriculum characteristics help or hinder the acquisition of reflective practice.

Methodology
Design:
Qualitative methodology. A multi-institutional focus group study.

Main Focus group question: what do you think reflective practice is, how does it occur in the curriculum (via teaching, learning and assessment) and what factors helps or hinders the acquisition of reflective practice?

Sampling: Preformed groups (PBL/ILA/tutorial groups) will be invited to participate, since in most cases the students have already been selected for gender and age during the tutorial group allocation process.
o Sheffield 18 students
o Manchester 20 students
o HYMS 18 students
o Leeds 20 students
o Durham 20 students

Students who have participated will be given a £10 book token as an acknowledgement of their contribution to the project.

Plan
The focus group interviews to be held between December 2006 and February 2007. The interview schedule has already been developed following two student interviews and a pilot focus group at Sheffield University. Two focus groups each will be conducted in each of the participating universities. Progress of the interviews will be iterative, i.e., any new themes that emerge in an interview will be incorporated into the interview schedule for the subsequent interview. PVS will moderate all focus groups across the universities. All interviews will be audiotaped.

Analysis
The audio tapes will be transcribed by one individual. The research group will then meet to develop initial codes (during this meeting all will have access to the interview transcriptions and scribed notes). PVS will carry out analysis of all focus groups using the initial codes developed at this meeting. Interrater agreement will be ascertained by another qualitative researcher from the group coding a selection of the data. The codes will be recorded on an Excel spreadsheet and sub-themes and final themes developed.

Ethics approval will be sought from the Sheffield School of Medicine Ethics Committee. The other partner Schools will seek approval locally once the Sheffield approval is given.

Proposed activities

1.Piloting to develop the interview schedule. Completed May 2006.
2.Ethics approval will be sought from local University research ethics committees. May-June 2006.
3.Focus groups will be conducted across the institutions with pre-formed groups (PBL/ILA/tutorial groups). The focus groups will be moderated by one member of the research group to improve objectivity. December 2006- February 2007.
4.Interviews will be transcribed and analysed between March-June 2007.

Proposed outcomes

The outcomes of this work will inform educators and help fulfil the GMC requirement and Tomorrows Doctors specification of ensuring medical graduates are reflective professional practitioners.

We hope to disseminate our findings via Medical Education conferences and publication in journals with an interest in medical education. The multi-institutional perspective will be a valuable theme for the paper. We also hope to present a workshop on the findings from this project at the AMEE 2007 conference.

Proposed expertise

Dr. Patsy Stark is a senior lecturer in Medical Education. She co-founded the ICE module which focuses on reflection of critical incidents. She is also a member of the steering group of the PPD programme at Sheffield Medical School. Dr. Stark has a number of years of experience in medical education and in particular in teaching and assessing medical student's reflective practice. She also has expertise in qualitative research methods, especially in using focus groups as an outcome measure.

Dr. P.Vivekananda-Schmidt is a member of the steering group for the PPD programme for undergraduate medical students at Sheffield. She has led an Arthritis Research Campaign funded multicentre educational trial where the qualitative arm of the trial involved the design, conduct and analysis of focus groups and interviews. She has project management experience from her PhD in Vision Science, her postdoctoral project and from a local HEFCE mini project grant at Keele University.

Dr Michelle Marshall is a Lecturer in Medical Education. She is an experienced teacher and educational researcher with experience of teaching assessing reflective practice in healthcare.

Dr. John Sandars is a Senior Lecturer in Community Based Education and manager for the Personal and Professional Development strand in the undergraduate course. He is involved in developing and evaluating reflective practice using online portfolios and blogs using qualitative research.

Dr. Jane Roberts is a General Practitioner and academic lead for PPD at Durham with a particular interest in cultural competence.

Prof. Val Wass is professor of community based medical education at Manchester University. She leads on the development of professionalism across all years of the medical school curriculum which encourages reflective learning through personal formative portfolios. Her collaboration with Maastricht University in the Netherlands over the years has strengthened her experience of both qualitative and qualitative medical education research.

Dr. Jean McKendree is a cognitive scientist whose research has spanned topics including educational technology, dialogue in learning, graphical reasoning, and critical thinking over a variety of disciplines including artificial intelligence, mathematics, psychology, school science and medical education.

Expertise of grant holder and project team

Dr. Patsy Stark is a senior lecturer in Medical Education. She co-founded the ICE module which focuses on reflection of critical incidents. She is also a member of the steering group of the PPD programme at Sheffield Medical School. Dr. Stark has a number of years of experience in medical education and in particular in teaching and assessing medical student's reflective practice. She also has expertise in qualitative research methods, especially in using focus groups as an outcome measure.

Dr. P.Vivekananda-Schmidt is a member of the steering group for the PPD programme for undergraduate medical students at Sheffield. She has led an Arthritis Research Campaign funded multicentre educational trial where the qualitative arm of the trial involved the design, conduct and analysis of focus groups and interviews. She has project management experience from her PhD in Vision Science, her postdoctoral project and from a local HEFCE mini project grant at Keele University.

Dr Michelle Marshall is a Lecturer in Medical Education. She is an experienced teacher and educational researcher with experience of teaching assessing reflective practice in healthcare.

Dr. John Sandars is a Senior Lecturer in Community Based Education and manager for the Personal and Professional Development strand in the undergraduate course. He is involved in developing and evaluating reflective practice using online portfolios and blogs using qualitative research.

Dr. Jane Roberts is a General Practitioner and academic lead for PPD at Durham with a particular interest in cultural competence.

Prof. Val Wass is professor of community based medical education at Manchester University. She leads on the development of professionalism across all years of the medical school curriculum which encourages reflective learning through personal formative portfolios. Her collaboration with Maastricht University in the Netherlands over the years has strengthened her experience of both qualitative and qualitative medical education research.

Dr. Jean McKendree is a cognitive scientist whose research has spanned topics including educational technology, dialogue in learning, graphical reasoning, and critical thinking over a variety of disciplines including artificial intelligence, mathematics, psychology, school science and medical education.

Similar work

A literature review has been conducted to identify relevant evidence. This has been used in developing the interview schedule. Pilot interviews and pilot focus group have been conducted at Sheffield.

Contact details

Amount awarded: 2,595

MEDEV project contact: Nigel Purcell

Reports and resources

  • 423_423_UG_med_stud_percept_reflect_learn_cur_PVS_8Apr08.pdf
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    MEDEV, School of Medical Sciences Education Development,
    Faculty of Medical Sciences, Newcastle University, NE2 4HH

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