'Oh yes, that is also reflection'-Using discursive psychology to describe how GP registrars construct reflection.
Journal
Medical education
ISSN: 1365-2923
Titre abrégé: Med Educ
Pays: England
ID NLM: 7605655
Informations de publication
Date de publication:
09 Aug 2023
09 Aug 2023
Historique:
revised:
22
06
2023
received:
20
12
2022
accepted:
12
07
2023
medline:
9
8
2023
pubmed:
9
8
2023
entrez:
9
8
2023
Statut:
aheadofprint
Résumé
Learners in medical education generally perceive that reflection is important, but they also find that reflection is not always valuable or practically applicable. We address the gap between the potential benefits of reflection and its practical implementation in medical education. We examined the perspective of Dutch GP registrars who (must) reflect for their GP specialty training to understand their participant perspective on reflection. Our aim is stimulating alignment between reflective activities that occur in a medical curriculum and the ideals of reflection as a valuable educational activity. We conducted, video-recorded and transcribed seven focus group sessions with GP registrars in 2021 across two Dutch GP educational programmes. We used discursive psychology to analyse the focus group data by focusing on 'assessments of reflection'. We analysed their discursive features (how something was said) and content features (what was said) and related these to each other to understand how GP registrars construct reflection. Participants constructed reflection with nuance; they combined negative and positive assessments that displayed varied orientations to reflection. First, their combined assessments showed complex orientations to norms and experiences with reflecting in practice and that these are not simply negative or positive. Second, GP registrars constructed reflection as a negotiable topic and showed how reflection and its value can be variably understood. Third, through combined assessments, they displayed an orientation to the integration of reflection with other educational tasks, which impacts its value. Generally, GP registrars speak positively about reflection, but the value of reflection partly depends on its proper integration with other educational tasks. When meaningful integration fails, activities to stimulate reflection can overshoot their own goal and hamper learner motivation to reflect. Developing a healthy 'reflection culture' could mitigate some challenges. Therein, reflection is treated as important while learners also have adequate autonomy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : ZonMw
ID : 839130011
Pays : Netherlands
Informations de copyright
© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.
Références
Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Med Educ. 2015;49(5):461-475. doi:10.1111/medu.12680
Ng SL, Mylopoulos M, Kangasjarvi E, et al. Critically reflective practice and its sources: a qualitative exploration. Med Educ. 2020;54(4):312-319. doi:10.1111/medu.14032
Fragkos KC. Reflective practice in healthcare education: an umbrella review. Educ Sci. 2016;6(3):1-16. doi:10.1080/10401334.2017.1392864
Chaffey L, de Leeuw EJ, Finnigan G. Facilitating students' reflective practice in a medical course: literature review. Educ Health. 2012;25(3):198-203. doi:10.4103/1357-6283.109787
Contreras JA, Edwards-Maddox S, Hall A, Lee MA. Effects of reflective practice on baccalaureate nursing students' stress, anxiety and competency: an integrative review. Worldviews Evid Based Nurs. 2020;17(3):239-245. doi:10.1111/wvn.12438
Winkel AF, Yingling S, Jones A-A, Nicholson J. Reflection as a learning tool in graduate medical education: a systematic review. J Grad Med Educ. 2017;9(4):430-439. doi:10.4300/jgme-d-16-00500.1
Mamede S, Schmidt HG. Reflection in medical diagnosis: a literature review. Health Profess Educ. 2017;3(1):15-25. doi:10.1016/j.hpe.2017.01.003
Kuiper RA, Pesut DJ. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory. J Adv Nurs. 2004;45(4):381-391. doi:10.1046/j.1365-2648.2003.02921.x
Artioli G, Deiana L, De Vincenzo F, et al. Health professionals and students' experiences of reflective writing in learning: a qualitative meta-synthesis. BMC Med Educ. 2021;21(1):394. doi:10.1186/s12909-021-02831-4
Tretheway R, Taylor J, O'Hara L, Percival N. A missing ethical competency? A review of critical reflection in health promotion. Health Promot J Austr. 2015;26(3):216-221. doi:10.1071/he15047
Schaepkens SPC, Lijster T. Mind the gap: a philosophical analysis of reflection's many benefits. Teach Learn Med. 2022;35(3):368-377. doi:10.1080/10401334.2022.2142794
Ruth-Sahd LA. Reflective practice: a critical analysis of data-based studies and implications for nursing education. J Nurs Educ. 2003;42(11):488-497. doi:10.3928/0148-4834-20031101-07
Kurt M. Quality in reflective thinking: elicitation and classification of reflective acts. Qual Quant. 2018;52(1):247-259. doi:10.1007/s11135-017-0609-1
Lutz G, Pankoke N, Goldblatt H, Hofmann M, Zupanic M. Enhancing medical students' reflectivity in mentoring groups for professional development-a qualitative analysis. BMC Med Educ. 2017;17(1):122. doi:10.1186/s12909-017-0951-y
Gleeson D, Arwyn-Jones J, Awan M, White I, Halse O. Medical student Schwartz rounds: a powerful medium for medical student reflective practice. Adv Med Educ Pract. 2020;11:775-780. doi:10.2147/AMEP.S273181
Persson EK, Kvist LJ, Ekelin M. Midwifery students' experiences of learning through the use of written reflections-an interview study. Nurse Educ Pract. 2018;30:73-78. doi:10.1016/j.nepr.2018.01.005
Tsang AKL, Walsh LJ. Oral health students' perceptions of clinical reflective learning-relevance to their development as evolving professionals. Eur J Dental Educ. 2010;14(2):99-105. doi:10.1111/j.1600-0579.2009.00598.x
Constantinou M, Kuys SS. Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement: a qualitative study. Physiotherapy. 2013;99(1):49-55. doi:10.1016/j.physio.2011.12.002
Grant A, Kinnersley P, Metcalf E, Pill R, Houston H. Students' views of reflective learning techniques: an efficacy study at a UK medical school. Med Educ. 2006;40(4):379-388. doi:10.1111/j.1365-2929.2006.02415.x
Birden HH, Usherwood T. “They liked it if you said you cried”: how medical students perceive the teaching of professionalism. Med J Aust. 2013;199(6):406-409. doi:10.5694/mja12.11827
Maltha K, Kant J, de Groot F, Neeskens L. Huisartsenopleiding heeft een update nodig. Medisch Contact. 2020;oktober.
Hobbs V. Faking it or hating it: can reflective practice be forced? Reflective Pract. 2007;8(3):405-417. doi:10.1080/14623940701425063
Eaton C. “I don't get it”,-the challenge of teaching reflective practice to health and care practitioners. Reflective Pract. 2016;17(2):159-166. doi:10.1080/14623943.2016.1145582
Chan CKY, Lee KKW. Reflection literacy: a multilevel perspective on the challenges of using reflections in higher education through a comprehensive literature review. Educ Res Rev. 2021;32:100376. doi:10.1016/j.edurev.2020.100376
Rees C, Sheard C. Undergraduate medical students' views about a reflective portfolio assessment of their communication skills learning. Med Educ. 2004;38(2):125-128. doi:10.1111/j.1365-2923.2004.01750.x
van Enk A, Regehr G. HPE as a field: implications for the production of compelling knowledge. Teach Learn Med. 2018;30(3):337-344. doi:10.1080/10401334.2017.1392864
Sandars J, Cleary TJ. Self-regulation theory: applications to medical education: AMEE Guide No. 58. Med Teach. 2011;33(11):875-886. doi:10.3109/0142159X.2011.595434
de la Croix A, Veen M. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspect Med Educ. 2018;7(6):394-400. doi:10.1007/s40037-018-0479-9
Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach. 2009;31(8):685-695. doi:10.1080/01421590903050374
Bindels E, Verberg C, Scherpbier A, Heeneman S, Lombarts K. Reflection revisited: how physicians conceptualize and experience reflection in professional practice-a qualitative study. BMC Med Educ. 2018;18(1):105. doi:10.1186/s12909-018-1218-y
Veen M, Snijders Blok B, Bareman F, Bueving H. Uitwisselen van ervaringen in de huisartsopleiding. Huisarts en wetenschap. 2015;58(1):6-10. doi:10.1007/s12445-015-0008-6
Wieringa-de Waard M. Wordt de patiënt er beter van? Over huisartsopleiding, kwaliteit, evidence-based medicine en nog het een en ander. Vossiuspers UvA; 2008. doi:10.5117/9789056295295
van Braak M, Veen M, Muris J, van den Berg P, Giroldi E. A professional knowledge base for collaborative reflection education: a qualitative description of teacher goals and strategies. Perspect Med Educ. 2022;11(1):53-59. doi:10.1007/s40037-021-00677-6
van Braak M, Giroldi E, Huiskes M, Diemers AD, Veen M, van den Berg P. A participant perspective on collaborative reflection: video-stimulated interviews show what residents value and why. Adv Health Sci Educ Theory Pract. 2021;26(3):865-879. doi:10.1007/s10459-020-10026-7
Veen M, van Braak M. Education's attentional core: collaborative learning from experiences in GP vocational training in The Netherlands. In: Feldges T, ed. Education in Europe: Contemporary Approaches Across the Continent. Routledge; 2022. In press.
van der Gulden R, Timmerman AA, Sagasser MH, et al. How does portfolio use support self-regulated learning during general practitioner specialty training? A qualitative focus group study. BMJ Open. 2023;13(2):e066879. doi:10.1136/bmjopen-2022-066879
Puchta C, Potter J. Focus Group Practice. Sage; 2004. doi:10.4135/9781849209168
Morgan DL. Basic and Advanced Focus Groups. Sage; 2019. doi:10.4135/9781071814307
Schaepkens SPC, Veen M, de la Croix A. Is reflection like soap? A critical narrative umbrella review of approaches to reflection in medical education research. Adv Health Sci Educ Theory Pract. 2021;27(2):537-551. doi:10.1007/s10459-021-10082-7
Wiggins S. Discursive Psychology. Theory, Method and Applications. Sage; 2017. doi:10.4135/9781473983335
Potter J, Hepburn A. Discursive psychology as a qualitative approach for analysing interaction in medical settings. Med Educ. 2005;39(3):338-344. doi:10.1111/j.1365-2929.2005.02099.x
Boeckhout M, Beusink M, Bouter L, et al. Niet-WMO-plichtig onderzoek en ethische toetsing. Ministerie van VWS; 2020.
World-Medical-Association. WMA Declaration of Helsinki - Ethical Principles for medical research involving human subjects. World Medical Association. 2021. Accessed April 16, 2021. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
Edwards D, Potter J. Discursive Psychology. Sage; 1992.
Kristiansen TM, Grønkjaer M. Focus groups as social arenas for the negotiation of normativity. Int J Qual Methods. 2018;17(1):160940691774739. doi:10.1177/1609406917747393
Huma A, Alexander M, Stokoe E, Tileaga C. Introduction to special issue on discursive psychology. Qual Res Psychol. 2020;17(3):313-335. doi:10.1080/14780887.2020.1729910
Halkier B. Focus groups as social enactments: integrating interaction and content in the analysis of focus group data. Qualitative Research. 2010;10(1):71-89. doi:10.1177/1468794109348683
Melia C, Kent A, Meredith J, Lamont A. Constructing and negotiating boundaries of morally acceptable alcohol use: a discursive psychology of justifying alcohol consumption. Addict Behav. 2021;123:107057. doi:10.1016/j.addbeh.2021.107057
Potter J, Edwards D. Rethinking cognition: on Coulter on discourse and mind. Hum Stud. 2003;26(2):165-181. doi:10.1023/A:1024008104438
Varpio L, Ajjawi R, Monrouxe LV, O'Brien BC, Rees CE. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking. Med Educ. 2017;51(1):40-50. doi:10.1111/medu.13124
Edwards D, Potter J, te Molder H. Discursive psychology, mental states and descriptions. In: Conversation and Cognition. Cambridge University Press; 2005:241-259. doi:10.1017/CBO9780511489990.012
Potter J, te Molder H. Talking cognition: mapping and making the terrain. In: te Molder H, Potter J, eds. Conversation and Cognition. Cambridge University Press; 2005:1-54. doi:10.1017/CBO9780511489990.002
Paulus TM, Lester JN. ATLAS.ti for conversation and discourse analysis studies. Int J Soc Res Methodol. 2016;19(4):405-428. doi:10.1080/13645579.2015.1021949
Atlas.ti 9 (version 9.1.7.0). Berlin, Germany: Atlas.ti GmbH.; 2020.
Lindström A, Mondada L. Assessments in social interaction: introduction to the special issue. Res Lang Soc Inter. 2009;42(4):299-308. doi:10.1080/08351810903296457
Pomerantz A. Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes. In: Atkinson MJ, Heritage J, eds. Structures of Social Action: Studies in Conversation Analysis. Cambridge University Press; 1984:57-101. doi:10.1017/CBO9780511665868.008
Potter J, Hepburn A, Edwards D. Rethinking attitudes and social psychology-issues of function, order, and combination in subject-side and object-side assessments in natural settings. Qual Res Psychol. 2020;17(3):336-356. doi:10.1080/14780887.2020.1725952
Edwards D, Potter J. Some uses of subject-side assessments. Discourse Stud. 2017;19(5):497-514. doi:10.1177/1461445617715171
Goodwin C, Goodwin M. Assessments and the construction of context. In: Duranti A, Goodwin C, eds. Rethinking Context: Language as an Interactive Phenomenon. Cambridge University Press; 1992:147-189.
Sidnell J. Conversational Analysis. An Introduction. Blackwell Publishing, Ltd; 2010.
Huma B, Joyce JB. ‘One size doesn't fit all’: lessons from interaction analysis on tailoring Open Science practices to qualitative research. Br J Soc Psychol. 2022. doi:10.1111/bjso.12568
ten Have P. Doing Conversation Analysis. A Practical Guide. Second Edition. Sage; 2007. doi:10.4135/9781849208895
Fraser B. Pragmatic markers. Pragmatics. 1996;6(2):167-190.
Mazeland H. Responding to the double implication of telemarketers' opinion queries. Discourse Stud. 2004;6(1):95-115. doi:10.1177/1461445604039443
Donaghue N. Discursive psychological approaches to the (un)making of sex/gender. In: Dess NK, Marecek J, Bell LC, eds. Gender, Sex, and Sexualities: Psychological Perspectives. Oxford University Press; 2018:127-148.
Heritage J, Atkinson JM. A change-of-state token and aspects of its sequential placement. In: Structures of Social Action: Studies in Conversation Analysis. Cambridge University Press; 1985:299-345. doi:10.1017/CBO9780511665868.020
Edwards D, Fasulo A. “To be honest”: sequential uses of honesty phrases in talk-in-interaction. Res Lang Soc Inter. 2006;39(4):343-376. doi:10.1207/s15327973rlsi3904_1
Platt L. The ‘wicked problem’ of reflective practice: a critical literature review. Innov Pract. 2014;9(1):44-53. doi:10.24377/LJMU.iip.vol9iss1article108
Veen M, de la Croix A. The swamplands of reflection: using conversation analysis to reveal the architecture of group reflection sessions. Med Educ. 2017;51(3):324-336. doi:10.1111/medu.13154
Logren A, Ruusuvuori J, Laitinen J. Self-reflective talk in group counselling. Discourse Stud. 2017;19(4):422-440. doi:10.1177/1461445617706771
van Braak M, Huiskes M. ‘Doing being an expert’: a conversation analysis of expertise enactments in experience discussions in medical education. Linguist Educ. 2022;69:101052. doi:10.1016/j.linged.2022.101052
Rheinberg F, Vollmeyer R, Rollett W. Motivation and action in self-regulated learning-chapter 15. In: Boekaerts M, Pintrich PR, Zeidner M, eds. Handbook of Self-Regulation. Academic Press; 2000:503-529. doi:10.1016/B978-012109890-2/50044-5
de la Croix A, Schaepkens S, Veen M. Zombies in onderwijsland. Health Care Humanities als Medicijn tegen 'Skillification'. Tijdschrift voor Gezondheid en Ethiek. 2022;32(3):58-63.
van der Gulden R, Veen M, Thoonen BPA. A philosophical discussion of the support of self-regulated learning in medical education: the treasure hunt approach versus the (Dutch) “dropping” approach. Teach Learn Med. 2023;1-7. doi:10.1080/10401334.2023.2187810
Schön DA. The Reflective Practitioner. How Professionals Think in Action. Basic Books; 1983.
Biesta G. World-Centred Education: A View for the Present. Routledge; 2022. doi:10.4324/9781003098331
Hodges BD. Sea monsters & whirlpools: navigating between examination and reflection in medical education. Med Teach. 2015;37(3):261-266. doi:10.3109/0142159x.2014.993601
Kumagai AK, Naidu T. Reflection, dialogue, and the possibilities of space. Acad Med. 2015;90(3):283-288. doi:10.1097/acm.0000000000000582
Potter J. Two kinds of natural. Discourse Stud. 2002;4(4):539-542. doi:10.1177/14614456020040040901
Edwards D, Stokoe EH. Discursive psychology, focus group interviews and participants' categories. Br J Dev Psychol. 2004;22(4):499-507. doi:10.1348/0261510042378209
van Braak M, Huiskes M, Schaepkens S, Veen M. Shall we all unmute? A conversation analysis of participation in online reflection sessions for general practitioners in training. Languages. 2021;6(2):72. doi:10.3390/languages6020072