Evaluation of a compulsory reflective group for medical students

Abstract

Introduction Medical students need to be placed in an environment where they are given the opportunity to learn the knowledge, skills and attitudes which will enable them to practice medicine in a safe and professional manner. Professionalism in part is the ability to use the knowledge and skills that have been learnt in an ethical, cultural and socially responsible way. The challenge that all medical schools face is how to teach this in an already crowded curriculum. Medical courses are often compartmentalised, with different departments taking responsibility for creating an educational environment where the curriculum for their specialty can be learnt. The students undertake separate mini courses and may move in cohorts over large geographical areas. In order to address the need to focus teaching on professionalism, the Department of General Practice and Primary Health Care at the University of Auckland runs a reflective group educational activity which takes place in the Year 5 and Year 6 formal teaching days during their clinical attachments. These days are taught at different sites by different academic general practice educators. The session is delivered in an agreed structured format to standardise the experience. Aim The aim of this research was to evaluate this reflective group activity, in order to discover whether participating in the compulsory reflective group enabled students to share emotional experiences constructively. The themes discussed during the groups were also evaluated. In addition the influence of the activity on future professional behaviour of medical students was investigated. Methodology Case study was adopted as the research method for this study. This method examines a specific event or events in its context and seeks to explore and explain what is happening. Different forms of data are collected and triangulated in this type of research. All Year 5 and Year 6 University of Auckland medical students in 2015, whose general practice attachment occurred after ethics approval was granted for this research, were invited to participate in the study. There were 141 students in Year 5 and 162 students in Year 5 so the total number invited to participate was 303. They were asked whether they agreed to completing a pre- and post-group questionnaire, and whether they agreed to their reflective group being audiotaped for research purposes, with anonymity assured. The general practice academics were also asked to participate in a questionnaire. The results were analysed using descriptive and iterative statistics and cross sectional thematic analysis. Findings The students shared emotional experiences which fell into the three themes of; witnessing unprofessional behaviour, meeting difficult clinical scenarios for the first time and the hierarchy of medicine. These themes were similar to those reported in other studies on reflective activities at medical school. The majority of the students felt that they had learnt something relevant to their future practice. The participants valued the opportunity to share safely and learnt that they were not alone in having emotional experiences. The opportunity to share together with an experienced facilitator was valued. The general practice academics valued the activity and felt that the groups provided a unique educational opportunity which the student appreciated. None of the facilitators had run a group where an emotional experience was not shared. The general practice academics learnt that the students had to deal with harrowing things. Participation in the group did not change the number of students who would consider participating in a reflective group as part of their future professional activities. However, 82% of the participants would like to repeat the activity during their medical school training. Conclusion Despite the groups being compulsory, and the membership of the group being dictated by geographical cohort only, the students universally used the opportunity to share emotional experiences. The issues discussed were; witnessing unprofessional behaviour, meeting difficult clinical scenarios for the first time and the hierarchy of medical training. The majority of students responded positively to the experience and would like to have the opportunity to repeat this during their medical training. The facilitators also felt that the groups were valuable. The format of the group may provide a versatile approach to reflective group work which could be more widely adopted.