By Patricia Stubenberg

“No words are ofterner on our lips than thinking and thought.”  – John Dewey

The teaching physician has opportunities for personal and professional growth through reflection and revisiting not only their own experiences in training and practice, but also their role as clinical teachers with medical students and residents.  Studies on reflection in teaching are abundant including, Freese’s work on Reframing One’s Teaching¹, Dewey’s Art of Reflection², and the theoretical underpinnings of reflective engagement, metacognition, and transformative learning.  The literature on reflection in clinical teaching is expanding through scholars including, Irby et al.³ and Sanders⁴.  This essay offers perspective on the value of reflective activity to advance medical education in training the next generation of physicians…

Reflective clinical teaching gains value through facilitating engaged conversation and higher-order thinking and considers a global picture of context, skills, and values to encourage personal and professional growth.  Qualitative research in medical education is one tool which can inspire conversation, through guided reflection, in developing feedback to guide teaching and practice.  The qualitative researcher who pursues meaning through one’s story can develop considerable thematic interpretations which can contribute to the value of a reflective clinical teaching framework:

• The interview which sought meaning from a pediatric intensivist who speaks of a memorable moment when a first-year medical student shared in the emotional pain of a young burn patient and the student wanting to cut his hair and give it to the child.
• The value of clinical teaching driven intrinsically from a private medical practice physicians’ passion for medicine and caring for the patient with unique conditions and who is alienated from society.
• The primary care physician who overcame teaching challenges and underscored the importance of self-awareness in adapting to the medical student’s learning level.
• The surgical oncologist who reflected on the gift of humanity and allowing patients to die with dignity⁵.

It is these conversations that help one examine their actions and insight to guide teaching practices.  The physician who reflects on their own medical education journey and current practices helps raise the bar in clinical teaching and reaches for clinical teaching excellence in training future physicians.  Ultimately, it is the pediatric patient in intensive care, the patient with a unique condition and alienated from society, the patient dying with dignity, and all other patients, who benefits.

Patricia Stubenberg, PhD, MPH, CHCP is the Director of Continuing Medical Education and Preceptor Development at the Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, TN

References

1. Freese, AR. (2006). Reframing one’s teaching: Discovering our teacher selves through reflection and inquiry. Teaching and Teacher Education, 22(1), 100-119.
2. Dewey, John. (1933). How we think: A restatement of the relation of reflective thinking to the educative process. Boston: D.C. Heath and Company.
3. Irby, DM., Ramsey, PG., Gillmore, GM., & Schaad, D. (1991). Characteristics of effective clinical teachers of ambulatory care medicine. Academic Medicine, 66(1), 54-55.
4. Sandars J. (2009). The use of reflection in medical education: AMEE Guide No. 44. Med Teach, 31:685-95.
5. Stubenberg, Patricia A. (2013). “Descriptions of Clinical Teaching Excellence in the First Two Years of Medical School: The Views of Academic and Community-Based Preceptors”. Graduate Theses and Dissertations.