Reflection 2 @ CHECET 2013

Further thoughts on a reflective case study for Year 4 medical students

Following comments from course presenters and fellow participants, I have recognized that the learning outcomes for my teaching intervention need to be distilled. They ought to be clearer for myself and for the students.

If the students initially recognize the value of their input in terms of their classroom activity and their reflections, they will feel more motivated that they are contributing to change beyond a sense of simply complying with a curricular task. For this CHEC course project I will limit my case study to the students’ online reflective task which indicates a shift from my original thinking.

Further insights into the process are triggered by the most recent student workshop. Students responded to the online reflective task as follows:

Total students in block 39

·       4  LMS Forum posts into the six designated threads in line with the reflective framework (Contrast with previous student group at 22)

·       1  LMS Question/Answer post (anonymous)

(This is the first time a student has chosen this option

·       20  Emails sent to educator (Far more than any other group since this project began in 2012)

·       14  No response received online

Students are instructed to hand in a hard copy to the course administrator

Classroom workshop (22nd April 2013) evaluation comments received: 33

30 comments on the reflective spiral tool

26 students noted that it was helpful particularly valuing the logical step-by-step process, the guiding questions and the authenticity of the task

4 did not find it helpful feeling it was a redundant exercise or no reason offered

Themes picked up  in terms of collaboration are:

Positive

Hesitancy but recognition of the value for others to hear about an experience

A sense of debriefing as students share their discomfort with others

Normalizing of difficult experiences when students read about their colleagues’ experiences

Pushes students to think about the incident in a deeper way

Gave structure to students’ reflections enabling them to discuss their perspectives with a critical friend

Challenges:

    Online posts are viewed as, “daunting” to expose personal thoughts and feelings

Feelings of fear and nervousness to expose oneself

Feel safer and more comfortable engaging in a conversation or sending a mail to the facilitator

Timing is tricky as students are close to their end-of-block exam

Format seems contrite rather than a free range option for reflecting

   

Limitations:

By talking to the students and reading their evaluation comments, it appears that there is resistance to sharing their written reflections. Although reflection is advanced through the curriculum, openly sharing difficult personal issues seems not to be a familiar practice. There appears to be a limited feeling of trust amongst each other and towards the educators. In addition time pressures are very real to these students working with a loaded theoretical and practical curriculum.

Facilitating factors:

As the educator driving this project, I have the freedom to take risks and to explore new opportunities using my own creativity without limitations imposed on me by others who wish to maintain a more traditional form of teaching.

Workshop evaluation comments indicate an overriding appreciation for the value gained in sharing insights and hearing about the experiences of colleagues. Those students who chose to bounce their reflections off a critical friend, recognized the extra value gained in this process.

My suggestions:

If I am clearer about the outcomes of the process at the introductory session, it may encourage students to be more proactive. Apart from the individual's personal growth, students' voices are being valued by the department rather than sidelined.

I’m considering how assessment could take place in this process. Will it encourage participation or diminish the authenticity of the task? Perhaps this is something I can share with the students as I put a rubric together. I would like to include participation and sharing as key factors for gaining recognition.

To assess this task I will need to meet with the course convenors to get their buy-in to the process. This is facilitated by a Departmental head who is a champion in social justice issues in women’s health.

Intended outcomes:

Students:

1. Learn from both positive and negative practices by reflecting critically on their own and others’ experiences
2. Shift beyond feelings of frustration, anger, guilt, helplessness towards collaborative positive learning that can mediate change
3. Recognize the broader influences on practices such as understanding the background and beliefs of other healthcare providers. For instance Rachel Jewkes (1998) found that many midwives were themselves abused at home hence violating human rights in Maternal Obstetrics Unitis (MOUs) is viewed as acceptable and normalized. Processes for accountability seem unclear. Recent unpublished research in the School of Public Health and Family Medicine (Hanne Haricharan) indicates that Health Committees are generally not functioning as they ought to be.
4. Experience and engage with multiple perspectives identified through a human rights lens
5. Appreciate the diverse needs of women in labour
6. Identify the value of education and respect for healthcare users and providers

Educator:

• Draw out learning from positive practices as well as critical incidents where the process is not as planned or predicted, through a collaborative approach
• Be willing to engage with “troubled knowledge” towards improving student learning and maternal health by providing a comfortable and safe platform for openly and transparently sharing difficult and uncomfortable experiences (Michalinos Zembylas 2012)
• Develop collaborative teaching tools using the affordances of technology – before, during and after the students’ experiences
• Draw on the expertise and experience of others to improve my ideas and teaching
• Share my teaching with others

Department:

• Product: Students’ experiences noted and shared

o   To equip students to take a stance in promoting positive practices

o   to promote curricular change in the Faculty

o   to develop policies and practices that can enhance maternal health and well-being

o   to shift the established culture of accepted abusive practices in the MOUs.