Reflective practice in medicine: The hidden curriculum challenge

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-10-19 DOI:10.1111/tct.13682

Michelle Ní Mhurchú, Peter Cantillon

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Abstract

Background

Despite the known benefits of reflection in various health care professions, it is still not a thriving practice in medical education. The literature suggests that this may be due to tensions between epistemological tenets of reflection and biomedicine. Further research is needed into experiences of doctors as they implement reflection in medical education settings. We set out to explore how these experiences were influenced by hidden curricula to provide insights into personal and contextual features of medical settings influencing engagement in reflection.

Methods

Using an interpretative phenomenological analysis (IPA) approach, four semi-structured qualitative interviews were conducted virtually. Participants were doctors who graduated from a postgraduate diploma in clinical education with core reflective practice components. Interviews were recorded, transcribed, coded and analysed using IPA. Opportunities to review and amend transcriptions were provided.

Findings

Three superordinate themes were identified including epistemological divergence, fear of showing vulnerability and reflection volte-face. Challenges in engaging in practices epistemologically different to predominant discourses in medicine were compounded by fears of vulnerability and a common antipathy towards reflection. All developed more accommodating perspectives towards reflection with shared experiences of a programme incorporating reflective practice.

Conclusion

The hidden curriculum can have positive and negative impacts on doctors' engagement in reflection. In facilitating reflective practice for this group, we recommend assisting with awareness of ways of thinking and being in medicine, offering reassurance that reflection may initially feel like running contrary to predominant discourses and finally, role modelling openness to vulnerability to better integrate and promote meaningful engagement in reflection.

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医学反思性实践：隐藏的课程挑战。

背景：尽管在各种医疗保健专业中，反思有着众所周知的好处，但在医学教育中，反思仍然不是一种繁荣的做法。文献表明，这可能是由于反思的认识论原则和生物医学之间的紧张关系。需要进一步研究医生在医学教育环境中进行反思的经验。我们开始探索这些经历是如何受到隐藏课程的影响的，以深入了解影响反思参与的医疗环境的个人和背景特征。方法：采用解释性现象学分析（IPA）方法，进行四次半结构化的定性访谈。参与者是毕业于临床教育研究生文凭的医生，具有核心反思实践组成部分。使用IPA对访谈进行记录、转录、编码和分析。提供了审查和修改转录本的机会。研究结果：确定了三个上级主题，包括认识论分歧、对表现出脆弱性的恐惧和反思的转变。对脆弱性的恐惧和对反思的普遍反感加剧了从事与医学主流话语不同的认识论实践的挑战。所有人都形成了更为包容的反思视角，并分享了一个包含反思实践的方案的经验。结论：隐性课程对医生参与反思有积极和消极的影响。在促进这一群体的反思实践时，我们建议帮助提高对思维方式和医学的认识，让人们放心，反思最初可能会感觉与主流话语背道而驰，最后，塑造对脆弱性的开放性，以更好地整合和促进有意义的反思。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.