Letters to the Editor
Plough teaching into the heart of the medical curriculum
Using written text-based approach to promote reflection: Does it work? Dear Sir
Dear Sir Pervaz Iqbal et al.’s (2014) critique of Basehore et al.’s (2014) research article on peer-rating by medical students makes for some interesting reading. Potential limitations were identified in feedback quality, assessment authenticity, lack of clinical experience in peers and clinical misconceptions. It cannot be ignored, however, that peer assessment has fantastic potential with benefits for both students undergoing assessment and those providing it too. Teaching is only possible with a thorough understanding of the subject material and this can only help learning for both the parties. Of course stretched resources and faculty pressures might make peer-assisted learning a pragmatic economic choice which can only detract from the real benefits and make it look like learning ‘‘on the cheap’’. However, teaching is becoming increasingly recognized as a vital skill of the doctor, not only as the educator for his or her patients, but also in developing and nurturing the skills of medical students and more junior colleagues. It is to this end that I believe formal instruction in medical education should be incorporated into the medical school curriculum, in order to prepare medical students for their future teaching roles. There is no doubt that peerassessment would be a useful element in this training. The doctor as an educator is not a new concept; from the ancient Hippocratic Oath to the most recent GMC guidance, the doctor who teaches is seen as fulfilling an intrinsic element of their role. Why then, should an understanding of basic teaching theory not become a necessary requirement for all newly qualified junior doctors? This would not only prove beneficial to those who would receive teaching from junior doctors, but would also help these young practitioners cement their own understanding and develop new skills valuable in their future careers. If the benefits of peer-assisted learning are to be reaped then we need to sow some basic teaching theory during the undergraduate season. Lucy J. Havard, Royal Free Hospital, London. E-mail: lucy. [email protected]
Declaration of interest: The author reports no conflicts of interest.
References Basehore PM, Pomerantz SC, Gentile M. 2014. Reliability and benefits of medical student peers in rating complex clinical skills. Med Teach 36(5):409–414. Pervaz Iqbal M, O’Sullivan AJ, Velan G, Balasooriya C. 2014. Letters to the editor: Are we seeing the full picture of peer-assessment in medical education? Med Teach 36(11):1007.
The article by Andrews (2014) enlightened me. The author’s vivid description of her attempts at using reflection with preclinical students was very real and illuminating. The students’ ability to follow Donald Schon’s three-step model of reflective practice was amazing. Yes, reflections need to be real – from real encounters with real people. The author identified ‘‘engagement’’ as the key element that provided the students with real experiences and they in return, responded with genuine reflections. I wish to share an example of using reflection where students had no direct access to real experience. Yet they felt connected and demonstrated engagement. In our new medical curriculum, Year 1 students were introduced to the concept of reflective writing. Literature on reflection in medical education revealed written text-based approaches do not appeal to the ‘‘net generation’’ of learners and suggested the creative use of multimedia for reflection. To strike a balance, three resources – HIV/AIDS, organ donation, dengue (in Malaysia) were uploaded and resource links were provided. As a formative assessment, students had to login to access the online resources, selected one of the resource and wrote a short reflective essay about it. General guidelines were provided. Several questions that could prompt reflection were given. All the 179 students submitted the essays online. Although not all the essays fit the description of a structured, thoughtful piece of academic writing that displayed reflective ability and cultural sensitivity, students’ engagement with the resources were evident. Students responded with much thought and insights, and reacted with strong emotions. Phrases like ‘‘I was totally amazed/deeply disappointed’’, ‘‘It worried me’’, appeared repeatedly throughout their essays. Some students had even gone through the three phases of reflection: noticing, processing and future action. Excerpts from an essay to illustrate: ‘‘. . . this is what I never think about before . . .’’ (noticing); ‘‘. . . do you ever think of donating your organs?’’ (processing); ‘‘. . . our decisions to become organ donors which my parents and I are now’’ (future action). Although real experience is desirable, online written textbased resources can promote reflection, perhaps particularly so if assessment-related. Through guided reflection and a structured approach, pre-clinical students can learn to reflect. Joong Hiong Sim, Faculty of Medicine, University of Malaya, Malaysia. E-mail: [email protected]
Acknowledgments The author would like to thank Associate Professor Dr. Lim Soo Kun from the Faculty of Medicine, University of Malaya, for coordinating the reflective essay assignment.
405
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Plough teaching into the heart of the medical curriculum
Using written text-based approach to promote reflection: Does it work? Dear Sir
Dear Sir Pervaz Iqbal et al.’s (2014) critique of Basehore et al.’s (2014) research article on peer-rating by medical students makes for some interesting reading. Potential limitations were identified in feedback quality, assessment authenticity, lack of clinical experience in peers and clinical misconceptions. It cannot be ignored, however, that peer assessment has fantastic potential with benefits for both students undergoing assessment and those providing it too. Teaching is only possible with a thorough understanding of the subject material and this can only help learning for both the parties. Of course stretched resources and faculty pressures might make peer-assisted learning a pragmatic economic choice which can only detract from the real benefits and make it look like learning ‘‘on the cheap’’. However, teaching is becoming increasingly recognized as a vital skill of the doctor, not only as the educator for his or her patients, but also in developing and nurturing the skills of medical students and more junior colleagues. It is to this end that I believe formal instruction in medical education should be incorporated into the medical school curriculum, in order to prepare medical students for their future teaching roles. There is no doubt that peerassessment would be a useful element in this training. The doctor as an educator is not a new concept; from the ancient Hippocratic Oath to the most recent GMC guidance, the doctor who teaches is seen as fulfilling an intrinsic element of their role. Why then, should an understanding of basic teaching theory not become a necessary requirement for all newly qualified junior doctors? This would not only prove beneficial to those who would receive teaching from junior doctors, but would also help these young practitioners cement their own understanding and develop new skills valuable in their future careers. If the benefits of peer-assisted learning are to be reaped then we need to sow some basic teaching theory during the undergraduate season. Lucy J. Havard, Royal Free Hospital, London. E-mail: lucy. [email protected]
Declaration of interest: The author reports no conflicts of interest.
References Basehore PM, Pomerantz SC, Gentile M. 2014. Reliability and benefits of medical student peers in rating complex clinical skills. Med Teach 36(5):409–414. Pervaz Iqbal M, O’Sullivan AJ, Velan G, Balasooriya C. 2014. Letters to the editor: Are we seeing the full picture of peer-assessment in medical education? Med Teach 36(11):1007.
The article by Andrews (2014) enlightened me. The author’s vivid description of her attempts at using reflection with preclinical students was very real and illuminating. The students’ ability to follow Donald Schon’s three-step model of reflective practice was amazing. Yes, reflections need to be real – from real encounters with real people. The author identified ‘‘engagement’’ as the key element that provided the students with real experiences and they in return, responded with genuine reflections. I wish to share an example of using reflection where students had no direct access to real experience. Yet they felt connected and demonstrated engagement. In our new medical curriculum, Year 1 students were introduced to the concept of reflective writing. Literature on reflection in medical education revealed written text-based approaches do not appeal to the ‘‘net generation’’ of learners and suggested the creative use of multimedia for reflection. To strike a balance, three resources – HIV/AIDS, organ donation, dengue (in Malaysia) were uploaded and resource links were provided. As a formative assessment, students had to login to access the online resources, selected one of the resource and wrote a short reflective essay about it. General guidelines were provided. Several questions that could prompt reflection were given. All the 179 students submitted the essays online. Although not all the essays fit the description of a structured, thoughtful piece of academic writing that displayed reflective ability and cultural sensitivity, students’ engagement with the resources were evident. Students responded with much thought and insights, and reacted with strong emotions. Phrases like ‘‘I was totally amazed/deeply disappointed’’, ‘‘It worried me’’, appeared repeatedly throughout their essays. Some students had even gone through the three phases of reflection: noticing, processing and future action. Excerpts from an essay to illustrate: ‘‘. . . this is what I never think about before . . .’’ (noticing); ‘‘. . . do you ever think of donating your organs?’’ (processing); ‘‘. . . our decisions to become organ donors which my parents and I are now’’ (future action). Although real experience is desirable, online written textbased resources can promote reflection, perhaps particularly so if assessment-related. Through guided reflection and a structured approach, pre-clinical students can learn to reflect. Joong Hiong Sim, Faculty of Medicine, University of Malaya, Malaysia. E-mail: [email protected]
Acknowledgments The author would like to thank Associate Professor Dr. Lim Soo Kun from the Faculty of Medicine, University of Malaya, for coordinating the reflective essay assignment.
405
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
