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You are working directly with writers, and not overpaying intermediaries. We only provide unique papers written entirely by the writers from scratch. Some students expressed a dislike for having to formally write a reflective essay. It is possible to arrange for all of the medical students to individually meet at least two patients receiving palliative or end of life care. Students found these encounters valuable and many wrote about the benefit of formally writing about these experiences. Students reported finding this model useful in widening their skill-set and understanding of palliative care.
Once thought to be too difficult or inappropriate, students now routinely encounter the issues and practicalities of caring for people approaching the end of their lives, although the form and content of teaching varies considerably both nationally and internationally [ 3 , 4 , 5 ]. In the UK, the recently revised Association for Palliative Medicine national curriculum for medical student education recommends the main areas to be addressed, including: basic principles; physical care; psychosocial care; communication; social and family relationships; grief and bereavement; personal and professional issues; and ethical and legal issues [ 6 ].
Each medical school is developing their own way of addressing the knowledge and skills that students will need when providing palliative and end of life care [ 7 ].
Reflective writing on health promotion during nursing clinical placement - Essay Example
At the same time as the rise in palliative care teaching, there has been an increased emphasis on reflection within medicine. Reflection has therefore become an important element of the appraisal and revalidation processes [ 9 ]. Self-reflection can take place in many different forms including one-to-one mentoring, small group discussions and written methods such as diaries, portfolios and essays and is increasingly being used in undergraduate medical education [ 10 ].
Reflective writing is one way to incorporate reflection into medical teaching and has some advantages over face-to-face methods in that it is easier to administer and assess [ 11 ]. However there is evidence that reflective writing is not of itself adequate to teach reflective practice: it has not been shown to improve the quality or level of reflection [ 10 ] though it may be valuable in other ways [ 12 ].
Given the range of professional and personal issues that arise during encounters with patients approaching the end of their lives, [ 13 ] these instances provide a valuable opportunity for such reflective teaching. The University of Cambridge School of Clinical Medicine palliative care course includes reflective writing during the final year, arising from individual meetings with two patients approaching the end of their lives, during senior General Practice GP and senior Medicine placements.
Prior to this final year, students have ten half day palliative care sessions covering symptom management, service provision, the needs of different patient groups, and ethical and communication issues. At the time of these studies, SB led the palliative care course component and RM led the professionalism component, which includes a focus on reflective practice; the other authors are not involved in delivering teaching on these components.
In the autumn of their final academic year, students have an introductory lecture about the reflective essays, outlining the logistics of identifying and meeting the patients and the expected content and structure of reflective essays. Students are encouraged to refer to this and other literature in their written assignments as a way of linking theory, narrative, and medicine.
During their senior GP placement, their GP tutor identifies a suitable patient. These may include patients who have cancer, chest disease, dementia, heart failure, or stroke; they do not need to be in the terminal phase. Afterwards, students discuss the cases with GP tutors before writing the GP-based reflective essay. During their senior hospital medicine placement students are asked to independently identify a patient to interview from the patients they meet on the wards. Small-group case discussions are held with hospital consultants prior to writing the hospital-based reflective essay.
How To Write a Reflective Essay On Aboriginal Health?
Introduction to the patient, family and setting, including illnesses and treatments to date;. Psychological, social and existential issues relevant to the patient and their family;. Professional and ethical issues now or in the future, including future care planning, and how students would feel if they were the responsible doctor;.
Personal issues raised by the meeting and writing; now as a medical student, in the future as a doctor and as an individual;. Each section is marked on a scale of 0 inadequate to 3 excellent , with a marking grid illustrating what satisfies each of these categories Additional file 1. A zero in any category results in the essay being returned to student for further work. Additional marks are awarded for originality, personal insight and clarity. The assignment is a required course component: submission is a requirement in order to proceed to the final examinations, although not counting towards these examination marks.
Formative written feedback is provided; to encourage students to engage with the assignment, the top ten assignments for each placement are awarded University prizes. During and , two research projects investigated these reflective essays. The Clinical School supported both studies. Protocols were submitted and approved by the University Psychology Research Ethics committee.
In practice, the majority of those who did not give their consent are likely to be students who were absent during the recruitment session, although this cannot be ascertained because of issues of anonymity. For each study, each student was assigned a random identification number ID , which are included with the quotes to demonstrate the breadth of the dataset presented.
For both studies written consent was provided for the data to be reported anonymously; consent was not obtained for the sharing of datasets or the essays in their entirety.
Qualitative data for both studies was managed within NVivo. The first project was an exploratory study. By drawing on theories about socialisation [ 18 ] and hidden and informal curriculum [ 19 ], it examined how students were writing about their encounters. What students wrote about the exercise itself and informal observation of several teaching sessions were included in the analysis. Both of these papers discuss how, through these encounters and essays, the students were engaging with their professional identities and future role as doctors. The second project evaluated this reflective exercise by assessing self-reflection conducted by RM.
In , a quantitative questionnaire instrument [ 22 ] was administered to all final year students before and after writing their first reflective essays to see if the exercise changed their level of self-reflection, data from which is to be reported elsewhere [ 23 ]. For the purposes of this paper, we examined the qualitative data to review what the students said they found valuable or not from this palliative care teaching element, which involved patient contact and reflective writing. For example, a remark about writing the essay as being time-consuming was interpreted as a negative remark, even if a student did not explicitly state that they did not enjoy the activity because of this.
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Consequently, RM and EB discussed the two coding structures from each project, comparing the interpretive themes that each study had generated with this new research question in mind. The two coding structures from each project were combined using the groupings provided below, enabling triangulation of two qualitative data sources. The theme headings were derived from how the students labelled their learning experience.
We have chosen to use these as they reflect what the students interpreted as valuable elements of the exercise. The purpose of this study was not to review if they were displaying reflective qualities in their writing, although educators on the course found having examples of this useful for future iterations of the teaching see Discussion.
The new analysis was presented to colleagues who teach on the palliative care course to elucidate their views and check appropriateness of the themes presented below. Study GP. Students appreciated the time and patient exposure the interview element of the exercise provided them. These were aspects of medicine that the students did not fully appreciate or articulate until they undertook this exercise.
By being asked to consider the physical, social, psychological, existential elements, the holistic philosophy of palliative care was reinforced to the students. Students were able to identify specific aspects of their communication skills that they practiced.
Reflective on Health Care Management - Essay Example
For some students, this was by far the most valuable element of the exercise and emphasised how the activity fit with other elements of their teaching. Students therefore found it beneficial to reflect on their own limitations and to think about their professional development. The reflective writing element of the exercise therefore allowed students to enhance the learning experience. I didn't appreciate having to write a long essay about it. These views were more prevalent in the free text element of the second research study than in the reflective essays themselves; four students wrote explicitly negatively about the writing element in the questionnaire compared to two within the essays.
It is likely that students felt freer to express these views anonymously outside of the formally marked reflective essays, although these numbers are relatively small compared to the total sample size for each study. We have included these sentiments here as deviant case analysis, to acknowledge the range of responses to the activity, and to highlight what aspects some students did not find useful.
Extract of sample "Reflective writing on health promotion during nursing clinical placement"
In spite of complaints about the practicalities of the activity, students overwhelmingly reported that they were appreciative of the exercise because of the breadth and depth of the learning it provided. Final year medical students found it valuable to meet patients in the palliative phase of illness, and to reflect on these encounters, at times in ways that they did not expect.
While an emotionally and clinically challenging task, most reported obtaining benefit as they prepared for their future role as junior doctors, in keeping with previous studies [ 13 , 24 ]. The teaching faculty are able to arrange two such encounters for all students approximately each year.
Palliative care teaching has been increasing in medical schools within the UK and other parts of the world [ 5 , 7 , 25 ]. The findings from this study about what the students value about teaching in this area reflects findings from other research.