|
Example 2
Scenario: Using Reflective Practice to Develop Competence in Patient Care and Practice-based Learning and Improvement during Case Conferences.
You wonder whether residents benefit as much as possible from the weekly case conferences in your program. During these conferences, residents organize their presentations according to a predetermined outline. The outline is particularly useful in guiding the residents’ clinical thinking. As program director, you want to avoid what has become somewhat of a predictable exercise, insofar as residents appear to miss some of the patterns that emerge in their cases, even while they successfully organize their case presentations.
The illustration below describes how you may use RP to accomplish learning objectives for Patient Care and Practice-Based Learning and Improvement during case conferences. The learning objectives for this activity are that residents will be able to: 1) develop and carry out patient management plans (Patient Care); 2) exercise appropriate clinical judgment (Patient Care); and, 3) analyze their practice experience and perform practice-based improvement activities using a systematic methodology (Practice-Based Learning and Improvement).
Illustration:
Case conferences provide an excellent opportunity for RP, whereby residents learn to think through problems rather than simply present the facts of a case. Faculty who facilitate the conferences will guide reflection by asking good questions. Certain types of questions enhance reflection, and faculty should become familiar with these questions and their purpose:
- “What” questions at the onset of an activity help identify a problem: “What do you see?” “What is the most important fact in this case?” “What did you think, feel, or see regarding the patient?”
- “Why” questions involve analyzing the problem. “Why was that important?” “Why do you think the patient reacted that way?” In a supportive learning environment, “why” questions are not seen to be a challenge, but rather as means to guide self-reflection.
- “How” questions enable residents to form hypotheses or to develop tentative theories. They help residents reflect on previous knowledge and connect it to new knowledge.
- “What” questions at the conclusion of an activity become important when the attending asks, “What should you do now?” “What is the plan of action?” “What might you do differently in the future?”
To create a safe and supportive context, faculty might “think out loud” through these same questions as they present a case from their own practice. While residents in the scenario above use the predetermined outline for case presentations, by applying RP skills, they also
|
 |
 |
|
