“The important thing is to make the lesson of each case tell
on your education.”
Sir William Osler
Recently, more attention is being given to the loss of idealism and erosion of professionalism during the clinical years of medical training. (In fact a 4th year medical student wrote one of the most influential and frequently cited references on this subject!) Lack (or loss) of reflection appears to be a key factor in this problem. Furthermore, physicians who utilize their own self-awareness are more effective, efficient, and satisfied. Patient satisfaction and compliance are also directly related to physician humanism. And more practically, students with higher reflection-in-learning scores also had higher GPA’s according to one study.
In the medical profession we are privileged to interact with people in the most private, intimate, and often stressful situations. Unfortunately, these interactions do not always go as planned and medical students, in particular, can find themselves witnessing or even feeling pressured to participate in interactions that are troubling. Quickly, the lines of professionalism can become blurred if these issues are not addressed.
Conversely, during these formative years of your training, you will also have the opportunity to work with outstanding colleagues and you will take care of extraordinary patients who will move you and hopefully influence your professional development. Unfortunately, without active reflection on these seminal, “unforgettable” experiences, we do forget.
Traditionally, a critical incident report is a means to reflect on some of these troubling interactions. It is a written description of any incident that either happened to you or that you witnessed involving a lapse in professional behavior, including inappropriate treatment of patients, family or health care workers. In other words, it is something that happened during your clinical experience that you keep thinking about or feeling like you should talk about (whether or not you do). For the purposes of this reflective exercise, you do not need to limit yourself to negative experiences. I believe there are positive critical incidents too.
Whether you choose a positive or negative experience, make sure you include the following key features:
- Brief description of the incident
- Reflection on why you think it affected you
- Comment on how you think this will affect your future practice
- Optionally, you may choose to reference some literature (medical or non-medical) that you think would be relevant or enhance the discussion.
Obviously, confidentiality is an issue. No real patient names should be used and if the patient is very unusual and well known, you may need to alter some of the case specifics to preserve confidentiality. If you are at all uncomfortable reporting something that involved you directly, you may present the case in the 3rd person as something you witnessed rather than directly experienced. These are the only acceptable reasons to alter the facts of the incident. The reflective writing is not limited to occurrences during the Medicine Clerkship. You can use an incident from any time during your medical training.
There is no length requirement but 1-2 pages is the average. This reflection will be included in your educational portfolio. Participation in one small (5-6 people) discussion group is mandatory and will last 60-90 minutes and homemade snacks are provided. During this time you can either read your reflection or present the highlights. A group discussion will follow and be facilitated by Dr. Harrell and Dr. Lynch. You are welcome to attend all of the discussion sessions.
Evaluation is based on participation as this is a very personal experience.
