Reflection in Practice

Doctor writtingReflection. You’re familiar with it, in its various forms. Your face in the mirror, your thoughts on a page; as the Latin suggests, little pieces of you are bent back on themselves and aligned on a surface for convenient viewing. Reflection often seems like arbitrary testing or busy work, the sort from which it would be nice to be freed in higher education. However, since the 1983 introduction of a book titled “The Reflective Practitioner,” reflective practice has become “A Thing” in education—of all types—across the United States. The idea that thinking improves practice has morphed into a cohesive body of theory. Many educational programs now teach reflection.

However, there is a gap.

More and more people argue that U.S. medical schools should teach reflective practice as if it were just as important as the names of our bones. But while researchers have conducted many studies, few have found significant quantitative evidence that reflection improves medical practice. Some report correlation between reflective coursework and increased GPA or scores; others claim that students who reflect on their anatomical coursework demonstrate better recollection of structure and functions. On a whole, though, the evidence has been scant and questionable.

So why do medical educators and professionals continue to argue that reflection is crucial to the medical education? Stephen Lefrak, director of the Humanities in Medicine program at Washington University School of Medicine (WUSM), said that reflection is “best able to teach doctors how to get patients to reflect, and to talk to patients. We don’t have those skills; we don’t develop them [without practice].” Lefrak said he favors analyst-guided reflection and has run several programs over the course of his career that focus on providing a space for reflection free of fear and administrative interference. “It was certainly useful,” he said. “How do you deal with the experience of the medical profession as a student? It’s hard to do. Reflection is crucial for the doctor’s mental health.”

Lefrak said he laments the medical community’s disinclination to encourage reflection as part of a physician’s work. Some medical schools have begun to work with Medical Humanities programs similar to the one Lefrak leads. Medical Humanities explores what Lefrak calls “the existential part of illness”—as opposed to pathology itself. Some have called reflection “a medical humanities approach” to the health profession. Perhaps these programs might one day provide a doorway into reflective practice. Right now, though, they are neglected by medical schools.

Robert Patterson, head of WUSTL’s Writing Center, offers an explanation from the perspective of a writing teacher: putting things down in words creates coherence. “It allows you to realize, ‘hey, the way I’m thinking about ballet and what I’m getting out of it is really similar to the things I’m getting out of EMT work’, and that lets you better understand what drives you,” Patterson said. And more than that, it pushes you to ask the question, “why did they want me to learn in these ways?” This, he said, allows people to take so much more out of an educational experience.

You may see, then, why reflection might be used in medical practice despite a lack of empirical evidence, why researchers push to find more tangible demonstration of its impacts and why doctors believe that it needs more incorporation into medical curriculae. Reflection has the potential to improve the least tangible, least measurable parts of a blooming physician: the ways they think, the ways they understand themselves, and, as doctors, the ways that self-knowledge changes how they interact with patients.

It’s not just for the physician, though. Maybe you are pre-med and will write reflections in medical school a few years from now; maybe you are in the B-school and will run into other forms of reflective practice; maybe you refuse to ever write something that resembles a class reflection ever again. But it is worth it, for a bit, to step back and think about thinking. How often do you sit back and try to find coherence between what you love? What could you gain from slowing your life, writing down some thoughts, and looking at the reflection of your day, only to see it from angles you had never noticed before?


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