Reflection in medical education is a fundamental tool to help prevent burnout

Drawing on its Jesuit Catholic heritage, Loyola University Chicago Stritch School of Medicine has long understood the importance of reflection in medical education as a key element in physician formation. With physician burnout on the rise, it is all the more integral for students to learn ways to engage better with the challenges faced in the medical profession. Stritch faculty members believe reflection is a fundamental tool to help students process and cope with the tremendous physical, emotional, and mental pressure that can accompany their vocation.

These views were explained in Physician, Know Thyself: The Role of Reflection in Bioethics and Professionalism Education, an article written by Stritch faculty in the most recent issue of Johns Hopkins University Press's Narrative Inquiry in Bioethics: A Journal Qualitative Research.

Though Stritch incorporates reflection into all four-years of its formal curriculum and co-curricular programs, the article focused on the specific involvement of bioethics faculty with reflection as demonstrated in three key areas: Patient Centered Medicine (a three-year course), the Bioethics and Professionalism Honors Program, and the Physician's Vocation Program.

Reflective practice is a key element of Jesuit Catholic education and fosters self-awareness. "...our hope is that reflective practice deepens our students' commitments to becoming men and women for others," wrote lead author Katherine Wasson, PhD, MPH, assistant professor in the Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, and her co-authors. "Beyond merely exhorting students to behave ethically, this process of reflection encourages our students to delve more deeply into their own aspirations, fears, anxieties, and hopes as they progress through medical school."

From the beginning of their education Stritch medical students learn the art of reflection in their Patient Centered Medicine Course. All first year medical students are divided into groups of eight students who will be their core group for the remainder of their tenure. The groups are led by two faculty members, at least one who is a physician. The groups meet together every week during the first year to create an open, trusting environment. It is within these groups that students are asked to reflect on their experiences as first-year students and then again during their third-year clinical rotations.

Students are given a small notebook that can fit into their lab coat as a place where they can write answers to reflective questions including:

1. What surprised you?
2. What touched you?
3. What inspired you?
4. Do you feel you are becoming the physician you wish to be?

"The facilitators try not to dominate the discussions and instead allow the students to shape the discussion and build on one another's reflections," wrote Wasson and colleagues.

The Bioethics and Professionalism Honors Program is co-curricular and open to any interested student. It aims to develop further the character and intellect of the students. With the guidance of a faculty advisor, reflection plays a key role in the program's curriculum to promote the student's professional development and self-directed learning and to encourage communal rather than competitive activity. In addition, students attend four seminars and complete a capstone proposal and project related to bioethics and/or professionalism issues.

"On the one hand, we hope that reflection would enable students to maintain a course toward their ideals, i.e., toward becoming the physician they set out to be. But closely relate to this ideal is the fact that students can be stripped of their ideals by the toxicity of the clinical training environment. We intended to use reflection to enable students to transition from being passive victims of such an environment to proactively guiding their development as physicians," wrote the authors.

The hope is that students learn to step back from a situation to reflect critically, evaluate what is happening to everyone involved in the situation, and identify the positive and negative effects of those experiences.

Finally, the Physician's Vocation Program is unique to Stritch and is a forum for students rooted in the Spiritual tradition of Ignatius Loyola that explores the intersection of faith and the practice of medicine. Reflection in this program focuses on how human experience shapes the way students practice medicine and how these experiences can be reflected on in light of faith. For many of these students, it helps remind them of the reasons they wanted to become doctors in the first place.

"As healthcare becomes more driven by metrics, efficiency, throughput, and outcomes, the affective human dimension of illness for both the caregiver and patient finds less room for considering the personal dimension of the clinician-patient relationship which contributes to burnout and cynicism," Wasson and colleagues wrote.

According to the authors, the hope of teaching students the value of reflection will create in them a greater self-awareness, enhanced emotional intelligence, deepening commitment to social justice, and help prevent burnout.

"The ability to reflect is crucial for future physicians as they enter a fast paced and changing world in healthcare," wrote Wasson and colleagues. "Humanizing an educational experience can be at times emotionally and intellectually overwhelming and even toxic, but ultimately rewarding and even transformative."

Source: Loyola University Health System