Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education

Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being - are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.     

Celebrating 50 years of Reflective Practice: Versions of Creative Problem Solving

The original work of Alex Osborn making the creative process more explicit, and the following 50 years of research and development on creative problem solving, have made an important and wide‐spread contribution to those interested in the deliberate development of creative talent. This article provided a summary of the many versions of creative problem solving and the key scholarly issues underpinning their development for one main group of collaborators. Future research and development needs were also identified.     

Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education

Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes (empathic conflict, bias in healthcare, and the humanity of medicine) and one overarching theme (near-peer affinities). The premedical students’ essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors’ status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine.

     

叙事医学反思性写作对共同决策价值探析

以叙事医学工具反思性写作为切入点,首先从医方、患方及外部环境三个角度分析了当前医患共同决策所面临的临床实践困境,其次在对反思性写作概念、实践特点概述的基础上,提出了叙事能力对临床工作的重要性、叙事医学伦理对决策困境的作用,最后从促使医方自我反思,避免引导式决策及权威主义;弥合医患视阈差异,达成决策共识;阐明并澄清患者偏好及价值观,促进个体化共同决策;提高患者参与决策意愿,调动参与决策积极性;缓和医患关系,实现医患共情,促进共同决策良性互动五个方面阐述了反思性写作对医患共同决策困境的助力作用。

     

Playing Along the Porous Edge of Chaos and Discipline: Pathways to the Creative Analytic Process

The oscillation between chaos and discipline plays along a porous line of form and formlessness. The ability to play with these polarities represents an important part of creative expression.     

Rethinking Care Theory: The Practice of Caring and the Obligation to Care

Care theorists have made significant gains over the past twenty‐five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral and political philosophy.     

From the Galleries to the Clinic: Applying Art Museum Lessons to Patient Care

Increasingly, medical educators integrate art-viewing into curricular interventions that teach clinical observation—often with local art museum educators. How can cross-disciplinary collaborators explicitly connect the skills learned in the art museum with those used at the bedside? One approach is for educators to align their pedagogical approach using similar teaching methods in the separate contexts of the galleries and the clinic. We describe two linked pedagogical exercises—Visual Thinking Strategies (VTS) in the museum galleries and observation at the bedside—from “Training the Eye: Improving the Art of Physical Diagnosis,” an elective museum-based course at Harvard Medical School. It is our opinion that while strategic interactions with the visual arts can improve skills, it is essential for students to apply them in a clinical context with faculty support—requiring educators across disciplines to learn from one another.     

Learning Through Shared Christian Praxis: Reflective Practice in the Classroom

The cultivation of reflective practice has become a commonly accepted goal of theological education. However, theological educators must face the challenge of teaching and assessing reflective practice. Hypothesizing that this concern is best addressed in community, the authors of this article devised a collaborative action‐research project using Thomas Groome's “shared Christian praxis” model. They describe the ways in which they have, over the course of the project, modified their pedagogy to improve their students' reflection on practice.     

More than just the mean: moving to a dynamic view of performance-based compensation

Compensation decisions have important consequences for employees and organizations and affect factors such as retention, motivation, and recruitment. Past research has primarily focused on mean performance as a predictor of compensation, promoting the implicit assumption that alternative aspects of dynamic performance are not relevant. To address this gap in the literature, we examined the influence of dynamic performance characteristics on compensation decisions in the National Basketball Association (NBA). We predicted that, in addition to performance mean, performance trend and variability would also affect compensation decisions. Results revealed that performance mean and trend, but not variability, were significantly and positively related to changes in compensation levels of NBA players. Moreover, trend (but not mean or variability) predicted compensation when controlling for future performance, suggesting that organizations overweighted trend in their compensation decisions. Theoretical and practical implications are discussed.     

More than meets the eye: Context effects in word identification

The influence of semantic context on word identification was examined using masked target displays. Related prime words enhanced a signal detection measure of sensitivity in making lexical decisions and in determining whether a probe word matched the target word. When line drawings were used as primes, a similar benefit was obtained with the probe task. Although these results suggest that contextual information affects perceptual encoding, this conclusion is questioned on the grounds that sensitivity in these tasks may be determined by independent contributions of perceptual and contextual information. The plausibility of this view is supported by a simulation of the experiments using a connectionist model in which perceptual and semantic information make independent contributions to word identification. The model also predicts results with two other analytic methods that have been used to argue for priming effects on perceptual encoding.     

Higher Education and Health Care Development: The Case of Northern Cyprus

The aim of this study is to investigate long-run equilibrium relationship and the direction of causality between health care development and higher education in Northern Cyprus, which has shown a tremendous development in higher education sector. Results of the present study reveal that higher education is a long term determinant of health care development in this small island. Health care in Northern Cyprus converges to its long term equilibrium level by 35.2 % speed of adjustment every year through the channel of higher education growth in Northern Cyprus. The other finding of this study is that there exists unidirectional causality in the short term period that runs from higher education growth to health care growth in Northern Cyprus.     

From the Couch to the Chair: Applying Psychoanalytic Theory and Practice in Counseling

In this article, the authors offer a contemporary perspective on psychoanalytic theory. The authors present a clinical vignette that illustrates how one analyst applied the principles of transference, countertransference, and resistance in a modern clinical setting. The authors describe how analysis is similar to and different from humanistic counseling and conclude by describing how analytic insights might be applied in the clinical practice of counselors.     

Interests and Neonates: There Is More to the Story than We Explicitly Acknowledge

Although there are many different moral arguments concerning the use of Best Interests in neonatal decision-making, there seems in practice a firm commitment to application of the concept. And yet, there is still little reflection given by practitioners about what employing a Best Interest determination means in infant care. The following lays out a comprehensive taxonomy of interest-sources in order to provide for more robust considerations of what constitutes best interests of/for neonates.     

Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective

Psychological safety plays a vital role in helping people overcome barriers to learning and change in interpersonally challenging work environments. This article focuses on two such contexts—health care and education. The authors theorize differences in psychological safety based on work type, hierarchical status, and leadership effectiveness. Consistent with prior research, the authors employ cross-industry comparison to highlight distinctive features of different professions. The goal is to illuminate similarities and differences with implications for future psychological safety research. To do this, the authors review relevant literature and present analyses of large data samples in each industry to stimulate further research on psychological safety in both sectors, separately and together.