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Reflective Writing in Medical Education: A Writing Professional’s Exploration of Purposes and Practices
AuthorZytkoskee, Adrian M
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The practice of reflective writing (RW), which tends to be exploratory prose employed for the purpose of helping healthcare practitioners grapple with psychosocial aspects of medicine, has become widely employed in medical education. Its entrance into the field in the late 1990s was a direct response to the biomedical model common in Western medicine, which situates patients as a sum of their biological parts and physicians as disembodied minds. While medical education has done an excellent job researching the efficacy of RW in addressing this dualistic model, very little scholarship has explored the theoretical and pedagogical approaches informing its instruction and production. As a result, essential questions and practices have remained unexplored in scholarly conversations, which sequesters knowledge within the confines of individual institutions and leaves those embarking upon their journeys as RW facilitators unsupported. Accordingly, through thick teacher research emerging from my experience as a RW facilitator in medical education and my field of composition studies’ extensive theoretical and pedagogical engagement with related writing practices, I address this gap through several moves. First, emerging from student reflections and correlating feedback from members of our RW team, I present “listening,” “guiding,” and “encouraging” approaches to feedback, what I term a “feedback framework,” and explore their individual functions and value in responding to subject matter and writing craft. Next, grounded in an illness narrative project I designed and implemented with second-year students, I outline student concerns relating to both the composition and sharing of vulnerable narratives and present facilitators with theoretical and pedagogical responses grounded in my teaching experience, composition studies, and the voices of students who had transformative experiences. Third, through analysis of the writings from a small, third-year clerkship RW group, I present and explore students’ use of writing to “cathart negative emotions,” “process uncertainty in medicine,” and “bear witness to the lives of others and self for the development of empathy,” rhetorical moves that provide what I term as a “manageable framework” for understanding, discussing, and guiding RW work. Finally, drawing upon the pedagogical conclusions emerging from the research projects, I outline a comprehensive four-year RW curriculum in order to provide a foundation upon which RW instructors may tailor curriculum to meet specific institutional needs. In performing this work, I hope to contribute a composition studies perspective to the pedagogical understanding and practice of RW in medical education in order to strengthen this important work and, as a result, aid in the process of helping students become the type of empathetic and thoughtful physicians making medicine a more humane practice.
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