CONTEXT
Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging—and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism.
METHOD
In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comparison to identify themes and to understand the relationships among them.
RESULTS
Medical educators reported using reflective writing as a learning tool to develop insight and as an assessment tool to unearth evidence of insight. The goal of learning may compete with the goal of assessment, creating tension that leads to uncertainty about the sincerity, quality and effectiveness of reflective writing as well as concerns about learner safety. Educators reported uncertainty about whether learners write to pass or to introspect and about how to judge the effectiveness of reflective writing as a learning tool. They expressed concern about creating a safe environment for learners—one that enables the genuine reflection required for insight development—while meeting requirements of remediation.
CONCLUSIONS
Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism.
COVID-19 restrictions have prompted many medical schools to shift to virtual interview methods for medical school applicant selection. While extensive reflection has been documented around both the process and benefits of transitioning to a virtual Multiple Mini Interview (V-MMI) format, less attention has been given to examining the unintended consequences of this adaptation on increasing representation from underrepresented groups. In this Black Ice article, we consider the equity implications of taking a virtual approach to conducting MMIs and present some practical tips to ensure medical schools are giving attention to and addressing equity issues that may affect applicant and assessor engagement and success. The following seven recommendations include actionable steps medical schools can take immediately to optimize the interview process. This guide can be adapted to residency matching services and other health professions education programs that utilize the MMI.
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