Background: Used primarily as a pedagogical evaluation tool for didactic teaching and skill development, reflective practice (RP) for its own merits is poorly understood. This study aimed to systematically review the literature regarding the role of group RP in fostering empathy, wellbeing, and professionalism in medical students. Methods: Electronic searches of empirical studies published between 1 January 2010 and 22 March 2022 from Medline, Embase, and PsychINFO databases were conducted. Empirical studies of any design (qualitative or quantitative) which included RP (1) involving medical students; (2) with a focus on fostering empathy, or professionalism, or personal wellbeing; and (3) provided in a group setting were included. Duplicates, non-English articles, grey literature and articles using RP to examine pedagogy and specific technical skills were excluded. Both authors screened articles independently to derive a final list of included studies, with any discrepancies resolved by discussion, until consensus reached. Articles were rated for methodological quality using the Attree and Milton checklist for qualitative studies; the Oxford Centre for Evidence-Based Medicine criteria, and the Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative studies. Results: Of 314 articles identified, 18 were included: 9 qualitative; 4 quantitative and 5 mixed methodology. Settings included United States (6), United Kingdom (3), Australia (3), France (2), Taiwan (2), Germany (1), and Ireland (1). Themes were (i) professionalism: bridging theoretical paradigms and practice; (ii) halting empathy decline; (iii) wellbeing: shared experience. Additional themes regarding the “successful“ delivery of RP groups in facilitating these outcomes also emerged. Conclusions: This first systematic review of group RP in medical students shows that RP may bring theory to life in clinical dilemmas, while fostering collegiality and mitigating against isolation amongst students, despite the absence of studies directly examining wellbeing. These findings support the value of RP integration focusing on emotive and humanitarian processes into contemporary medical education for medical students. Systematic review registration: PROSPERO CRD42022322496.
The appraised studies were limited in their number and methodology. More qualitative studies are needed to inform policy on recruitment into psychiatry.
Objectives: To understand a patient’s experience of treatment and recovery from medically unexplained tremors affecting hand and neck. The patient attended a Liaison Psychiatry Outpatient Clinic.Method: A case study using interview method focusing on the nature and severity of illness; effects of symptoms; expectations of treatment; changes observed and the patient’s expectation of services.Results: The patient was “extremely” stressed about his symptoms and “apprehensive” about attending mental health services. He experienced resolution of physical symptoms and improvements in mental wellbeing. Mental health treatment comprised medications and psychological therapies.Conclusions: Persons experiencing medically unexplained symptoms deserve positive experiences of well-funded specialist healthcare.
This case presents a patient’s perspective of clinical care and management of chronic pain with a psychiatric component, the latter of which was not initially apparent to both patient and services. It aims to understand patient’s experience of illness (part A), its effects on patient’s family (part B), experience of care from liaison psychiatry (part C), service provision for persons with chronic pain and its often-neglected mental health aspect (part D), and patient’s hopes for the future (part E). Early involvement of liaison psychiatry may target the interaction between physical and psychological factors and provide appropriate interventions across the health-care system.
Background and objective: The neglect of older people at the end of life in residential care documented in the Australian Royal Commission into Aged Care and Quality and Safety mandates urgent solutions to improve care. This integrative literature review aimed to explore the potential role of the palliative care nurse practitioner (PC-NP) in promoting quality end of life in residential care.Methods: Databases Medline, Emcare, PsychINFO and CINAHL were searched from January 2010 to April 2022. Full text of primary articles meeting inclusion criteria encompassing residents living in residential care settings, the role of the PC-NP in supporting quality dying were obtained and independently screened to determine final studies for review. Findings were thematically analysed. Two reviewers independently extracted data and assessed level of evidence and quality ratings for both quantitative and qualitative studies.Results: Of 12 articles meeting eligibility criteria, four specifically focused on the PC-NP or the palliative care nurse in residential care, seven examined the generic nurse practitioner role, and one the aged care nurse role in supporting palliative care. Themes common to all roles including positive patient outcomes, advance care planning, hospital avoidance, staff education and enhanced communication with families. Themes specific to the PC-NP included meeting end-of-life needs, end-of-life prescribing, and enhancing the role of the General Practitioner.Conclusions: Although reflected in only a handful of studies, this integrative review has provided preliminary insights into potential contributions of the PC-NP to quality end-of-life care for residential care residents.
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