Do photographs, older adults’ narratives and collaborative dialogue foster anticipatory reflection (“preflection”) in medical students?

Abstract

BackgroundIn changing higher education environments, medical educators are increasingly challenged to prepare new doctors to care for ageing populations. The Depth of Field: Exploring Ageing resource (DOF) uses photographs, reflective questioning prompts, older adults’ narratives and collaborative dialogue to foster anticipatory reflection or ‘preflection’ in medical students prior to their first geriatric medicine clinical placement. The aim of this research is to explore whether photographs, narratives and small group collaborative dialogue fosters reflective learning, enhances reflective capacity and has the potential to shift medical students’ attitudes towards caring for older adults.MethodsThis study used a mixed method evaluation design, measuring attitudes using pre and post questionnaire responses and individual written reflections drawn from 128 second year medical students, exploring their perceptions toward older adults.ResultsQuantitative and qualitative data indicated that the DOF session generated reflective learning that resulted in positive shifts in medical students’ perceptions towards older adults. The qualitative reflections were captured in four main themes: the opportunity provided to Envision working with older adults; the Tension created to challenge learners’ misinformed assumptions, and the work of Dismantling those assumptions, leading to Seeing older people as individuals.ConclusionsThese findings highlight how visual and narrative methodologies can be used as an effective reflective learning tool to challenge medical students’ assumptions around ageing and how these may influence their care of older adults.

Understanding Australian medical student attitudes towards older people

“…Another recent mixed method study considered the effect of an innovative anticipatory reflective learning strategy in geriatric medicine curriculum, facilitated for 128 second‐year University of Western Australian medical students . In this study, students were shown photographs, offered older adult narratives and made to engage in collaborative dialogue to foster the reflection on their interactions with older patients.…”

“…Notably, the study captured a positive shift in student attitudes towards older people after the reflective learning sessions, as measured by statistically significant improvement in eight of the 13 items of a locally adapted UCLA‐GAS instrument, and by qualitative feedback. The authors conclude that ‘The findings demonstrate the importance of facilitating learning opportunities for preflection as they create a safe space for students to begin the developmental process of becoming aware of potential bias, to explore and unpack their thoughts around ageing and integrate this growing awareness into their future clinical experiences and practise with older adults in more mindful ways’ [; p.7,8].…”

“…Encouragingly, baseline medical student attitudes were found to range from neutral to positive . Also, attitudes were more positive after a curriculum intervention . However, our current understanding of the attitudes of Australian medical students towards older people is incomplete and potentially flawed, as it is based on two quantitative instruments developed for use in the United States , without adequate local validation studies, and on qualitative evidence.…”

“…Also, in view of significant differences in funding for retirement and health care between US and Australian society, the attitudinal meaning from student responses to item 12 would likely mean different things in each country. An attempt was made to modify the UCLA‐GAS in the more recent West Australian study , indicating a perceived need to adapt the instrument for Australian data collection. This further clouds the utility of the UCLA‐GAS in Australia, as repeatability and generalisability of any instrument are a necessary requirement to demonstrate its validity.…”

Depth of Field: Teaching the Art of Reflection to Medical Students

“…Pre-post questionnaire and individual written reflections were collected to explore whether the documentary style photographs and collaborative classroom dialogue fosters reflective learning and has the potential to shift medical student's attitudes towards caring for older adults. The data showed that visual and narrative methodologies (used in DOF) stimulated reflective learning processes that generated a positive shift in medical students' perceptions towards older adults [1].…”