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At Indiana University (IU), reflection and appreciative inquiry are woven into the medical school curriculum starting in the first year of study. Medical students at the IU Lafayette campus routinely reflect on their experiences making house calls as part of their Introduction to Clinical Medicine class. During five biweekly home visits, they form a respectful relationship with a family with chronic health concerns. The students practice skills such as caring presence, empathic listening and verbal and nonverbal facilitative communication behaviors, as well as provide useful, non-medical services such as shopping and transportation.
Educators at IU use a strength-based model that empowers the visiting students and families to form a caring partnership with each other. Reflection, both in small group discussions and through written assignments, plays a key role in this service-learning curriculum.
Dr. Janet Hortin, now at Duke University, was instrumental in developing the model used for the curriculum at the IU Lafayette campus. Small group reflection sessions are held every other week to reinforce ways of mindfully being present for one another. Poetry, short narratives and artwork are used to transport the students to a welcoming space where they can explore how to develop caring, respectful relationships across cultural and generational differences. Robert Coles' A Life in Medicine is used as a resource for guiding provocative reflection and discussion about professionalism and ethics.
Dr. Hortin relates: “Through reflection, we come to understand some of our personal biases and challenges in dealing with people from different backgrounds. We foster a sense of trust and mutual support within the class of 16 students so that we attend to one another as well as to the mentor families. The rigors and stressors of the medical life are discussed along with self-care topics such as coping with failure and mistakes.”
Many of the themes in the reflective writing assignments and small group discussion sessions center on the students' house call experiences. Stories abound. Students have a front-row seat from which they can witness how biological, psychological, social, spiritual and economic factors impact the well-being of their mentor family. A few examples of issues encountered during house call experiences that students have chosen to reflect upon in their written work and discussions include combating caregiver burnout, transitioning from home care to an assisted living facility, estrangement from family members, coping with the loss of a spouse and use of herbal or complementary therapies.
Written reflective activities include assignments about the healing power of touch, elements of a healing environment, walking in your neighbor's shoes for a day, assessing your strengths and the mentor families' strengths, assessing networks of support within the community and family and painting a word picture of the mentor family. These assignments are submitted online, allowing for prompt feedback and dialogue with the instructor.
The students select their best written work for an end-of-semester portfolio to demonstrate the trajectory of their personal and professional growth. During individual conferences, the portfolio is presented and discussed with the instructor. This portfolio project, known as “The Good Neighbor Mentoring Project,” seeks to reinforce habits of reflection and attentive human engagement within the medical school.
Safe, welcoming spaces for reflection must be available throughout medical training if one is to, as Arthur Frank writes, “renew a sense of generosity in medicine.”
Adapted from Hortin J. Engaging reflection in health professional education. RCCI Newsletter, Indiana University School of Medicine. 2009;6(1):4-5.
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