Deliberate practice in medicine: reflection

During our first semester of med school, when we had our class where we learned to interview patients, we had to write a journal entry after each encounter. It wasn’t due for a few days after class, so mine usually got written in the final minutes before the deadline. The first half, writing the patient history, was easy. Less easy was to come up with some deep thoughts about the patient encounter to fill up the final paragraph. Needless to say, it wasn’t my favorite exercise. It’s hard to force meaning into an encounter when you’re more focused on what questions to ask to fill up the silence.

Reflection gets used that way, and maybe it has it’s place, but reflection as a form of deliberate practice isn’t really about our growth as a person. This guide describes reflection in medical education as “experiential learning” and outlines the following steps in the process: 1. noticing what happened, whether through our own perceptions, feedback from others, or analysis of critical incidents; 2. processing, including learning needs and also the emotional content of a situation; and 3. developing a plan to meet learning needs. (The appendix includes some prompts.) Essentially, reflection as a tool is acting as your own coach.

One of my (multitude) of complaints about medical education is that the time to do this isn’t really built in. You’re either busy with patient care, or you’re not doing something clinical. The problem is it’s hard to remember the details of a situation after you’re not in the midst of it. I think in med school in particular there should be time blocked out so it doesn’t feel like an obligation: you could structure it so you see a clinic patients in the morning, and then have time blocked out to write both a note and also identify a learning need and do some reading. In residency, it’s harder, but as I’m going forward, I notice I do have down time during the day, which I usually use to do some combination of browsing the internet, practicing French vocab, and chatting. It’s much harder to make myself read, and when I do, it’s frequently random. So that’s a challenge to me, I guess…definitely room for improvement.


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