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Residents’ use of case-based reflection exercises

Judith Belle Brown, PhD
Professor in the Centre for Studies in Family Medicine at the University of Western Ontario in London

Correspondence to: Dr Cheri Bethune, Discipline of Family Medicine, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Philip Dr, St John’s, NL A1B 3V6; telephone 709 777-6743; e-mail cbethune{at}mun.ca

OBJECTIVE Qualitative exploration of the experience of family practice residents in using semistructured case-based reflection exercises as a learning medium.

DESIGN Qualitative study using in-depth interviews.

SETTING Memorial University’s Family Medicine Residency Program in St John’s, Newfoundland.

PARTICIPANTS Graduates of the residency program who had taken part ina pilot project that involved completion of case-based reflection exercises as a medium for enhancing learning.

METHOD In-depth interviews were conducted with graduates who had used the reflection exercises during their postgraduate training. All participants were in active practice. All of the audiotaped interviews were transcribed verbatim. Thematic analysis continued until saturation was reached.

MAIN FINDINGS Eight interviews were conducted that included 5 women and 3 men. Three themes emerged from the data analysis: effect on the learning process, effect on the patient-doctor relationship, and effect on the learner.

CONCLUSION The experience of using the reflection exercises appeared to affect how family practice residents learned. Three major themes emerged: the reflection exercises as a continuing education process offered participants a strategy for future learning in practice; the exercises offered a different perspective on the patient-doctor interaction that had doctors looking for cues to deeper meaning; and the exercises engaged the learners in a reflective process that revealed qualities about themselves that gave them personal insight. These reflective strategies haverelevance for all physicians in their attempts to incorporate new knowledge and understanding into their practices. Similar dimensions are articulated in the educational literature, and this study supports the usefulness of case-based reflection as a catalyst in the education of family physicians.