The ways social networks shape reflection on early significant clinical experiences in medical school

Authors

  • Samantha Stasiuk University of British Columbia
  • Maria Hubinette University of British Columbia
  • Laura Nimmon University of British Columbia

DOI:

https://doi.org/10.36834/cmej.73422

Abstract

Background: Medical curricula are increasingly providing opportunities to guide reflection for medical students.  However, educational approaches are often limited to formalized classroom initiatives where reflection is prescriptive and measurable. There is paucity of literature that explores the personal ways students may experience authentic reflection outside of curricular time.  The purpose of this study was to understand how social networks might shape dimensions of reflection. 

Methods: This study employed a qualitative social network analysis approach with a core sample of seven first year undergraduate medical students who described their relationships with 61 individuals in their networks. Data consisted of participant generated sociograms and individual semi-structured interviews.

Results: Many learners struggled to find significant ways to involve their social networks outside of medicine in their new educational experiences.  It appeared that some medical students began in-grouping, becoming more socially exclusive.  Interestingly, participants emphasized how curricular opportunities such as reflective portfolio sessions were useful for capturing a diversity of perspectives.

Conclusions: Our study is one of the first to characterize the social networks inside and outside of medical school that students utilize to discuss and reflect on early significant clinical experiences. Recent commentary in the literature has suggested reflection is diverse and personal in nature and our study offers empirical evidence to demonstrate this. Our insights emphasize the importance of moving from an instrumental approach to an authentic socially situated approach if we wish to cultivate reflective lifelong learning.

References

Nguyen QD, Fernandez N, Karsenti T, Charlin B. What is reflection? A conceptual analysis of major definitions and a proposal of a five-component model. Med Educ. 2014;48(12):1176-1189. https://doi.org/10.1111/medu.12583

Driessen E, Van Tartwijk J, Van Der Vleuten C, Wass V. Portfolios in medical education: Why do they meet with mixed success? A systematic review. Med Educ. 2007;41(12):1224-1233. https://doi.org/10.1111/j.1365-2923.2007.02944.x

Barnard-Ashton P, Rothberg A, McInerney P. The integration of blended learning into an occupational therapy curriculum: a qualitative reflection. BMC Med Educ. 2017;17(1):1-14. https://doi.org/10.1186/s12909-017-0977-1

Ng SL, Mylopoulos M, Kangasjarvi E, et al. Critically reflective practice and its sources: A qualitative exploration. Med Educ. 2020;54(4):312-319. https://doi.org/10.1111/medu.14032

Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach. 2009;31(8):685-695. https://doi.org/10.1080/01421590903050374

Murdoch-Eaton D, Sandars J. Reflection: moving from a mandatory ritual to meaningful professional development. Arch Dis Child. 2014;99(3):279-283. https://doi.org/10.1136/archdischild-2013-303948

Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Heal Sci Educ. 2009;14(4):595-621. https://doi.org/10.1007/s10459-007-9090-2

Wald HS. Professional identity (trans)formation in medical education: reflection, relationship, resilience. Acad Med. 2015;90(6):701-706. https://doi.org/10.1097/ACM.0000000000000731

Stubbing E, Helmich E, Cleland J. Authoring the identity of learner before doctor in the figured world of medical school. Perspect Med Educ. 2018:40-46. https://doi.org/10.1007/s40037-017-0399-0

Driessen EW, Van Tartwijk J, Overeem K, Vermunt JD, Van Der Vleuten CPM. Conditions for successful reflective use of portfolios in undergraduate medical education. Med Educ. 2005;39(12):1230-1235. https://doi.org/10.1111/j.1365-2929.2005.02337.x

Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. 2014;89(11):1446-1451. https://doi.org/10.1097/ACM.0000000000000427

Steinert Y. Educational theory and strategies to support professionalism and professional identity formation. In: Cruess RL, Cruess SR, Steinert Y, eds. Teaching Medical Professionalism, 2nd Edition. Cambridge University Press; 2016:68-83. https://doi.org/10.1017/cbo9781316178485.007

Wilson H. Critical reflection in medical training and the biomedical world view. Med Educ. 2020;54(4):281-283. https://doi.org/10.1111/medu.14077

de la Croix A, Veen M. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspect Med Educ. 2018:1-7. https://doi.org/10.1007/s40037-018-0479-9

Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: A critical narrative review. Med Educ. 2015;49(5):461-475. https://doi.org/10.1111/medu.12680

Wass V, Harrison C. Empowering the learner to reflect: do we need another approach? Med Educ. 2014;48(12):1146-1147. https://doi.org/10.1111/medu.12612

Fragkos KC. Reflective practice in healthcare education: an umbrella review. Educ Sci. 2016;6(3). https://doi.org/10.3390/educsci6030027

Uygur J, Stuart E, De Paor M, et al. A best evidence in medical education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51. Med Teach. 2019;41(1):3-16. https://doi.org/10.1080/0142159X.2018.1505037

Aronson L. Twelve tips for teaching reflection at all levels of medical education. Med Teach. 2011;33(3):200-205. https://doi.org/10.3109/0142159X.2010.507714

Schei E, Fuks A, Boudreau JD. Reflection in medical education: intellectual humility, discovery, and know-how. Med Heal Care Philos. 2019;22:167-178.

Driessen E. Do portfolios have a future? Adv Heal Sci Educ. 2017;22(1):221-228. https://doi.org/10.1007/s10459-016-9679-4

Isba R, Woolf K, Hanneman R. Social network analysis in medical education. Med Educ. 2017;51(1):81-88. https://doi.org/10.1111/medu.13152

Nimmon L, Regehr G. The complexity of patients’ health communication social networks: a broadening of physician communication. Teach Learn Med. 2018;30(4):352-366. https://doi.org/10.1080/10401334.2017.1407656

Roberts LW. Belonging, respectful inclusion, and diversity in medical education. Acad Med. 2020;95(5):661-664. https://doi.org/10.1097/ACM.0000000000003215

Prideaux D. Social network analysis in medical education: a methodology in search of a theory. Med Educ. 2017;51(1):9-10. https://doi.org/10.1111/medu.13217

Nimmon L, Cristancho S. When I say … networks and systems. Med Educ. 2019;53(4):3-5. https://doi.org/10.1111/medu.13673

Buckley H, Nimmon L. learning in faculty development: the role of social networks. Acad Med. 2020;95(11S):S20-S27. https://doi.org/10.1097/acm.0000000000003627

Marin A, Wellman B. Social network analysis: an introduction. In: Carrington P, Scott J, eds. Handbook of Social Network Analysis. London: SAGE; 2011:11-25.

Nimmon L, Artino AR, Varpio L, Artino Jr AR, Varpio L. Social network theory in interprofessional education: revealing hidden power. J Grad Med Educ. 2019;11(3):247-250. https://doi.org/10.4300/JGME-D-19-00253.1

Atherley AEN, Nimmon L, Teunissen PW, Dolmans D, Hegazi I, Hu W. Students’ social networks are diverse, dynamic and deliberate when transitioning to clinical training. Med Educ. 2020;00(September):1-11. https://doi.org/10.1111/medu.14382

Nimmon L, Atherley A. Qualitative ego networks in health professions education: capturing the self in relation to others. Med Educ. 2022;56(1):71-81. https://doi.org/10.1111/medu.14663

University of British Columbia Faculty of Medicine. Statistical data on application and admissions.; 2017.

Varpio L, Ajjawi R, Monrouxe L V., Brien BCO, Rees CE. Shedding the cobra effect: Problematising thematic emergence, triangulation , saturation and member checking. Med Educ. 2017;51(1):40-50. https://doi.org/10.1111/medu.13124

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753-1760. https://doi.org/10.1177/1049732315617444

Bellotti E. Qualitative networks: mixed methods in sociological research. new York: Routledge; 2015. https://doi.org/10.5565/rev/redes.638

Hogan B, Carrasco JA, Wellman B. Visualizing personal networks: Working with participant-aided sociograms. Field methods. 2007;19(2):116-144. https://doi.org/10.1177/1525822X06298589

Huot S, Rudman DL. Extending beyond qualitative interviewing to illuminate the tacit nature of everyday occupation: Occupational mapping and participatory occupation methods. OJTR Occup Particip Heal. 2015;35(3):142-150. https://doi.org/10.1177/1539449215576488

Hollstein B. Qualitative approaches. In: Carrington P, Scott J, eds. Handbook of Social Network Analysis. London: SAGE; 2011:404-416.

Larsson J, Holmström I. Phenomenographic or phenomenological analysis : Does it matter? Examples from a study on anaesthesiologists’ work. Int J Qual Stud Health Well-being. 2007;2(1):55-64. https://doi.org/10.1080/17482620601068105

Wojnar DM, Swanson KM. Phenomenology: an exploration. J Holist Nurs. 2007;25(3):172-180. https://doi.org/10.1177/0898010106295172

Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;0(0):1-9. https://doi.org/10.1080/0142159X.2020.1755030

Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant. 2002;36:391-409.

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Heal Sci. 2013;15(3):398-405. https://doi.org/10.1111/nhs.12048

Kuper A, Lingard L, Levinson W, John S, Eaton L. Critically appraising qualitative research. Was the sample used in the study appropriate to its research. Bmj. 2008;337(a1035):1-6. https://www.bmj.com/content/337/bmj.a1035.

King N, Bravington A, Brooks J, Hardy B, Melvin J, Wilde D. The pictor technique: a method for exploring the experience of collaborative working. Qual Health Res. 2013;23(8):1138-1152. https://doi.org/10.1177/1049732313495326

Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. Br Med J. 2000;320(7226):50-52. https://doi.org/10.1136/bmj.320.7226.50

Hogg MA, Terry DJ, White KM. A tale of two theories : a critical comparison of identity theory with social identity theory. Soc Psychol Q. 1995;58(4):255-269. https://doi.org/10.2307/2787127

Burford B. Group processes in medical education: learning from social identity theory. Med Educ. 2012;46(2):143-152. https://doi.org/10.1111/j.1365-2923.2011.04099.x

Gillespie H, Kelly M, Gormley G, King N, Gilliland D, Dornan T. How can tomorrow’s doctors be more caring? A phenomenological investigation. Med Educ. 2018;52(10):1052-1063. https://doi.org/10.1111/medu.13684

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251. https://doi.org/10.1097/ACM.0000000000000388

Lovell B. “We are a tight community”: social groups and social identity in medical undergraduates. Med Educ. 2015;49(10):1016-1027. https://doi.org/10.1111/medu.12781

Ashforth BE, Mael F. Social Identity Theory and the Organization. Acad Manag Rev. 1989;14(1):20-39. https://doi.org/10.5465/AMR.1989.4278999

McPherson M, Smith-Lovin L, Cook JM. Birds of a feather: homophily in social networks. Annu Rev Sociol. 2001;27:415-444. https://doi.org/10.1146/annurev.soc.27.1.415

Weaver R, Peters K, Koch J, Wilson I. “Part of the team”: professional identity and social exclusivity in medical students. Med Educ. 2011;45(12):1220-1229. https://doi.org/10.1111/j.1365-2923.2011.04046.x

Blakey H, Blanshard E, Cole H, Leslie F, Sen R. Are medical students socially exclusive? A comparison with economics students. Med Educ. 2008;42(11):1088-1091. https://doi.org/10.1111/j.1365-2923.2008.03126.x

Nimmon L, Regehr G. The complexity of patients’ health communication social networks: a broadening of physician communication. teach Learn Med. December 2017:1-15. https://doi.org/10.1080/10401334.2017.1407656

Bleakley A, Bligh J. Students learning from patients: let’s get real in medical education. Adv Heal Sci Educ. 2008;13(1):89-107. https://doi.org/10.1007/s10459-006-9028-0

Shapiro J. Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philos Ethics, Humanit Med. 2008;3(1):1-11. https://doi.org/10.1186/1747-5341-3-10

Keren D, Lockyer J, Ellaway RH. Social studying and learning among medical students: a scoping review. Perspect Med Educ. 2017;6(5):311-318. https://doi.org/10.1007/s40037-017-0358-9

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Published

2022-05-27

How to Cite

1.
Stasiuk S, Hubinette M, Nimmon L. The ways social networks shape reflection on early significant clinical experiences in medical school. Can. Med. Ed. J [Internet]. 2022 May 27 [cited 2022 Sep. 29];13(5):28-3. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/73422

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Original Research