By Mark Kuczewski, Katherine Wasson, Kayhan Parsi, and Emily Anderson
Judging from coverage in the literature lately, reflection as an educational tool is becoming increasingly popular in medical school. But instructors use reflection for lots of different reasons. In a recent article, we described how we use reflection in the formal curriculum and in two co-curricular programs at Loyola University Chicago Stritch School of Medicine.
Reflection permeates, even saturates, the curriculum here. It aligns neatly with the school’s culture and reinforces it. As we create a community of learners engaged in reflection, it raises a number of opportunities and challenges for our future work.
Many educators use reflection as a tool to promote Professional Identity Formation (PIF). This literature highlights several related but differing functions fostered by reflection that can contribute to professional identity formation. Reflection potentially can reduce stress and promote wellness. It may drive improvement in students who critically examine their strengths and skills and can help them develop their understanding of the physician’s role. Although we’ve seen all of these outcomes and more at Loyola Stritch, they’re not really why we value reflection so greatly.
As a Jesuit and Catholic school, our culture is hospitable to reflection. The school’s sponsoring order of priests known as the Society of Jesus (“Jesuits”) bring a humanistic approach to education that takes “seeing God in all things” as a point of departure for our educational mission. It’s easy to see that if God is in everything, then our ordinary subjective experience is worthy of exploring and savoring. When you teach at a Jesuit school, there are phrases you hear all the time that are part of how we understand what we’re trying to do. We are often said to be trying to produce “men and women for others.” Jesuit education is characterized by caring for the person (cura personalis) who, through formative reflection, in turn orients his or her life to serving others. Of course, we sometimes skip these links in our chain of reasoning and just say that Jesuit education is about social justice. This shared culture likely explains the large number of reflective exercises that have sprung up independently around our school.
We have recently begun to work with the many faculty employing reflective exercises. We hope that we can assist in improving the quality of the exercises by helping the faculty understand the goals for their use; and make a somewhat disjointed curriculum into a more comprehensive one. We are starting by looking at such matters as the quality and consistency of prompts and feedback.
We would like to help our colleagues be more effective educators and it would be wonderful if we can find ways to show the effectiveness of their exercises. However, our first priority is to show that we value reflection, and evaluation must be in its service. Following the ideals of the Jesuits, we see the habit of reflecting as an intrinsic good that also can bear a variety of fruits. As a result, as we consider ways to provide feedback or evaluation, we ask what kind of feedback might increase the value the student places on reflection. So, in our recent conversations, we find ourselves advocating that faculty also share their reflections with students and create opportunities for students and faculty to relate to each other’s reflections. In short, we think we are seeking to build on our culture of reflection and to become a community of reflection. We suspect that participation in such a community will lead our graduates to maintain a habit of reflection beyond medical school.
Mark G. Kuczewski, PhD, is the Father Michael I. English, S.J., Professor of Medical Ethics, Director of the Neiswanger Institute for Bioethics and Health Policy, and Chair of the Department of Medical Education at the Loyola University Chicago Stritch School of Medicine. He can be reached at email@example.com.
Katherine Wasson, PhD, MPH, is assistant professor of bioethics at the Loyola University Chicago Stritch School of Medicine.
Kayhan Parsi, JD, PhD, is professor of bioethics and graduate program director, Neiswanger Institute for Bioethics and Health Policy, at the Loyola University Chicago Stritch School of Medicine.
Emily Anderson is assistant professor of bioethics at the Loyola University Chicago Stritch School of Medicine.