Jennifer Weller¹
Tanisha Jowsey² and Carlos Campos¹
1 University of Auckland
2 Bond University

Critical reflection is an essential skill in health professionals education and is routinely taught and assessed. How are critical reflection skills supported in clinical practice, and in particular, critical reflection on leadership and team building skills in acute care teams. 

Teams make better decisions if all team members contribute to decision-making, ask questions and voice concerns. Psychological safety is required for this active engagement in patient care.(1) However, patient harm, avoidable only if someone had spoken up, and been listened to continue to be reported. Staff won't speak up if it's feels unsafe to do so. Clinical leaders need to take responsibility for ensuring psychologically safety where all staff feel safe to express their views. We aimed to develop a tool for clinicians to critically reflect on their own attitudes and behaviours impacting psychological safety in their clinical teams. 

Methods 

In a grounded theory interview study of multi-professional senior surgical staff we explored reactions to being spoken up to and created a theoretical model from which we develop a 9- item critical reflection tool for senior staff on their attitudes and behaviours around team members speaking up to them. We piloted this with 47 multi-disciplinary healthcare practitioners attending simulation based team-training instructors courses. We analysed the written responses to test the tool’s ability to provoke reflection, and to further refine the tool. 

We developed an 8-item, tool comprising Likert scale ratings and written rationale for each rating. Analysis of written responses from pilot data confirms our tool promotes personal in- depth critical reflection on attitudes and behaviours relevant to promoting psychological safety in healthcare teams. 

Future research will address the ability of the tool to promote critical reflection in a wider healthcare audience, and its value as an intervention to promote change in attitudes and behavours. 

References (maximum three) 

1. Edmondson AC, Roloff KS. Overcoming barriers to collaboration: Psychological safety and learning in diverse teams. InTeam effectiveness in complex organizations 2008 Nov 20 (pp. 217-242). Routledge. 

2. Long J, Jowsey T, Garden A, Henderson K, Weller J. The flip side of speaking up: a new model to facilitate positive responses to speaking up in the operating theatre. British Journal of Anaesthesia. 2020 Dec 1;125(6):1099-106. 

Vicki Jones¹
Sharmyn Turner¹ and Nathan Ryckman¹
1 University of Auckland 

Critical reflection is central to professionalism (MCNZ, 2021). In years four and five (Phase 2) of the medical programme, students' reflective practice skills are assessed using a student-led written portfolio. Portfolios are marked and moderated using a descriptive rubric with eight (numerically graded) criteria, 

To test the reliability and defensibility of grading, the Phase 2 results data for 2021-2022 was statistically analysed. Outcomes were compared to a ‘blind’ benchmarking exercise that utilised the current marking and moderating process. 

Results 

Despite numerical grades values for ‘pass’ and ‘distinction’ outcomes overlapping, the numerical grades are significantly higher for ‘distinction’ compared to ‘pass’ outcomes. Further, the distribution of ‘distinction’ outcomes became less spread over time as assessors gain experience in utilising the qualitative assessment rubric. 

Summative assessment works to engage students’ reflective practice skills (Driessen et al., 2005). However, setting rigid assessment cut-points where qualitative assessment tools are used can serve to diminish the richness of the assessed content. Delineating between ‘pass’ and ‘distinction’ grades requires assessor flexibility and may not always be a direct reflection of a derived numerical assessment outcome (Biggs, 1992). 

There appears to be little statistical basis to support a particular cut-point for a ‘distinction’ over a ‘pass’. This may be desirable considering the qualitative nature of the assessment. Rather than adhering to a rigid numerical structure to delineate between ‘pass’ and ‘distinction’, the PPS markers and moderator are encouraged to base their outcomes on the overall synthesis of quality and depth observed in each portfolio. Harnessing the experience of a stable marking team is important to optimise assessment reliability. 

A revised rubric incorporating a te ao Māori perspective is in development. The final version will be analysed and benchmarked to ensure future grading remains robust and defensible. 

References (maximum three) 

Biggs, J. B. (1992). A qualitative approach to grading students. Herdsa News, 14(3), 3-6. 

Driessen, E.W., van Tartwijk, J., Overeem, K., Vermunt, J.D., ven der Vleuten, C.P.M. (2005). Conditions for successful reflective use of portfolios in undergraduate medical education. Medical Education, 39, 1230 – 1235. https://doi.org/10.1111/j.1365-2929.2005.02337.x 

Medical Council of New Zealand. (2021). Good Medical Practice. https://www.mcnz.org.nz/assets/standards/b3ad8bfba4/Good-Medical-Practice.pdf 

David McLean1 Martin Richardson¹
1 Epworth HealthCare 

We applied a novel and innovative approach to the critical skill of reflective practice amongst medical student by utilizing creative writing strategies to promote an evaluation and analysis of attitudes and practices. The aim was to identify gaps in learning and to facilitate an awareness of ways to complement the positivist, constructivist of most students by alerting them to alternative perspectives when it came to evaluating performance. This became the subject of a research paper in The Journal of Medical Humanities in May 2022. 

The importance of our research lay in our stated aims to investigate the effects such an approach would have on student engagement, their perceptions of reflective practice and how this impacted on their ways of knowing. This meant we were delving into the reasons and attitudes held by students when it came to their perception of clinical studies many of which hadn't been identified or articulated by the cohort. They were given an opportunity to express sublimated thoughts and feelings which had remained hidden, namely their fears and doubts. It also exposed for the institution an opportunity to reflect on how it taught students and the implied agendas that existed within an institution. 

The strategies used are deceptively simple - one could even say surreptitious - but they are inclusive, non-threatening, playful and engaging. This has been seen as counter to the pressure and gravity normally associated with medical studies. It is also a way of relieving the pressure and tension some students feel because of the assumptions they have about medical studies. 

We want to run a workshop at the conference to demonstrate the strategies we utilized amongst the students to give participants an insight into just how deceptively easy it can be to implement such a program and how beneficial the outcomes can be. The abstract nature of the task runs counter to the scientific and logical approaches normally taken in the teaching of students and the qualitative nature of the evaluation is in direct contrast to the outcome orientation of medical studies. 

Anyone in a leadership role looking at expanding awareness of how we learn would be an ideal candidate to attend the workshop. Those responsible for the mental health and psychological wellbeing of students might find this of particular interest. 

Attendees need no previous knowledge to be able to participate but, rather, need a willingness to actively engage in the activities. 

Attendees will be able to build on their repertoire of strategies and approaches when it comes to fostering a learning community that can critically analyse how individuals are taught and how they respond and engage to the established model of delivery when undertaking clinical studies. 

References (maximum three) 

David McLean, Neville Chiavaroli, Charlotte Denniston, Martin Richardson 2022. "In‐verse reflection: structured creative writing exercises to promote reflective learning in medical students." Journal of Medical Humanities 43:493–504 https://rdcu.be/cN0XS 

Forbes, Lisa K. 2021. “The Process of Playful Learning in Higher Education: A Phenomenological Study.” Journal of Teaching and Learning 15 (1): 57–73. https:// doi. org/ 10. 22329/ jtl. v15i1. 6515. 

Shapiro, Johanna, and Howard Stein. 2005. “Poetic License: Writing Poetry as a Way for Medical Students to Examine Their Professional Relational Systems.” Families, Systems, & Health 23 (3): 278–292. https:// doi. org/ 10. 1037/ 1091- 7527. 23.3. 278.