Peih-ying Lu¹
Anna Shan Chun Hsu¹, Po-Chih Chang^1,2 and Hsin-Liang Liu²
1 Kaohsiung Medical University
2 Kaohsiung Medical University Chung-Ho Memorial Hospital 

Medical professionalism and communication skills are core competencies for doctors. Despite these competencies' complexity, developmental and multi-faceted contextual nature, they are often assessed using checklists in clinical learning(1,2). This study examined how cultural competence, communication skills, and empathy are assessed through students’ reflective writing in a two-day Clinical Learning Through Extended Immersion in Medical Simulation(CLEIMS). Pre-/post-session surveys were used to cross-exam the results. 

During the 2021-2022 academic year, students in second-year clerkship(n=185) attended CLEIMS. In teams of 4-6, students rotated at 20–25-minute intervals through six stations with scenarios containing psycho-social-cultural contents. Students encountered situations such as breaking bad news to a waiting wife, caring for lone residing elderly. Students completed a pre-session survey related to professionalism and physician-patient communication, and a similar post-session survey and reflective writing assignment to share their feelings and experiences. 

A total of 163 reflective writings were analyzed using inductive thematic analysis. Findings showed students (i)described standardized approach used to communicate bad news; (ii)provided examples of how they empathized or failed to empathize with others; (iii)explained ways to interact with culturally diverse patients; (iv)identified their feelings/values and how these influenced decision-making. Students self-assessed survey data were cross-examined. Survey responses also reflected trends similar to the qualitative findings, which revealed students need more support and guidance. 

As professionalism and communication skills develop gradually throughout the learning spectrum, reflective writings allow teachers to conduct in-depth assessments and understanding of students' learning(3) and identify areas needing further guidance. A closer examination also manifested students' awareness of others' feelings and perspectives and some core elements of professionalism, such as cultural competence. Reflective writings create space for personal insight, and re-contextualization of students’ learning from different incidences, allowing teachers to give timely feedback. 

Reflective writing is an approach to understanding students' development of professionalism, and continuous feedback from educators is necessary. 

References (maximum three) 

1. Hawkins, R. E., Katsufrakis, P. J., Holtman, M. C., & Clauser, B. E. (2009). Assessment of medical professionalism: Who, what, when, where, how, and... why?. Medical teacher, 31(4), 348-361. 

2. Hodges, B., Paul, R., Ginsburg, S., & The Ottawa Consensus Group Members. (2019). Assessment of professionalism: From where have we come–to where are we going? An update from the Ottawa Consensus Group on the assessment of professionalism. Medical Teacher, 41(3), 249-255. 

3. Charon, R., & Hermann, N. (2012). Commentary: a sense of story, or why teach reflective writing?. Academic Medicine, 87(1), 5-7.