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Reflective Medical Practice - Dr. Gawad
The document discusses reflective medical practice, emphasizing its definition as a learning process through self-evaluation and critical analysis of clinical experiences. It outlines the principles of 'reflection-in-action' and 'reflection-on-action,' the importance of self-awareness, and various frameworks to facilitate reflection. Additionally, it provides practical templates and case examples that illustrate how to apply reflective practices in clinical settings.
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Reflective Medical Practice - Dr. Gawad
- 1. Reflective Medical Practice Whatdoes it mean? Different Principles? How to apply it? Mohammed Abdel Gawad Nephrology Specialist Kidney & Urology Center (KUC) Alexandria - EGY drgawad@gmail.com GKA Master Class – Alexandria 2014
- 2. Reflective Medical Practice • • • • • • • • Whatdoes it mean? Why does it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 3. Reflective Medical Practice • • • • • • • • Whatdoes it mean? Why does it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 4. Reflective Medical Practice Whatdoes it mean? Your daily practice: Contact with: Patients Brookfield, 1995 Thiel, 1999 Quinn, 2000 Paterson, Chapman, 2013 Your colleagues The patient’s relatives Non medical staff
- 5. Reflective Medical Practice Whatdoes it mean? Your daily practice: Contact with: Patients Your colleagues The patient’s relatives Non medical staff Evaluate your own clinical decision making Evaluate your interactions with patients and team members Using the results of self-evaluation to influence future Brookfield, 1995 Thiel, 1999 Quinn, 2000 Paterson, Chapman, 2013
- 6. Reflective Medical Practice Whatdoes it mean? Your daily practice: Contact with: Patients Your colleagues The patient’s relatives Non medical staff Evaluate your own clinical decision making Evaluate your interactions with patients and team members Using the results of self-evaluation to influence future Brookfield, 1995 Thiel, 1999 Quinn, 2000 Paterson, Chapman, 2013 Reflective Medical Practice
- 7. Reflective Medical Practice Whatdoes it mean? • It is the process of learning through and from experience towards gaining new insights of self and/or practice. • It also tends to involve the individual practitioner in being self-aware and critically evaluating their own responses to practice situations. Boud et al 1985 Boyd and Fales, 1983 Mezirow, 1981 Jarvis, 1992
- 8. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why does it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 9. Reflective Medical Practice Whydoes it exist? Learning must not be absorbed by a process of osmosis when juniors work closely with more seniors Smith, C.S. and Irby, D.M. (1997). The Roles of Experience and Reflection in Ambulatory Care Education. Academic Medicine. Vol. 72. 32-35.
- 10. Reflective Medical Practice Whydoes it exist? Learning must not be absorbed by a process of osmosis when juniors work closely with more seniors Medical educator must move from that of “purveyor of information” to that of “facilitator of learning” Smith, C.S. and Irby, D.M. (1997). The Roles of Experience and Reflection in Ambulatory Care Education. Academic Medicine. Vol. 72. 32-35.
- 11. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why dose it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 12. Reflective Medical Practice DifferentPrinciples/Types Different Principles/Types ‘Reflection-IN-action’ (thinking while doing) (after-the-event thinking) Where the competent practitioner uses knowledge, experience and judgment to guide decisions in real life clinical situations as they are happening. Schon (1990) ‘Reflection-ON-action’ Which happens after the experience, enables learning about clinical practice and promotes development of such practice.
- 13. Reflective Medical Practice DifferentPrinciples/Types Different Principles/Types ‘Reflection-IN-action’ (thinking while doing) (after-the-event thinking) Where the competent practitioner uses knowledge, experience and judgment to guide decisions in real life clinical situations as they are happening. Schon (1990) ‘Reflection-ON-action’ Which happens after the experience, enables learning about clinical practice and promotes development of such practice.
- 14. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why dose it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 15. How to ApplyReflective Medical Practice? You will need the following for practice reflection: Reflective notebook to write notes, non answerable enquiries and thoughts A framework to help the learner adopt the discipline of reflection Allocate a supervisor for the learner to reflect with “provide a sounding board” Palmer, A., Burns, S. and Bulman, C. (1994). Reflective Practice in Nursing. Oxford: Blackwell Scientific.
- 16. How to ApplyReflective Medical Practice? You will need the following for practice reflection: Reflective notebook to write notes, non answerable enquiries and thoughts A framework to help the learner adopt the discipline of reflection Allocate a supervisor for the learner to reflect with “provide a sounding board” Palmer, A., Burns, S. and Bulman, C. (1994). Reflective Practice in Nursing. Oxford: Blackwell Scientific.
- 17. How to ApplyReflective Medical Practice? Frameworks – General Idea Always Ask
- 18. How to ApplyReflective Medical Practice? Frameworks – General Idea
- 19. How to ApplyReflective Medical Practice? Frameworks – Gibbs Cycle Gibbs, G. (1988). Learning by Doing; a guide to teaching and learning Methods. Oxford: Further Education Unit, Oxford Polytechnic.
- 20. How to ApplyReflective Medical Practice? Frameworks – Kolb’s Cycle
- 21. How to ApplyReflective Medical Practice? Frameworks – Rolfe’s Cycle
- 22. How to ApplyReflective Medical Practice? Frameworks – John’s Cycle
- 23. How to ApplyReflective Medical Practice? Recommended Template • Describe a Clinical Issue/Event/Incident/or Error that you have encountered in your daily work practice. Describe what happened. • Describe your Reflection-IN-Action: Describe how you reacted, how you felt. • Describe your Reflection-ON-Action: Describe your analysis of what happened. • Describe your Conclusions. • Describe what your learned from that experience. • Describe your action plan to deal with a similar situation in the future.
- 24. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why dose it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 25. Essentials to ApplyReflective Medical Practice Critical Thinking Always support your reflection by critical thinking and evidence based
- 26. Essentials to ApplyReflective Medical Practice Self Awareness Self Awareness is vital if there is to be any attempt at a behavior change
- 27. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why dose it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 28. Seniors & ReflectiveMedical Practice 28 y old female with lupus nephritis that is controlled long time ago (on steroids, azathioprine after completing euro lupus regimen with cyclophosphamide). She got pregnant, her aPL Abs were positive, we started low dose aspirin and LMW heparin prophylaxis. The treating PROF increased her maintenance steroid therapy to 20 mg from 5 mg. The junior asked him WHY?, The PROF said in 2ry APS (2ry to SLE) therapy needs more with immunosuppression rather than just anticoagulation.
- 29. Seniors & ReflectiveMedical Practice • The junior searched the pubmed and found a very good review telling that the basic treatment will be LDA + LMWH or unfractionated heparin • As it's her first pregnancy there is no need to increase her steroid level as long as there is no complications yet, also steroids are associated with preterm delivery, HTN, gestational diabetes. • He returned back to the PROF with the info, then he decreased her steroid level again.
- 30. Don’t Hesitate toReflect Your Senior’s Practice & Actions
- 31. Teaching Matrix Doctors whowork as educators must reflect themselves too Feins, A., Waterman, M.A., Peters, A.S. and Kim, M. (1996). The Teaching Matrix: A Tool for organising Teaching and Promoting Professional Growth. Academic Medicine. Vol. 71. 1200-1203.
- 32. Teaching Matrix Feins, A.,Waterman, M.A., Peters, A.S. and Kim, M. (1996). The Teaching Matrix: A Tool for organising Teaching and Promoting Professional Growth. Academic Medicine. Vol. 71. 1200-1203.
- 33. Teaching Matrix • Whoare the target audience? • What is the time allowed for me for presentation? • Is it educational or state of the art and appraisal?
- 34. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why dose it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 35. Just to Rememberthe Recommended Template • Describe a Clinical Issue/Event/Incident/or Error that you have encountered in your daily work practice. Describe what happened. • Describe your Reflection-IN-Action: Describe how you reacted, how you felt. • Describe your Reflection-ON-Action: Describe your analysis of what happened. • Describe your Conclusions. • Describe what your learned from that experience. • Describe your action plan to deal with a similar situation in the future.
- 36. Clinical Issue/Event/Incident • 27years old married female on hemodialysis since 2 years from well functioning AVF, 3 times per day, 4 hrs each session. • She is not DM, HTN. She has no immunological disorder (SLE). The cause of kidney disease is unknown. • She is on ESA therapy adjusted to her body weight. Her TSAT is 35% and S.Ferritin is 550. Hb level is 9.5 g/dl, although she is on ideal ESA dose according her body weight. • She is complaining of continues sense of fatigue, nausea and vomiting. What is your reflection IN action?
- 37. • You raisedher ESA dose by 25% and after one month her Hb level is 10g/dl, and there was no improvement in her symptoms. What is next? • You raised her ESA dose again by 25% (total 50%) and after one month her Hb level is 10.2g/dl, and there was no improvement in her symptoms. What is next?
- 38. All causes ofresistant anemia are excluded • • • • • • • • • Her anemia is normocytic normochromic. Her platelets and WBC are normal. No evidence of hemolysis. S.Vit B12, folate levels are normal. No evidence of infection. Her PTH level & trend are accepted. Her thyroid function is normal. ESR is not too high. She is not malnourished. What is next? You decided to search the literature?
- 39. You decided tosearch the literature? What are the key words you will use to search? resistant anemia female hemodilaysis
- 40. You decided tosearch the literature? What are the key words you will use to search? resistant resistant anemia anemia female hemodilaysis female hemodilaysis
- 41. So which testyou will use to confirm her pregnancy? Beta HCG
- 42. So which testyou will use to confirm her pregnancy? Beta HCG As CKD patients have different hormonal physiology than normal population So, You decided to search the literature?
- 43. What is yourReflection On Action? • Did you diagnose the case late? • Did you use the appropriate test for diagnosis? • What is your future plan when you face a CKD female of child bearing age? • Any other Reflection?
- 44. Conclusions & Whatyou learned • Although the incidence of pregnancy in child bearing females on HD is low, you have to put it in mind all the time. • Diagnosis of pregnancy in CKD patients needs a high degree of suspicion. • Because beta HCG is removed by the kidney, beta HCG levels are higher at each stage of gestation than in women with normal renal function So pregnancy diagnosis must be by US. • Always discuss with your child bearing aged HD females the risk of pregnancy and advice her about contraception. • Pregnant CKD patient (whether on HD or not) is a special category of patients and need special care and follow up.
- 45. Reflective Medical Practice • • • • • • • • Whatdose it mean? Why dose it exist? Different Principles/Types How to Apply Reflective Medical Practice? Essentials to Apply Reflective Medical Practice Seniors & Reflective Medical Practice An Example of Reflective Practice Benefits of Reflective Medical Practice
- 46. You have toreflect your medical practice To covert short term memory to long term one
- 47. You have toreflect your medical practice For Better Performance
- 48. You have toreflect your medical practice So you will not loss resources or waste time
- 49. You have toreflect your medical practice So you will be able to choose the best solution for your difficult situations
- 50. You have toreflect your medical practice To develop your own way of management
- 51. You have toreflect your medical practice To develop your own way of management
- 52.