ICCH 2011 Presentation on Significant Event Analysis, reflective exercise for med students. AACH member.

1. Significant Event ReflectionUniversity of MinnesotaMedical School Kenneth P. Olson, MD David V. Power, MD, MPH Therese M. Zink, MD, MPH Department of Family Medicine and Community Health

2. Significant Event Reflection (SER) Initially developed due to: A clear ‘gap’ in curriculum, esp. years 3 and 4 Motivated faculty The only other reflective activity in curriculum isoptional: The Healer’s Art, year 1 Facilitated reflective exercise based on the critical incident analysis work of Branch, et al

3. Family Medicine Clerkship SER established as a required activity during the Family Medicine Clerkship in 2007 Required clerkship for all students, year 3 or 4 Four week outpatient clinical experience with weekly centralized small group activities

4. Significant Event Reflection Single session, mid-clerkship, about 2 hours 5 to 8 students, usually 6 Selected, experienced faculty facilitators Initially included non-FM facilitators Before the session, students reflect on and write about an experience that moved them Instructions and examples posted on Moodlewebsite (see Handout)

6. SER Goal and objectives Goal: provide a safe environment for the student to examine the impact and meaning of a significant event with peers. Objectives: Reflect on an event with peers Listen generously

7. SER Description Format (see handout) Brief introductions Many of the students do not know each other Ground rules set by the group Confidentiality, mutual respect often identified by the students. No “fixing” and speak only for yourself often offered by the facilitator

8. SER Description Each student tells or reads his/her story with discussion between. Students often volunteer how the event has affected them Other students may ask questions, offer their own experiences Facilitator may ask questions also

9. SER Themes Data collected between May 2010 and September 2011 and is ongoing. After each session, faculty recorded themes of the stories Initially identified somethemes Added some over time Merged some similar themes

10. Data Collection Form

11. Results: Themes

12. Major Themes Expanded Personal Awareness Values Conflict Bonding story and Therapeutic Listening Stressful Situation and Knowledge Gap Hidden Curriculum and Specialty Turf War Student does Clean-up or Spends Time with the Family First Code, First Death, Fetal Demise, Major Anomalies System Tragedy (Legal, Social, Medical)

13. Some poignant stories The morgue (personal awareness, death) bridge collapse The fellow (unprofessional behavior with a power differential, stress and knowledge gap) “Go take care of this patient…” The attending (outstanding model, student bonding) Cultural awareness in the face of the “crazy” post partum patient

14. More poignant stories The drug addict and the valve replacement (values conflict) The eulogy invitation (bonding story) Acquaintance cum patient Atrial fib and the bone marrow transplant (specialty turf war and hidden curriculum) CPR (bonding and death) First person conversation with comatose patient

15. Outcomes Well established in clerkship curriculum All students tolerate it being required Committed, reliable group of 4 usual facilitators 3 of whom are retired from full time practice Several students have published narratives (See handout)

16. Evaluations, 5/10 – 4/11

17. Conclusions SER is valued by most medical students To identify and relieve distress Develop deeper understanding of events Breakdown isolation they may feel Lifelong learning exercise Remains the only formal setting for student sharing in the clinical years

18. Feedback / Discussion Questions? Insights? olson174@umn.edu power007@umn.edu zink0003@umn.edu