Virginia McCarthy, MDiv “Am I becoming the person and physician I want to become?” Using Student Reflections to Measure Outcomes in Community and Global Health Education Amy Blair, M.D. Amy Buchanan, M.D. Virginia McCarthy, MDiv Rebecca Maddrell, MS3

Disclosures Nothing to disclose

Global Health Participation

Definitions Most people reflect, but the skill medical professionals need, Critical Reflection, is different: Reflection - looking back at something, considering it Critical reflection - the process of analyzing, questioning and reframing a personal experience to enhance learning and inform future behavior A skill developed over time with practice and feedback Used by health professionals to promote lifelong learning and improve outcomes UCSF LEaP reflection materials

Reflection Prompt A brief description of your experience, from start to finish including, travel, living conditions, clinical, community and leisure activities What did you learn about the local health care system in relation to the US health care system? If you were in a resource-poor setting, what challenges did this bring to your normal process of diagnosis and treatment? What are you bringing home with you from this rotation that you will apply to your future practice as a physician? How did and will this experience influence the kind of person and physician you would like to become?

Uses of Student Reflections Evaluation Tool Impact on Student Program Outcomes A topic that is critical in any introduction to global health problems.

Evaluation Tool Reflections can be used to: Understand logistical concerns without being on-site “Meet” supervising physicians and ensure educational goals were met Improve student preparation Bidirectional

“When we arrived…the rooms included a closet, shelf, refrigerator and two beds that were made of one mattress on a metal frame…the dye in my bed sheets made my skin itch and I barely was able to sleep for the first 3 nights…Another living adjustment with the dorms was that there was no air conditioning available. With the weather reaching the mid-90s, I was sweating all the time and it was difficult to sleep at night, as there wasn’t even a fan in my room.” Kumasi, Ghana “The medical education I received in Ghana was more thorough and personal that I have ever received in my lifetime. Not only were all the consultants very knowledgeable, they were also very great teachers. Many of them spent a few hours each day teaching us about so many different topics. It was amazing to see so many different consultants who knew so much information about the whole of medicine and not just their specialty. In the U.S., many of us are interested in specializing in a certain area of medicine; however, I think it comes at the cost of losing a lot of the general medical knowledge.” Kumasi, Ghana

Impact on Student Personal growth Understanding of global citizenship Ethical considerations and challenges Influence on future path (specialty, practice location), personal and professional

“In total, this experience not only shaped the type of physician I want to become, but it also has helped shape the kind of person I want to be throughout residency. To begin, I never want to be a lazy resident, lazy friend, lazy daughter, or lazy person. I want to make sure to stay energized to always have the extra ounce of energy to go the extra mile to learn more and do more for those people in my life. This rotation also reemphasized to me how important it is to think about a patient’s individual context in society when prescribing a treatment for that person. This is especially important when treating those without as many resources.” –Hermosillo, Mexico "...not only did my rotation in Bolivia give a sample of the style of life I would like to continue to live and the mode in which my heart operates, but it also provided an excellent opportunity to practice medicine in a setting with less resources, different presenting complaints than what is typical for the Midwest, and a population of patients that was unique to the area. While certainly there is overlap I know that all of this in some way or another adds to my life experiences as a person and future doctor, and hence, helps to make a better physician and fuller human." Palacios, Bolivia

Program Outcomes Analyze content for data patterns (descriptive) and what was meant by the data (interpretive) Using numerical or textual codes to identify specific pieces of data which correspond to a theme or grade on Likert scale

Example Outcome: Personal growth Scale 1-5 1. No mention of growth 2. Indirect mention of growth 3. Mentioned concept, no elaboration 4. Limited elaboration, no stated goal 5. Developed elaboration, goal stated

Future Directions Change in program offerings Establish new prompts/orientation Guidance of student-review of personal reflections during medical school Global Health Medical education Mentor/rater training

Resources Aronson, Louise. UCSF LEaP (Learning from your Experiences as a Professional): Guidelines for Critical Reflection: January 2012. https://www.mededportal.org/publication/9073