인본주의적, 회복탄력적 의사 양성을 위한 전문직 정체성 형성: 이론을 실제와 연결시키기 위한 교육전략(Acad Med, 2015)

인본주의적, 회복탄력적 의사 양성을 위한 전문직 정체성 형성: 이론을 실제와 연결시키기 위한 교육전략(Acad Med, 2015)

Professional Identity Formation in Medical Education for Humanistic, Resilient Physicians: Pedagogic Strategies for Bridging Theory to Practice

Hedy S. Wald, PhD, David Anthony, MD, MSc, Tom A. Hutchinson, MB, Stephen Liben, MD, Mark Smilovitch, MD, and Anthony A. Donato, MD, MHPE

의사가 되려는 개인은 transformation이 필요합니다. 한 개인은 단순히 의사가 되는 법을 배우는 것이 아니라, 의사가 되는become 것입니다.

To be a physician requires a transformation of the individual—one does not simply learn to be a physician, one becomes a physician.

— Abraham Fuks and colleagues, “The Foundation of Physicianship”1

이 기사에서 우리는 전문적인 정체성 형성 (PIF)을 목표로 삼은 3 가지 교육 혁신을 소개합니다.

Within this article, we present three pedagogic innovations aimed at professional identity formation (PIF)

이러한 교수법의 공통된 특징은 핵심 역량에서 전문 역량에 이르는 성찰 기술 개발입니다 .3 안내된Guided 성찰은 PIF의 적극적인 건설 프로세스의 중요한 구성 요소입니다

A shared feature of these pedagogies is the development of reflective skills, core to professional competency.2,3 Guided reflection is a critical component of the active construction process of PI F. 4 

PIF과정의 중요성

Importance of the PIF Process

의학 교육은 기술과 지식을 가르치고 전문적인 정체성의 개발을 지원하는 이중dual 책임이있다.

Medical education has the dual responsibility of teaching skills and knowledge and of supporting the development of a professional identity.6,7

인본주의적인 기술, 행동 및 태도의 개발은 능동적 학습 과정이며, 이상적으로는 "인간에 대한 깊은 존경에 따라 ... 그들의 일반적인 복지와 번영에 대한 관심"에 이르게합니다. 성격 (덕과 속성 포함)의 배양과 인본주의적 의사의 행동을 평생 추구하기 위해서는 교수, 의료진, 학생들의 집단적 자기 인식을 필요로 한다.

Development of humanistic skills, behaviors, and attitudes is an active learning process, ideally leading to the “accordance of deep respect to humans … and concern for their general welfare and flourishing.”9 Cultivating the  character (including virtues and attributes) as well as lifelong pursuits and behaviors of humanistic physicians requires a collective self-awareness of faculty, house staff, and students4 and is of keen interest within medical education

의과대학생 "전체wholeness"와 engagement (환자 및 자아로부터의 과도한 분리를 피하는 것)는 "온 사람을 온 인격으로 돌보는 것"에 부합하는 돌보는 인본주의적이고 윤리적 인 의사의 훈련에 필수적입니다.

Medical student “wholeness” and engagement (avoiding excessive detachment from patients and from self) are essential for the training of caring, humanistic, and ethical physicians,10 in line with “bringing our whole person to whole person care.”11

성찰적 글쓰기 (reflection writing-RW)를 통한 성찰은 PIF에서 학생들의 지적, 감정적, 영적 차원의 배양을 강조한다.

reflective writing (RW)-enhanced reflection—emphasizes cultivation of students’ intellectual, emotional, and spiritual dimensions within PIF,

궁극적으로, 의료 전문가의 정체성은 "여러 단계와 오랜 시간에 걸쳐서 달성되는, 의료 전문직의 특성, 가치 및 규범이 내면화되어 개인이 의사와 같이 생각하고, 행동하고, 느끼도록 하는 자기 표현입니다."4 

Ultimately, a medical professional’s identity is “a representation of self, achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalized, resulting in an individual thinking, acting, and feeling like a physician.”4 

일반적으로 PIF는 잘 통합 된 개인적 및 전문적 개발 또는 다음과 같다.

In general, PIF may be conceptualized as well-integrated personal and professional development or 

“the moral and professional development of students, 

the integration of their individual maturation with growth in clinical competency, and 

their ability to stay true to values which are both personal and core values of the profession.”7

보건전문직교육에서 PIF 서포트를 위한 성찰의 촉진

Fostering Reflection to Support PIF in Health Professions Education and Practice

성찰적 글쓰기의 힘

The power of RW

임상 추론, 환자 의사 소통 및 전문성을위한 필수 역량 인 RC (Reflective Capacity)는 (학생들이 의사 - 환자 상호 작용의 복잡성을 탐구하고 반성하는 전문적인 자아를 개발함에 따라) 메타인지 및 정서 인식 기술을 포함합니다. 성찰이 반드시 직관적인 것은 아니므로, RW를 통해 성찰 기술을 향상시키고 보건 의료 직업 교육에서 개인적 및 전문적 개발을 지원할 수 있다.19-23

Reflective capacity (RC), an essential competency for clinical reasoning, patient–physician communication, and professionalism,3 encompasses skills of metacognition and emotional awareness as students explore the complexities of physician–patient interactions18 and develop a reflective professional self. Given that reflection is not necessarily intuitive, the use of RW to enhance reflective skills and support personal and professional development in health care professions education is well documented.19–23

A RW curriculum in a family medicine clerkship

At Alpert Medical School of Brown University (AMS), students’ structured RW, which was combined with guided individualized written feedback from interdisciplinary faculty (“interactive RW”), was first implemented in a doctoring course20 in 2005 and further developed within a family medicine clerkship beginning in 2009.27 AMS students participate in two cycles of interactive RW during a six-week required family medicine clerkship. The curricular objectives align with processes fundamental to and essential for students’ active construction of PIF—namely, 

• (1) improving students’ RC; 

• (2) sharing personal narratives within an authentic, safe community of learners7; and 

• (3) providing positive role modeling and adequate mentoring.28

The RW curriculum, which is a component of an existing small-group curriculum during weekly didactics, bridges classroom learning and clinical experiential learning. 

• In each of two RW cycles, students respond in writing to a prompt and electronically submit their RW to an interprofessional small-group faculty team—a physician and a clinical psychologist–medical educator (H.S.W.). 

• During the small-group session in the following week, an hour is devoted to collaborative reflection on and processing of the narratives (reflective triggers). Faculty facilitators emphasize the small groups as safe spaces for discussing challenges, triumphs, uncertainties, lessons learned, and inherent stresses of developing into a physician. Students are invited, though not required, to share their narratives, and the group is invited to respond.

Following this session, each student is provided written structured, individualized feedback to his or her narrative via e-mail from faculty. Written feedback is strictly formative, not included in the student’s final summary evaluation, and uses systematic frameworks for enhancing the educational impact of RW (described below). In crafting feedback, faculty often attach supplemental literature (resonating with students’ RW themes), including published reflective narratives, poetry, and/or peer-reviewed research. 

The curriculum structure includes four reflection tiers: 

• (1) community mentor experience (role modeling), 

• (2) RW (the writing process itself), 

• (3) small-group collaborative reflection and feedback, and 

• (4) individualized written formative feedback promoting a more in-depth reflective process. 

Experience followed by reflection within a community of peers is a key PIF component.29

Guided reflection is an integral component of PIF4; thus, we provide a faculty development (FD) session30 to enhance the educational impact of RW pedagogy as well as the availability of ongoing faculty advising and consultation. The formalized FD session promotes skilled readers/responders (and small-group facilitators) with instruction in 

• (1) systemized frameworks to guide the crafting of quality written feedback to students’ RW while attending to the intellectual and emotional processes of becoming a physician,31 and 

• (2) effective small-group facilitation. 

The frameworks are 

• (1) the Brown Educational Guide to the Analysis of Narrative (BEGAN)24,32 and 

• (2) the Reflection Evaluation For Learners’ Enhanced Competencies Tool (REFLECT) rubric.33 

The REFLECT rubric is used for formative assessment of reflective level within students’ RW and guides BEGAN application. 

PIF가 평생 과정이기 때문에 (협동적 성찰과 같은) 교육 또는 FD 세션 참여를 통한 교수 자신의 PIF가 이루어질 가능성이 있다.34,35 소그룹 토론의 촉진은 교수진의 성취 및 renewal의 원천이 될 수있다. .36 사실 우리 소그룹 교수 중 한 명이 최근에 이렇게 말했습니다. "이것은 내가 왜이 사업에 들어 갔는지를 상기시켜줍니다."

Given that PIF is a lifelong process, the potential for faculty members’ own PIF through the teaching (collaborative reflection) and participation in FD sessions is recognized.34,35 Facilitation of small- group discussions may be a source of fulfillment and renewal for faculty.36 Indeed, as one of our small-group faculty recently remarked, “This reminds me why I went into this business.”

Guided reflection within individualized RW feedback and/or a collaborative group process (using RW) on key wellness themes—such as 

• managing uncertainty23; 

• identifying gaps in self- care; and 

• fostering self-compassion37 and attitudes promoting constructive, healthy engagement with challenges at work

...may foster resiliency and enhance well-being to promote healthy, integrated PIF.10 

이와 같이 대화 형 RW는 지적 스트레칭, 정서적 인 근육 만들기, 임상 실습의 "마라톤"을위한 윤리적 적합성 증진과 같은 은유 적 "탄력성 운동"으로 최근 설명되었습니다 .5

As such, interactive RW has recently been described as a metaphorical “resiliency workout” with intellectual stretching, building emotional muscle, and fostering ethical fitness38 for the “marathon” of clinical practice.5 

우리의 목표에 부합하도록 유도된 비판적 성찰 기술 개발은 의대생의 스트레스를 줄이고 건강을 증진시키는 것으로 나타났습니다. 39-41 그리고 RW는 학생들의 공감 능력에 긍정적 인 영향을 미치는 것으로 나타났습니다 .42 학생들의 PW와 소그룹 성찰에는 통찰력이 풍부하며, 우리는 학생들이 자신과 의사로서의 역할에 대해 더 깊이 이해하는 것을 관찰하게 된다..

In line with our objectives, guided critical reflective skills development has been shown to reduce stress and foster wellness in medical students,39–41 and RW has been shown to positively influence students’ capacity for empathy.42 There is a richness of insight in students’ RW and small-group reflection, and we observe students gaining a deeper understanding of themselves and their roles as physicians.

의과대학생에서 PIF의 하나로 회복탄력성 증진하기

Promoting Resilience as Part of PIF in Medical Students

앞서 우리는 의학 교육의 초기 단계에서 회복력을 키우는 것에 대한 관심이 증가하고 있다고 설명했습니다. 의학 교육과 실습은 PIF를 초래할 수 있지만 건강한 직업적 정체성에 손상을 줄 수 있습니다. 실천하는 의사와 대학 의대생 모두에서 냉소주의와 번아웃이 높아지는 것이 이를 입증한다. 10,46,47 직업 분야에서 효과적으로 기능하는 것은 의료 PIF의 중요한 구성 요소이며, 회복탄력성의 정의는 "지속적인 스트레스와 역경에 직면하여 개인적이고 전문적인 복지를 유지할 수있는 능력"으로 정의된다. 불리한adverse 의료 상황에서 의과대학생은 기존의 개인적 정체성이 아니라 전문직으로서의 개인으로 응대해야 한다. 학생에 대한 멘토링은 그러한 시나리오를 준비하면서, 기능적 자기 개념과 행동 ( "훌륭한 의사"의 존재와 수행)을 발전시킵니다. 4

Earlier, we described the increasing interest in fostering resilience within early stages of medical education. Medical education and practice can result in PIF but also in damage to a healthy professional identity, as evidenced by the high levels of cynicism and burnout both in practicing physicians as well as in undergraduate medical students.10,46,47 Developing the necessary resilience to function effectively in the professional arena is a vital component of medical PIF,48 with a working definition of resilience being “the ability to maintain personal and professional well-being in the face of ongoing work stress and adversity.”48 Adverse medical situations challenge medical students to respond as professional individuals rather than as they would have in their preexisting personal identities.49 Mentoring students in preparing for such scenarios fosters the development of functional self- concepts and behaviors (the being and the doing of the “good physician”).4

Module One: Resilient responses to difficult clinical interactions

For a teaching module used at McGill University Faculty of Medicine since 2007, we developed brief, emotionally confronting, and ethically challenging clinical scenarios based on real events reported to faculty. Examples included 

• being verbally abused by a physician in authority, 

• being put under pressure to perform an ethically questionable procedure on a patient, 

• being manipulated by a resident to not answer questions posed by attending staff, and 

• having a conversation with an angry family about a seriously ill family member.

Each student plays a role in one scenario and observes two other scenarios. These teaching sessions consist of five separate sections: 

• (1) prebriefing for faculty (the prebriefing documents for faculty are available from us), 

• (2) prebriefing for faculty and students, 

• (3) scenarios followed by small-group debriefing, 

• (4) large-group debriefing, and 

• (5) debriefing for faculty.

We base our faculty briefing for these sessions and our teaching in the large-group debriefing on Satir and colleagues’50 work on congruent relating and Kabat-Zinn’s51 work on coping with stress mindfully. 

특히 Satir의 작업에서 우리는

• 스트레스가 많은 상황에서 자신, 다른 사람, 상황에 remaining present하는 것의 중요성 50

• 비난받으며, 비난 받거나, 매우 합리적이거나 혼란스러워하는 도움이되지 않는 생존 자세에서 자신을 붙잡기 위해 필요한 자기 인식.

• From Satir’s work in particular, we stress 

• the importance of remaining present to self, other, and context in stressful situations50 and 

• the self-awareness necessary to catch oneself in an unhelpful survival stance52 of placating, blaming, being super-reasonable, or distracting. 

Kabat-Zinn의 작업을 바탕으로 스트레스에 반응react하는 것과 반응responde하는 것의 차이점을 강조합니다 .51 우리는 이러한 주제에 대해 강의하지 않습니다. 오히려, 우리는 세션에서 나타나는 것을 사용하여 관련 사항을 강조합니다. 시나리오에 대하여(윤리적 딜레마 상황에서조차) 옳고 그른 반응을 강조하는 대신, 우리는 스트레스 상황의 시나리오에 대해서 congruent함을 유지하고, 스스로의 반응에 대해서 mindful하는 능력에 주로 초점을 둡니다.

• On the basis of Kabat-Zinn’s work, we emphasize the difference between reacting and responding to stress.51 We refrain from lecturing on these topics; rather, we use what emerges in the sessions to highlight relevant points. Instead of highlighting right or wrong responses to a scenario (even with an ethical dilemma), we focus primarily on a student’s ability to remain congruent50 and mindful in his or her response to a stressful scenario.

Module Two: Mindful clinical practice

Decreased stress and increased appreciation for life are demonstrated outcomes of mindfulness-based stress reduction courses first offered by the University of Massachusetts Medical School to patients with chronic pain.53 To address the problems of stress and burnout in medical students, “mindfulness-based medical” courses have recently been introduced into the curricula of several medical schools.54,55 New mindfulness-based medical undergraduate courses continue to emerge with outcome goals such as reducing student stress and cultivation of resilience, well-being, and personal growth.54,55 More broadly, mindful practice56 is highlighted as integral to the professional competency of physicians, requiring mentoring and guidance.

Synergy between the two modules

Our intention is synergy between these two teaching modules (mindful clinical practice before clerkships and resilient responses to difficult interactions during clerkships) to provide students with necessary knowledge, skills, and attitudes of mind fostering clinician resilience and enhanced well-being.

GME내에서 성찰 기술을 촉진하여 PIF 기르기

Fostering Reflective Skills to Cultivate the PIF Process Within GME

GME에서 PIF기르기의 중요성

The importance of cultivating PIF within GME

우리는 GME 내에서 복잡하고, 진행중이며, 역동적이며, 반복적 인 PIF 과정을 육성하기위한 효과적인 교육학의 실행의 중요성을 강조합니다. 직업의 하위 구성원은 의학 전문의 진술 된 가치와 의학의 현실 사이에서 불협화음을 조화시켜야합니다 이 과정은 학습자가 직업에 대한 암묵적이고 명시적인 기대를 동화하면서 환자 치료 경험의 서찰, 피드백, intercalation을 필요로한다.

We now turn to highlighting the importance of implementing effective pedagogy for cultivating the complex, ongoing, dynamic, and iterative PIF process within GME, given that junior members of the profession must reconcile dissonance between the stated values of the medical profession and the realities of medicine as practiced in the real world.58 This process requires reflection, feedback, and intercalation of patient care experiences as the learner assimilates tacit and explicit expectations of the profession.59 

• 레지던트는 의사를위한 최초의 전문적인 업무 경험을 대표하므로 직업의 연장자와의 성찰적 대화를 촉진하기위한 중요한시기입니다.

• 전문직 종사자로서의 역할에서부터 가치 평가, 의견 통합, 의사가되기까지 점진적으로 진보하는 것을 지원하려면 협업 학습 환경 내에서 숙련 된 종업원 지도 및 자문이 필요합니다 .58

• 이러한 지속적인 상호 작용은 PIF가 선형이 아니라 임상 경험에 의해 조장 된 위기와 학습자의 가치를 드러내고 도전하는 숨겨진 커리큘럼에 의해 추진된다는 점에서 중요합니다.

• 학습자의 성찰을 촉진하고 안내 할 수있는 역할 모델과 멘토는이 과정에서 매우 중요합니다.

• 이러한 중요한 멘토링 관계를 촉진하는 데 대한 위협은 교수진의 교육에 대한 관심 감소, 교육 시간 단축, 교수진에 대한 임상 요구 증가 등을 포함합니다.

• Residency represents the first professional work experience for physicians and is thus a critical time for facilitated reflective discussions with seniors in the profession. 

• Supporting the gradual progression from acting as a member of a profession to assuming its values, integrating feedback, and becoming a physician60 requires skilled longitudinal mentoring and advising within a collaborative learning environment.58 

• Such ongoing interaction is key, given that PIF is not linear but rather is pushed forward by crises fostered by clinical experiences and by the hidden curricula exposing and challenging a learner’s values.49 

• Role models and mentors who can facilitate and guide learners’ reflections are thus critical to this process.4 

• Threats to fostering these critical mentoring relationships include faculty members’ diminished interest in teaching,61 shortened training times, and increasing clinical demands on faculty.62

PIF 교과 중재는 주로 전문성 교육 및 평가에 중점을 두 었으며 윤리 및 직업에 대한 기대에 대한 강의 4 RW 세미나 3,8,9 및 촉진 된보고와 함께 실제 및 실제 경험에 대한 노출을 포함 할 수 있습니다 .63 최근 육성에 중점을 둡니다. GME의 "전문성"과 구별되는 PIF는 연수생이 자신의 가치와 이상을 재검토하고 의미를 연구하는 동안 반영하도록 배움으로써 훈련의 연속체와 실천에 대한 멘토와 역할 모델과의 종사적 참여를 강조합니다 .64 우리는 훈련 된 멘토에 의해 촉진 된 e- 포트폴리오에서의 연습은 PIF를 교육의 "그림자"에서 벗어나 반사 된 토론을 유도하는 데 도움이됩니다. 따라서이 연습은 PIF 목표를 추구하는 수단으로 사용됩니다. 즉, 학습자가 "그들이 누구인지, 그들이 누구인지, 누구가되고 싶은지"를 발견하도록 도와줍니다.

PIF curricular interventions have been primarily focused on teaching and assessing professionalism25 and may include 

• lectures on ethics and expectations of the profession,4 

• RW seminars,3,8,9 and 

• exposure to simulated and real experiences with facilitated debriefing.63 

The recent focus on fostering PIF in GME as distinct from “professionalism” emphasizes longitudinal engagement with mentors and role models throughout the continuum of training and into practice, during which trainees learn to reflect while reexamining their values and ideals and finding meaning in their work.64 We believe that reflective exercises in an e-portfolio, facilitated by trained mentors, help bring PIF out of the “shadows” of training and into the light of guided reflective discussion. As such, these exercises serve as a vehicle for pursuing PIF goals— namely, helping learners discover “who they are, who they are becoming, and who they wish to become.”4

PIF 목표를 위해 e-포트폴리오와 훈련된 멘토 사용

Using an e-portfolio and trained mentors to pursue PIF goals

At Reading Health System in Pennsylvania, an electronic professional development portfolio has served since 2008 as a documentation tool supporting residents’ reflections on performance and their self-monitoring, comparisons of self-assessments with external feedback, and generation of learning plans.65,66 Mentors are selected from a pool of full-time faculty educators and matched with individual residents at the start of residency, with each mentor assigned four to six mentees. The e-portfolio was overlaid on this existing mentoring process, with goals of promoting reflective skills, supporting self- directed learning, and enhancing career development.65 The portfolio backbone is the mentee’s curriculum vitae (CV). All scholarly activity and research efforts are uploaded, with automatic reminders (generated by any uploads) triggering future CV updates. The portfolio is designed to assist the resident

• (1) to reflect in action,2 with reflection-inviting questions for each document type; and 

• (2) to reflect on action, including the ability to open and view their descriptions of all sequential reflections in order to review longitudinal progress toward self-declared goals. 

Mentors coach mentees at triannual meetings to facilitate reflections on clinical evaluations, test scores, critical incident RW assignments, feedback from their teaching, and their presentations for meaning making and transformative learning. Self-directed learning is supported through mentor- coached reviews of uploaded chart audits and evidence-based medicine searches. The last portfolio section contains uploads of trainees’ short- and long-term professional development plans, initially created jointly by the mentor and the mentee, but solely by the mentee later in the program as the scaffolding process is gradually reduced and independence is achieved.67

각 거주자는 회의를 멘토링하기 전에 3 차원 및 밤 플로트 회전 동안 e- 포트폴리오 작성 및 반사적 과제를 완료합니다. 각 세션의 특정 연습 문제는 거주자가 3 년 동안의 거주 기간 동안 일련의 연례 및 세션 별 과제를 완료 한 경우 사전에 설명되어 있습니다 .65

Each resident completes e-portfolio writing and reflective assignments prior to mentoring meetings triannually and during night float rotations. Specific exercises for each session are outlined in advance for the resident, who completes a series of year- and session-specific assignments throughout the three years of residency.65 

• 멘토는 멘티에게 신빙성과 기밀성을 유지하기 위해 멘티에게만 형성적인 피드백을 제공합니다.

• 멘토는 또한 멘토가 프로그램 디렉터 (멘토가 아닌)와 연례 포트폴리오 검토를 준비하고 임상 적 능력위원회 (Clinical Competence Committee)의 지지자 역할을하도록 도와줍니다 .68

• 멘토링 회의에는 멘티가 결정한 의제가 포함 된 일련의 과제가 있습니다.

• 포트폴리오는 (일과 삶의 균형을 달성하고, 탄력성을 조성하여 번아웃를 예방하고, 미래의 노력을 도모하는 것과 같은 주제에 관한 PIF 토론을 위한) 대화식 "출발점"역할을합니다.

• Mentors provide only formative feedback to mentees, to maintain both authenticity and confidentiality for the mentees. 

• Mentors also help mentees prepare for annual summative portfolio reviews with the program director (not a mentor) and serve as their advocates to the Clinical Competence Committee.68 

• Mentoring meetings have a series of assignments with agendas determined by mentees. 

• The portfolio serves as the conversational “departure point” for PIF discussions about such topics as achieving work–life balance, fostering resiliency69 to prevent burnout,70 and future endeavors.

멘토 교육은 PIF 개입을 성공적으로 수행하는 데 중요합니다. 멘토는 자신의 교육에서 결코 경험하지 못했던 과정에 참여하게되어 FD가 프로그램 성공의 중요한 부분이되었습니다. 한 포트폴리오 챔피언 (A.A.D.)은 포트폴리오 멘토링 과정을 촉진하고 진행중인 FD를 수립하는 데 도움이되는 "성찰 코치"의 역할을 수행합니다. 멘토의 요구 사항 평가를 통해 반기 별 FD 세션을 디자인한다.

• "새로운 제자를 포트폴리오의 목표에 맞추기"

• "교육 개입 도구 모음"

• "멘토와 평가 시스템의 역할",

• "포트폴리오 평가를위한 질적 방법에 대한 소개"

Mentor training is critical to successful PIF interventions.4,71 Our mentors participate in a process most have never experienced in their own training, which makes FD a critical portion of the program’s success. One portfolio champion (A.A.D.) serves the role of “reflective coach” to assist in facilitating the portfolio mentoring process and craft ongoing FD. Mentors’ needs assessments led to designing biannual FD sessions,72 including the topics 

• “orienting the new mentee to goals of the portfolio,” 

• “a toolbox of educational interventions,” 

• “role of the mentor and the assessment system,”‘ and 

• “an introduction to qualitative methods to assess portfolios.” 

이 모든 과정에서 "멘토를 멘토링하는 것"에는 지지적 성찰 학습 환경을 조성하는 멘토와 멘티 간의 관계를 조장 할 수있는 "성찰적 멘토"를 육성하는 것이 포함됩니다. 멘토는 자신의 개인 포트폴리오를 웹 사이트에 유지함으로써 경험적으로 자신을 프로세스에 배정합니다. 멘토와 함께 자기 성찰 프로세스를 모델링하는 데 도움이 될 수 있습니다.

Within all of this, “mentoring the mentors” includes cultivating “reflection mentors” who can foster the kind of mentor–mentee relationships that create a supportive reflective learning environment. Mentors orient themselves to the process experientially by maintaining their own personal portfolio on the Web site, which can help inform their own modeling of the self-reflective process with mentees.

레지던트와 멘토에게 e-포트폴리오의 중요성

Importance of e-portfolios to both residents and their mentors

이 과정에서 배양 된 기술과 습관을 감안할 때, GME에서 그러한 PIF 개입의 효과에 대한 장기적인 연구가 필요합니다. 향후 방향에는 직원의 의사 탄력성 / 소진 수준, 자기 주도적 학습 및 지각 및보고 된 포트폴리오 측정에 대한 포트폴리오 사용의 장기 영향을 결정하기 위해 포트폴리오를 통해 멘토링에 노출 된 거주자의 질적 평가가 포함됩니다 (참여도가 낮은 사람들 포함). 관계 중심의 환자 치료에 미치는 영향, 포트폴리오에 대한 지속적인 참여 여부에 관계없이. e- 포트폴리오로 PIF를 육성하는 GME 멘토에게 미치는 영향을 평가하는 것도 중요합니다.

Given the skills and habits cultivated by this process, long-term studies of effectiveness of such PIF interventions in GME are needed. Future directions include qualitative assessments of residents exposed to mentoring through portfolios (including those who are less engaged) to determine the long-term impact of portfolio use on measures of staff physician resiliency/levels of burnout, self- directed learning, and perceived and reported impact on relationship- centered patient care, with or without their continued engagement with their portfolios. Evaluating the impact on GME mentors of cultivating PIF with e-portfolios is also of interest.

조나스 삭크 (Jonas Salk)는 "우리의 가장 큰 책임은 좋은 선조가되는 것입니다."74 이러한 책임을 수행하는 것은 성찰적 기술을 육성하고 코치하기 위한 효과적인 플랫폼에 의해 향상 될 수 있으며, 동시에 전문직의 가치를 전달impart하면서 경력 개발과 일과 삶의 균형을 추구할 수 있다. 우리는 전문성 개발 전자 포트폴리오가 거주자의 꿈 그림을 그리는 매력적인 "캔버스"역할을 할 수 있다고 믿고, 최신 직업 의학자를 직업에 소개하고 (잠재적으로 꿈을 실현하는 데 도움이되는)지도 및 안내를 제공하며, 그 과정에서 멘토 자체를 다시 활성화하십시오.

Jonas Salk said that “our greatest responsibility is to be good ancestors.”74 Carrying out this responsibility may be enhanced by effective platforms to foster and coach reflective skills, at the same time promoting career development and work–life balance while imparting the values of the profession. We believe a professional development e-portfolio can serve as an attractive “canvas” to paint the picture of a resident’s dreams, while offering coaching and guidance for introducing the newest members of medicine to the profession (and potentially help realize their dreams), and in the process, reenergize the mentors themselves.

요약

Summing Up

요약하면, 우리가 위에서 설명한 교육 전략은 이론에서 실천에 이르는 다리, PIF를 촉진하고 풍요롭게하는 주요 요소를 구현하고 구현하는 교량을 나타냅니다 .75 이러한 요소에는 지침 반영, 관계의 필수 역할, 형성 피드백 및 협동 학습 생성이 포함됩니다 사회화 과정을 촉진하기위한 환경 76 또는 "실천 공동체"77.

In summary, the pedagogic strategies we have described above represent bridges from theory to practice, embodying and integrating key elements of promoting and enriching PIF.75 Such elements include 

• guided reflection, 

• the integral role of relationships, 

• formative feedback, and 

• the creation of collaborative learning environments76 or “communities of practice”77 for promoting the socialization process.

의학 교육의 표준화 된 측면과 개인화 된 측면을 모두 포함하는 위에 제시된 교육 접근법은 이상적으로 "의사가되는 것"이라는 독점적 인 초점에서 "의사가되는 것"을 포함하는 더 광범위한 초점으로 전환하는 데 도움을 줄 수 있습니다. 49

The pedagogic approaches presented above, which include both standardized and personalized aspects of medical education, can ideally help educators shift away from “an exclusive focus on ‘doing the work of a physician’ toward a broader focus that also includes ‘being a physician.’”49

=====찾아야 함======

3 Epstein RM. Reflection, perception and the acquisition of wisdom. Med Educ. 2008;42:1048–1050.

26 Wong A, Trollope-Kumar K. Reflections: An inquiry into medical students’ professional identity formation. Med Educ. 2014;48:489–501.

43 Armstrong GW, Wald HS. Fostering reflective capacity with interactive reflective writing in medical education: Using formal analytic frameworks to guide formative feedback to students’ reflective writing. Med Teach. 2013;35:258.  XXX

33 Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP. Fostering and evaluating reflective capacity in medical education: Developing the REFLECT rubric for assessing reflective writing. Acad Med. 2012;87:41–50.

19 Wald HS, Reis SP. Beyond the margins: Reflective writing and development of reflective capacity in medical education. J Gen Intern Med. 2010;25:746–749.

63 Ginsburg S, Lingard L. “Is that normal?” Pre- clerkship students’ approaches to professional dilemmas. Med Educ. 2011;45:362–371.

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Acad Med. 2015 Jun;90(6):753-60. doi: 10.1097/ACM.0000000000000725.

Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice.

Wald HS1, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA.

Author information

1

H.S. Wald is clinical associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. D. Anthony is associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. T.A. Hutchinson is professor of medicine and director, McGill Programs in Whole Person Care, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S. Liben is associate professor of pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada. M. Smilovitch is associate professor of medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada. A.A. Donato is clinical associate professor of medicine, Jefferson Medical College, Philadelphia, Pennsylvania.

Abstract

Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identityformation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized and/or formal and informal curricular approaches. How can we best support the complex iterative PIF process for a humanistic, resilient health care professional? How can we effectively scaffold the necessary critical reflective learning and practice skill set for our learners to support the shaping of a professional identity?The authors present three pedagogic innovations contributing to the PIF process within undergraduate and graduate medical education (GME) at their institutions. These are (1) interactive reflective writing fostering reflective capacity, emotional awareness, and resiliency (as complexities within physician-patient interactions are explored) for personal and professional development; (2) synergistic teaching modules about mindful clinical practice and resilient responses to difficult interactions, to foster clinician resilience and enhanced well-being for effective professional functioning; and (3) strategies for effective use of a professionaldevelopment e-portfolio and faculty development of reflective coaching skills in GME.These strategies as "bridges from theory to practice" embody and integrate key elements of promoting and enriching PIF, including guided reflection, the significant role of relationships (faculty and peers), mindfulness, adequate feedback, and creating collaborative learning environments. Ideally, such pedagogic innovations can make a significant contribution toward enhancing quality of care and caring with resilience for the being, relating, and doing of a humanistichealth care professional.

Comment in

• In Reply to Ventres and Rosenberg. [Acad Med. 2016]
• Cultivating Cultures of Compassion. [Acad Med. 2016]

PMID:

 

25901874

 

DOI:

 

10.1097/ACM.0000000000000725