PS1 - 08: TWEET-FORMAT REFLECTIVE WRITING: A HIDDEN NEEDS ASSESSMENT?
Jeremy A Dressler, MD1, Beth A Ryder, MD1, Kristina Monterio, PhD2, Erin C Cheschi, BSE, MPA1, Michael D Connolly, MD1, Thomas J Miner, MD1, David T Harrington, MD1; 1The Warren Alpert Medical School of Brown University, Department of Surgery, 2The Warren Alpert Medical School of Brown University, Department of Medical Science
Introduction - Medical student reflection is an integral component of professional development, allowing for the acquisition of academic and experiential knowledge. We have demonstrated previously that a short-format reflective writing assignment is an effective modality for promoting student reflection. We hypothesized that this real-time reflection could be used to identify impactful experiences from the clerkship and potentially identify areas for content development. We further hypothesized that these experiences would be different from the feedback given on standard end of clerkship evaluations.
Methods – During the required six-week surgery clerkship, medical students were required to submit three 140-character written reflections (“tweets”) electronically via Canvas. Students also were required to complete a standardized end-of-clerkship evaluation. Tweets and clerkship evaluation responses were analyzed using modified grounded theory methods. A priori codes were created with regards to valence, content category, and presence of reflection. Sub-group analysis was performed for both the student reflections and clerkship surveys.
Results - During the 2016-2017 academic year, 286 short-format assignments and 107 clerkship evaluations were analyzed. Of the tweets submitted, 175 (61%) were reflective. Categories included: “patient interaction” – 151 (53%); “surgical education” – 109 (38%), “physician/resident interaction” – 45 (26%); and “career decisions” – 29 (10%). When sub-categorized, 50 (33%) of the tweets coded as “patient interaction” involved “critically ill or dying patients.” A majority of these tweets, 32 of 50 (64%), were reflective. Other frequently identified sub-categories included “misconceptions of learning” within “surgical education” – 26 tweets (23%) and “collaboration” within “physician/resident interaction” - 21 tweets (28%). When the end-of-clerkship evaluations were sub-categorized, we found “misconceptions of learning” most frequently, with 38 (36%) referencing this. No end-of-clerkship evaluations (0%) referenced “critically ill or dying patients” and only 3 (0.03%) referenced “collaboration.”
Conclusions - In contrast to formal clerkship evaluations, the feedback received by reviewing the reflective assignments provided real-time reactions to significant clerkship events, most notably with respect to critically ill or dying patients. Based on the amount of focus this received in the short-format assignments, we believe this shows a need for further curricular development on this topic.