REFLEXIVE PRACTICE: MORE THAN JUST REFLECTION…On my residency experience

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https://benheine.com         
no copyright infringement is intended

The following is part of a learning exercise I am preparing for this really cool class I am taking for my Master in Health Professions Education. It even has a cool acronym: INTAPT (INTerprofessional Applied Teaching and learning in health professions).  I have been MIA, but justifiably so. I think at least.

I elect to write this paper in a first-person style, perhaps to inculcate, somewhat facetiously, this idea of reflexivity. That is: being critically reflective of one’s own practice, action, thoughts in order to expands one’s zones of mastery, as Schön originally framed it in the medical education context. But it is not enough to practice reflectively. You need to also reflect in action. And perhaps, the ways in which these two types of reflections compliment each other and influence cognitive and behavioral processes is what embodies reflective practice.

I did my hospital dental residency back in 2014-2015. A narrative background is pertinent I feel. Touted, at least rhetorically, to be one of the best in the country. I thought carefully about why I wanted to do a residency. I wondered if other people do. I knew it would be more than a gateway to specialization for me (I did not specialize after all, yet at least). I wanted to immerse myself in a medical setting. Dentistry is a branch of medicine after all, albeit a unique one. I wanted to expand my skills, and gain insights into all dental specialties. I wanted to develop what my jujitsu Sensei always described as: comfort in discomfort. Or what Glenn Regehr refers to as “comfort with uncertainty”. I wanted to develop confidence and buy time to reflect on what I wanted to do thereafter. Perhaps my intentions were rooted in procrastination from joining the “workforce”. Who knows.

I observed a lot, and I wondered a lot, namely about what was missing from the experience. My favourite rotation was the Emergency Room. Everyone has a love-hate relationship with the ER. It was rich in learning opportunities, but you also dreaded getting paged at one in the middle of the night to go in to drain a space infection or manage a complex jaw fracture; put stainless steel wires through their gums to wire them shut, after reducing their fracture. It was intense. It made you fearless. Nonetheless, it remained my favourite. It was very fast paced, and you often worked independently, with no access to assistants, and minimal supervision. It was riddled with the “messy and indeterminate problems” that Schön describes as the nidus for sprouting expertise. It was also riddled with an inordinate amount of administrative work that somehow fell on the resident’s lap. We were working at the edge of our competence.

I felt like I needed a framework – some sort of structure – through which I can consolidate what I learnt, or thought I learned, in the ER. It ended up feeling like mindless hoarding of skills. It may have even led to some degree of emotional detachment and loss of interest, and anecdotal evidence of this abounds. Can this construct of reflective practice convert this mindless skill acquisition, into a mindful and meaningful learning experience? Well, this is what I set out to understand and explore. 

Thoughts?

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