A medical career is one that brings many challenges. Therefore, both resilience and reflection are essential concepts needed to overcome these challenges. In this essay, I will explore these two concepts and discuss what relevance they have to medical students and doctors.
Oxford Dictionaries define reflection as ‘serious thought or consideration’ (Oxford Dictionaries, 2018). Reflection is an activity used regularly by a wide range of professions. The Good Medical Practice highlights the importance of doctors reflecting on their practice and incorporating in patient feedback to ensure patient care is to a good standard (General Medical Council (GMC), 2013). Reflective practice enables a doctor to improve and adapt their communication skills to connect with and show empathy for different patients. The patient-doctor relationship is built on effective verbal and non-verbal forms (such as body posture and eye contact) of communication (Travaline, Ruchinskas, D’Alonzo, 2005). The patient-doctor relationship is a key concept in medicine and it is built on trust. It allows the doctor to have a better understanding of the patient’s medical history and the patient can be more involved in treatment. A study was carried out at Sherwood Forest Hospital (a National Health Service trust hospital), over a 22-month period between April 2004 and January 2006. Over this time, there were 849 inpatient admissions and 183 complaints; these complaints were analyzed to find that 25% were regarding poor communication (Siyambalapitya et al, 2007). This study took place over a large period of time and involved a reasonable sample size. A limitation is that the study only took place in one hospital. However, I believe the results of the study are still relevant and portray the need to devote more time to improving communication among healthcare professionals. Communication is an essential skill that I will develop, through regular reflection, as a medical student. For example, after communicating with a patient during my community-based medicine placement, I take the time to reflect on the consultation. I can then discuss aspects I will improve upon next time with my GP tutor.
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Complaints and compliments are reflected upon through revalidation and annual appraisals. Revalidation is the process by which doctors are assessed the General Medical Council’s standards. This is to identify the strengths and areas of improvement in a doctor’s practice and make changes using the feedback (General Medical Council, 2018). In medical education, constructive feedback promotes learning, meets standards, and enables students to develop an analytical approach to learning. Therefore, teachers of medicine should attend training programs on how to give feedback to ensure it is done in a beneficial way (Chowdhury, Kalu, 2004). As a medical student, I am constantly receiving feedback. For example, during my training in Basic Life Support, I received feedback from both my peers and my teachers on the technique of chest compressions. I took some time to reflect on this feedback which allowed me to come up with areas of improvement.
Self-directed learning is a major part of medical education. However, because of its low prevalence in schools, many students first encounter self-directed learning at medical school. Reflection as a student can help develop self-directed learning and improve motivation (Koshy et al, 2015). Self-directed learning will continue past medical school due to the life-long learning aspect of a medical career. According to Sanders, ‘an essential attribute of every healthcare professional is that they will become masters of their own ‘life-long learning’ (Sanders, 2009). Reflecting on self-direct learning as a medical student or a doctor enables you to prioritize your time and set goals for a more effective way of learning.
Medos describes resilience as ‘the ability to recover from setbacks, adapt well, and keep going in the face of adversity’ (Medos, 2017). A medical career can have many setbacks so resilience is a crucial attribute as a doctor. Stress-linked effects such as fatigue, drug use, and poor mental health usually arise as a medical student and therefore it is important that resiliency interventions are part of the medical course (Farquhar, Kamei, Vidyarthi, 2018). As a medical student, resilience is needed from the very beginning of starting university. The transition from school to university can be difficult. Living independently, making new friends, and settling into a new environment are some of the many reasons why students tend to feel nervous or overwhelmed. This can lead to stress, low self-esteem, and the feeling of social or academic inadequacy. A student’s ability to overcome these difficulties can determine their success at university (Holdsworth, Turner, Scott-Young, 2017). Looking back at my own experience of starting the course, I found it particularly hard to adapt to the new teaching methods. Lectures were not something I had encountered before and they are very different from lessons in school. Furthermore, the large amount of content in the MBChB course was an aspect I struggled with. However, with patience and perseverance, I was able to overcome this and I became used to the different teaching and learning styles. Throughout my time as a medical student, I will face many setbacks. Hence, resilience is a quality that will grow, preparing me for my future career.
In the United Kingdom, a major challenge doctors face is the rapidly growing and aging population. Consequently, there are increasing demands for National Health Service (NHS) to care for multiple long-term and chronic conditions. However, the NHS receives insufficient funding and as a result, there is more pressure on current doctors (British Medical Association (BMA), 2018). The BMA reported that ‘In 2012, 59% of consultants and 86% of GPs reported that their workload had increased in intensity over the past year’ (BMA, 2018). An increased workload can increase stress levels. A lack of resilience to overcome this stress may result in low well-being. This could lead to a lack of motivation, decreased professionalism, and an increase in the number of careless mistakes made by the doctor. Boas reported a study carried out by Mayo Clinic on 6,700 doctors, to find that stressed doctors are twice as likely to make errors during practice (Boas, 2016). Linking back to the GMC’s emphasis on delivering good patient care, doctors must ensure their well-being and mental health do not have a negative effect on their practice. Peters, Horn, and Gishen claim ‘Nationally and internationally, building medical student and doctor resilience will also deliver significant benefits to patients’ (Peters, Horn, Gishen 2018). This links back to the importance of teaching resilience as part of the medical course. The early build-up of resilience will not only have a positive impact on future doctors but on patients too.
On the other hand, mistakes made by medical students and doctors are necessary. Using reflection, mistakes can aid with the learning process. Reflection can be done using various models. An example is Kolb’s learning cycle which starts with a particular experience. This is reflected in developing a theory of learning, so conclusions can be drawn and a plan can be made to prevent similar experiences from occurring again (Forrest, 2008). Gibbs’ reflective cycle (1988) (an adaptation of Kolb’s learning cycle) breaks down reflection into different stages. This includes considering your feelings, evaluating and analyzing the situation, concluding, and then composing an action plan for the future. Both Gibbs and Kolb emphasize experience in their models, but Gibbs also includes the emotional and social aspects by analyzing the experience and taking into account feelings which may make it an easier model to follow in clinical practice (Husebo, O’Regan, Nestel, 2015). Personally, I believe reflection can be done in a number of ways- from discussion with an academic tutor to reflective writing. Moreover, there is research that suggests reflection is most effective when done critically and shared with other people who have had similar experiences (Helyer, 2015). Therefore, it may be beneficial for me to share and reflect on my difficulties with other medical students.
During my hospital placement, I had the opportunity to observe a consultation that involved the doctor breaking bad news. The doctor had to explain to a family member that the patient’s condition was rapidly deteriorating and they had chosen to go ahead with a ‘do not resuscitate’ order. This highlighted the importance of empathy and good communicational skills. However, it also portrayed the emotional distress a doctor can face. Resilience allowed the doctor to remain calm and composed whilst delivering the news. A medical student may also experience emotional distress during clinical years, such as patient deaths. A doctor must be able to cope with these demands through ways of resilience in order to focus on patient care (Howe, Smajdor, Stöckl, 2012). Additionally, doctors may often be viewed as role models by patients. Therefore, a resilient doctor can encourage the patient to also be resilient during treatment.
To conclude, reflection and resilience are attributes incorporated into the daily lives of medical students and doctors. Whether reflecting on a skill, feedback, or negative experience reflection is often combined with resilience in order to progress and succeed. I will continually develop both throughout my medical education.
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