Demonstrating Reflection: A Content Analysis of Reflection that English Teacher Candidates Demonstrate in Writing

This study is an analysis of the depth of reflection exhibited in written documents produced by English teacher candidates. Description and insights were drawn into the reflective thinking of the undergraduate teacher candidates in the context of teacher research essays that they produced. Reflection is widely viewed as enabling teacher candidates to make connections between actions and consequences as well as between theory and practice. Teacher education programs are encouraged by accreditation agencies to adopt a framework that helps teacher candidates to reflect on practice. However, there is no broadly accepted protocol in place for determining depth of reflection that is demonstrated by teacher candidates. Further, assessment of reflection is too often characterized by subjective rather than objective analysis. A four-category protocol developed by David Kember and colleagues provided guidance toward an assessment of the depth of reflection. No published study in the field of English Education has analyzed depth of reflection in the written work of teacher candidates with guidance from this protocol. I rated the depth of reflection as one of four categories: non-reflection, understanding, reflection, or critical reflection. Judgment of the depth of reflection for a teacher research essay is based on the highest level of reflection observed in the whole essay. I also engaged in content analysis of the teacher research essays in order to make inferences about the broader context of the written work of the teacher candidates, and systematically investigate the content of the teacher research essays. I describe the depth of reflection of teacher candidates as they address strengths and deficiencies they identified in their own instruction. Each of the eight teacher research essays in the study were coded either as reflective or as critically reflective, indicating that all student teachers made relationships between conceptual knowledge and the experience of student teaching. One teacher research essay showed evidence of critical reflection, or a change in a fundamental belief about teaching. An English teacher education program would be able to use the results of this analysis as evidence of reflective thinking demonstrated in the writing of teacher candidates. Kember\u27s four category protocol provides guidance for teacher educators to assess the depth of reflection demonstrated in writing by teacher candidates through a protocol that has been reliably tested. Use of the protocol can help a teacher educator and a teacher education program to make more informed decisions about ways to improve instruction to foster candidates who will become reflective teachers. Kember\u27s four category protocol can be useful as part of a goal of a teacher-education program to facilitate reflective thinking and reflective teaching among teacher candidates. The protocol can be useful as part of a goal of a teacher education program to facilitate reflective thinking and reflective teaching among candidates. When the aim of a teacher education program includes developing teachers who will be reflective practitioners, the use of a validated protocol to assess depth of reflection in the writing of teacher candidates is beneficial toward monitoring and reporting progress toward that goal

What is the best diagnostic approach to postmenopausal vaginal bleeding in women taking hormone replacement therapy?

Women on standard estrogen/progestin hormone replacement therapy (HRT) regimens frequently have irregular bleeding during the first 12 months of treatment. Therefore, those taking HRT should usually be evaluated after 1 year of treatment if bleeding continues. (Grade of recommendation: C, based on case series.) Evaluation of this bleeding should begin with a pelvic examination and Papanicolaou (Pap) test (if not done in the previous 12 months), then transvaginal ultrasound (TVUS), followed by endometrial biopsy or hysteroscopy, if indicated. (Grade: B, based on a systematic review of studies.

Does psychiatric treatment help patients with intractable chronic pain?

Tricyclic antidepressants and intensive multidisciplinary programs are moderately effective for reducing chronic back pain; tricyclics are also effective for diabetic neuropathy and irritable bowel syndrome (strength of recommendation [SOR]: A, meta-analyses and multiple small randomized controlled trials). Cognitive therapies are modestly effective for reducing pain in the following: chronic back pain, other chronic musculoskeletal disorders including rheumatoid arthritis (SOR: B, multiple meta-analyses with significant heterogeneity), and for chronic cancer pain (SOR: B, 1 meta-analysis of various quality studies)

Do antiarrhythmics prevent sudden death in patients with heart failure?

Beta-blockers (class II antiarrhythmics) reduce sudden death and total mortality in patients with heart failure (strength of recommendation [SOR]: A, based on systematic reviews of randomized controlled trials). Amiodarone (class III) may reduce sudden death in heart failure (SOR: B, extrapolation from randomized controlled trials), but evidence is weak that it reduces total mortality, and it has significant side effects. Class I and other class III antiarrhythmic agents appear cause an increase in mortality due to sudden death in heart failure (SOR: B, extrapolations from randomized controlled trials)

What nonpharmacological treatments are effective against common nongenital warts?

Cryotherapy has similar cure rates to topical salicylate (a pharmacologic therapy) for non-genital common warts (strength of recommendation [SOR]: B, based on systemic review of variable quality randomized trials). Duct tape may be equivalent to cryotherapy (SOR: B, based on a single randomized trial). CO2 laser, photodynamic therapy, pulsed dye laser (PDL), and Er:Yag laser therapies may also be effective for recalcitrant warts (SOR: C, based on observational cohort studies)

How should we follow athletes after a concussion?

Athletes sustaining a concussion should be held from contact activities a minimum of 7 days; they must be asymptomatic and their coordination and neuropsychological tests should have returned to their pre-injury baseline (strength of recommendation [SOR]: B, based on multiple prospective cohort studies). High-risk athletes (eg, those with a history of previous concussion, high- school age or younger, or female) may need to avoid contact even after all these criteria are met (SOR: C, expert opinion)

Which medications benefit patients with diastolic heart failure?

Angiotensin-converting enzyme inhibitors (ACEIs), propranolol, statins, furosemide, and some angiotensin receptor blockers (ARBs) benefit patients. Medications that reduce mortality in diastolic heart failure include ACEIs (strength of recommendation [SOR]: C, 1 prospective cohort trial with matched controls), propranolol (SOR: B, 1 randomized controlled trial [RCT]), and statins (SOR: C, 1 prospective cohort trial). Furosemide improves symptoms of heart failure and quality of life (SOR: C, 1 RCT, using cohort data). ARBs show mixed results: candesartan decreases hospital admissions (SOR: B, 1 large RCT); losartan improves exercise duration and quality of life (SOR: B, 2 small RCTs); irbesartan doesn't improve heart failure symptoms or other outcomes (SOR: B, 1 large RCT)

Does case management improve diabetes outcomes?

Patients with type 2 diabetes benefit from case management, as evidenced by decreased glycated hemoglobin (HbA1c). The improvement in HbA1c appeared larger when case managers could make changes in medications independently and multidisciplinary teams were used (strength of recommendation [SOR]: C, 2 meta-analyses of randomized controlled trials [RCTs] with consistent disease-oriented findings). Patients with type 1 diabetes who have case management and "intense control" experience fewer cardiovascular events and decreased retinopathy and clinical neuropathy (SOR: B, 1 large, good-quality RCT)

Idiopathic Thrombosis of the Inferior Vena Cava and Bilateral Femoral Veins in an Otherwise Healthy Male Soldier

Thrombosis of the inferior vena cava is less common than deep venous thrombosis of the lower extremities, particularly in the absence of an obvious congenital caval abnormality or hypercoagulable state. We present a case of IVC thrombosis in an otherwise healthy and active 28-year-old male soldier secondary to dehydration and venous webbing. IVC thrombosis is an uncommon and underrecognized condition; in this case, the patient’s caval thrombosis was initially mistaken for acute back strain. Prompt recognition is necessary to minimize long-term sequelae

When should patients with stroke receive thrombolytics?

Thrombolytic therapy should be limited to patients with acute ischemic stroke who meet strict inclusion and exclusion criteria and who can adhere to strict treatment protocol. Patients treated under these conditions have improved combined mortality and disability outcomes at 1 year when treated with recombinant tissue plasminogen activator (rtPA) (number needed to treat [NNT]=18; 95% confidence interval [CI], 11-56) (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials with significant heterogeneity)