In Pursuit of Time: an Inquiry into Kairos and Reflection in Medical Practice and Health Professions Education

‘Taking time’ to reflect on experience is important in health professions education and medical practice; however, time is increasingly becoming scarce, while tasks multiply and calendars dictate the pace of our day. On the one hand, the day is divided into sections that are measured, scheduled, and micromanaged. On the other hand, when loved ones ask how our day was, we do not list agenda items as if we are calendars ourselves; instead, we tell stories about how we are invested in our roles at work. What does taking time to reflect mean in this hectic day and age? In this chapter, we introduce the Greek notions of kairos, chronos, and scholê to explore taking time to think. Contemplation for early Greek thinkers was never seen as a task or activity, but precisely the opposite, as freedom from tasks to think. Then, with Walter Benjamin’s work on time, we explore why kairos is important to question an instrumental view of reflection. Generally, we argue that reflection without preconceived goals in mind is valuable to reinvigorate well-established ideas that come down to us as unquestioned heritage, and that taking time is of importance for this process

A culture of reflection in practice at the Dutch general practitioner’s specialty training

Our research on reflection in the GP specialty training, consists of two parts. In part one, we conducted philosophical research on the concept of reflection and identified three conceptual limitations. 1) reflection is a complex concept that receives specific meaning and value in practice. With each step away from practice and toward generally applicable reflection (e.g., through generalized typologies or models of reflection), reflection risks losing its concrete value in practice. 2) reflection is a human capacity that can easily be linked to many benefits in the education of health professions, but this malleable quality also creates the danger of reflection becoming an educational panacea. 3) we argue that reflection cannot only mean ‘A leads to B,’ but is also about unique moments that require action and lead to a new montage of ideas. In part two, we did not locate reflection and measured its effects in our data; instead, we described how participants themselves give concrete meaning and value to reflection in their education. Therefore, we described parts of the social interaction and educational repertoire of GP trainees, supervisors and teachers during various teaching moments in which reflection takes place according to those involved in GP education. We saw that the meaning of reflection takes specific shape in the existing educational culture with its collection of norms, values, as a reflection repertoire. We conclude that models and theories are important, but the oxygen that makes reflection concrete and valuable stems from practice and social interactions in education.<br/

A culture of reflection in practice at the Dutch general practitioner’s specialty training

Our research on reflection in the GP specialty training, consists of two parts. In part one, we conducted philosophical research on the concept of reflection and identified three conceptual limitations. 1) reflection is a complex concept that receives specific meaning and value in practice. With each step away from practice and toward generally applicable reflection (e.g., through generalized typologies or models of reflection), reflection risks losing its concrete value in practice. 2) reflection is a human capacity that can easily be linked to many benefits in the education of health professions, but this malleable quality also creates the danger of reflection becoming an educational panacea. 3) we argue that reflection cannot only mean ‘A leads to B,’ but is also about unique moments that require action and lead to a new montage of ideas. In part two, we did not locate reflection and measured its effects in our data; instead, we described how participants themselves give concrete meaning and value to reflection in their education. Therefore, we described parts of the social interaction and educational repertoire of GP trainees, supervisors and teachers during various teaching moments in which reflection takes place according to those involved in GP education. We saw that the meaning of reflection takes specific shape in the existing educational culture with its collection of norms, values, as a reflection repertoire. We conclude that models and theories are important, but the oxygen that makes reflection concrete and valuable stems from practice and social interactions in education.<br/

‘Oh yes, that is also reflection’—Using discursive psychology to describe how GP registrars construct reflection

Introduction: Learners in medical education generally perceive that reflection is important, but they also find that reflection is not always valuable or practically applicable. We address the gap between the potential benefits of reflection and its practical implementation in medical education. We examined the perspective of Dutch GP registrars who (must) reflect for their GP specialty training to understand their participant perspective on reflection. Our aim is stimulating alignment between reflective activities that occur in a medical curriculum and the ideals of reflection as a valuable educational activity. Methods: We conducted, video-recorded and transcribed seven focus group sessions with GP registrars in 2021 across two Dutch GP educational programmes. We used discursive psychology to analyse the focus group data by focusing on ‘assessments of reflection’. We analysed their discursive features (how something was said) and content features (what was said) and related these to each other to understand how GP registrars construct reflection. Results: Participants constructed reflection with nuance; they combined negative and positive assessments that displayed varied orientations to reflection. First, their combined assessments showed complex orientations to norms and experiences with reflecting in practice and that these are not simply negative or positive. Second, GP registrars constructed reflection as a negotiable topic and showed how reflection and its value can be variably understood. Third, through combined assessments, they displayed an orientation to the integration of reflection with other educational tasks, which impacts its value. Conclusions: Generally, GP registrars speak positively about reflection, but the value of reflection partly depends on its proper integration with other educational tasks. When meaningful integration fails, activities to stimulate reflection can overshoot their own goal and hamper learner motivation to reflect. Developing a healthy ‘reflection culture’ could mitigate some challenges. Therein, reflection is treated as important while learners also have adequate autonomy.</p

Influence of reactor wall conditions on etch processes in inductively coupled fluorocarbon plasmas

The influence of reactor wall conditions on the characteristics of high density fluorocarbon plasma etch processes has been studied. Results obtained during the etching of oxide, nitride, and silicon in an inductively coupled plasma source fed with various feedgases, such as CHF3, C3F6, and C3F6/H2, indicate that the reactor wall temperature is an important parameter in the etch process. Adequate temperature control can increase oxide etch selectivity over nitride and silicon. The loss of fluorocarbon species from the plasma to the walls is reduced as the wall temperature increased. The fluorocarbon deposition on a cooled substrate surface increases concomitantly, resulting in a more efficient suppression of silicon and nitride etch rates, whereas oxide etch rates remain nearly constant

‘You are not alone.’ An exploratory study on open-topic, guided collaborative reflection sessions during the General Practice placement

Background: To support professional development of medical students faced with challenges of the clinical phase, collaborative reflection sessions (CRSs) are used to share and reflect on workplace experiences. Facilitation of CRSs seems essential to optimise learning and to provide important skills for lifelong learning as a professional. However, little is known about which workplace experiences students share in CRSs without advance guidance on specific topics, and how reflecting on these experiences contributes to students’ professional development. Therefore, we explored which workplace experiences students shared, what they learned from reflection on these experiences, and how they perceived the value of CRSs. Methods: We conducted an exploratory study among medical students (N = 99) during their General Practice placement. Students were invited to openly share workplace experiences, without pre-imposed instruction. A thematic analysis was performed on shared experiences and student learning gains. Students’ perceptions of CRSs were analysed using descriptive statistics. Results: All 99 students volunteered to fill out the questionnaire. We found four themes relating to students’ shared experiences: interactions with patients, complex patient care, diagnostic or therapeutic considerations, and dealing with collegial issues. Regarding students’ learning gains, we found 6 themes: learning from others or learning from sharing with others, learning about learning, communication skills, self-regulation, determination of position within the healthcare team, and importance of good documentation. Students indicated that they learned from reflection on their own and peer’s workplace experiences. Students valued the CRSs as a safe environment in which to share workplace experiences and helpful for their professional development. Conclusions: In the challenging General Practice placement, open-topic, guided CRSs provide a helpful and valued learning environment relevant to professional development and offer opportunities for vicarious learning among peers. CRSs may also be a valuable tool to incorporate into other placements.</p

Prestatiemanagement bij Waardegedreven zorg: hoe verder?

Waardegedreven zorg (WGZ) wordt gezien als een potentieel belangrijke strategie voor zorgorganisaties om kwalitatief hoogwaardige zorg te bieden tegen relatief beperkte kosten. WGZ is meer concreet gericht op het maximaliseren van de (klinische en overige patiënt)uitkomsten per bestede euro. Wij bestuderen op basis van een verkenning van de Nederlandstalige en internationale literatuur in hoeverre deze strategie momenteel is ingebed in de prestatiemanagementsystemen van zorgorganisaties. Tevens reflecteren wij op de link tussen WGZ-strategieën en prestatiemanagement(systemen), die zeer beperkte aandacht krijgt in de wetenschappelijke literatuur. Wij identificeren daarnaast diverse aspecten van prestatiemanagement waarvan wij denken dat die node moeten worden behandeld in de WGZ-literatuur