Participant evaluations of group reflection:video-stimulated interviews show what residents value and why

The potential of reflection for learning and development is broadly accepted across the medical curriculum. Our understanding of how exactly reflection yields its educational promise, however, is limited to broad hints at the relation between reflection and learning. Yet, such understanding is essential to the (re)design of reflection education for learning and development. In this qualitative study, we used participants' video-stimulated comments on actual practice to identify features that do or do not make collaborative reflection valuable to participants. In doing so, we focus on aspects of the interactional process that constitute the educational activity of reflection. To identify valuable and less valuable features of collaborative reflection, we conducted one-on-one video-stimulated interviews with Dutch general practice residents about collaborative reflection sessions in their training program. Residents were invited to comment on any aspect of the session that they did or did not value. We synthesized all positively and negatively valued features and associated explanations put forward in residents' narratives into shared normative orientations about collaborative reflection: what are the shared norms that residents display in telling about positive and negative experiences with collaborative reflection? These normative orientations display residents' views on the aim of collaborative reflection (educational value for all) and the norms that allegedly contribute to realizing this aim (inclusivity and diversity, safety, and efficiency). These norms are also reflected in specific educational activities that ostensibly contribute to educational value. As such, the current synthesis of normative orientations displayed in residents' narratives about valuable and less valuable elements of collaborative reflection deepen our understanding of reflection and its supposed connection with educational outcomes. Moreover, the current empirical endeavor illustrates the value of video-stimulated interviews as a tool to value features of educational processes for future educational enhancements

What affects you? A conversation analysis of exploring emotions during reflection sessions in Dutch general practitioner training

IntroductionIn Dutch training for general practitioners (GPs), reflection on professional practice is key to their training. Such reflection is considered beneficial for professional development, especially when it entails discussing the emotional dimension of practice experiences. In the GP context, invitations to share the emotional side of things, such as “how did that make you feel?” are considered functional; yet, they are also sometimes viewed by participants as ‘grilling’, ‘just too much’ or ‘too intimate’. Put shortly, putting emotions on the table is institutionally embedded in the GP reflection context, but not always straightforward. Thus, we ask: ‘how do teachers and GP residents invite talk about emotions in educational reflection sessions?’.MethodsIn this study, we explored the Dutch phrase ‘raken, geraakt worden’ (being affected) as one interactional practice used to initiate emotion talk. We conducted a conversation analytic collection study of instances of this phenomenon based on 40 video recordings of hour-long ‘reflection sessions’ at the Dutch GP specialty training. During these sessions, approximately ten GPs in training discuss recent experiences from medical practice under supervision of one or two teachers.ResultsWe found that participants orientated to the relevance of ‘being affected’ as a topic for discussion. Variations of the form ‘what affects you now?’ may contribute to putting emotions on the table; they can project a stepwise exploration of the emotional dimension of an experience. The ‘what affects you now’, often done in interrogative format doing a noticing, in combination with a request, is a powerful tool to instigate transformative sequences. The form is less effective to put emotions on the table when the topic shift it initiates is not grounded in previously presented personal stakes or displayed emotion.DiscussionThe study’s findings show how detailed interactional analysis of one sequentially structured practice can benefit education and contribute to theory on emotions and reflection. The mobilizing power of ‘what affects you’ can serve institutional purposes by doing topical work in relation to educational aims, while its power can also be deflated when prior talk does not project the relevance of unpacking the emotional dimension of an experience. Its interactional workings may translate to other helping contexts as well

Teachers' open invitations in whole-class discussions

This article takes a conversation analytic approach to the often employed notions of ‘open-ended or authentic questions’ in classroom interaction. We analyzed the, as we called them, open invitations teachers utter after reading a piece of text during whole-class discussions in 4 Dutch upper primary school classes, of which 2 were followed for a longer period of time. Our data show that these invitations vary in openness. We found 4 different types: 1) invitations projecting (a series of) objectively true or false answers, 2) invitations projecting specific response types, 3) invitations that have a restricted referent but do not project specific response types, and 4) topic soliciting invitations giving room to various contributions. Virtually all invitations resulted in fitted responses. The subsequent interactions following the less open invitations typically resulted in series of parallel responses, whereas the more open invitations typically yielded discussions or the collaborative answering of clarification questions

What affects you? A conversation analysis of exploring emotions during reflection sessions in Dutch general practitioner training

Introduction: In Dutch training for general practitioners (GPs), reflection on professional practice is key to their training. Such reflection is considered beneficial for professional development, especially when it entails discussing the emotional dimension of practice experiences. In the GP context, invitations to share the emotional side of things, such as “how did that make you feel?” are considered functional; yet, they are also sometimes viewed by participants as ‘grilling’, ‘just too much’ or ‘too intimate’. Put shortly, putting emotions on the table is institutionally embedded in the GP reflection context, but not always straightforward. Thus, we ask: ‘how do teachers and GP residents invite talk about emotions in educational reflection sessions?’. Methods: In this study, we explored the Dutch phrase ‘raken, geraakt worden’ (being affected) as one interactional practice used to initiate emotion talk. We conducted a conversation analytic collection study of instances of this phenomenon based on 40 video recordings of hour-long ‘reflection sessions’ at the Dutch GP specialty training. During these sessions, approximately ten GPs in training discuss recent experiences from medical practice under supervision of one or two teachers. Results: We found that participants orientated to the relevance of ‘being affected’ as a topic for discussion. Variations of the form ‘what affects you now?’ may contribute to putting emotions on the table; they can project a stepwise exploration of the emotional dimension of an experience. The ‘what affects you now’, often done in interrogative format doing a noticing, in combination with a request, is a powerful tool to instigate transformative sequences. The form is less effective to put emotions on the table when the topic shift it initiates is not grounded in previously presented personal stakes or displayed emotion. Discussion: The study’s findings show how detailed interactional analysis of one sequentially structured practice can benefit education and contribute to theory on emotions and reflection. The mobilizing power of ‘what affects you’ can serve institutional purposes by doing topical work in relation to educational aims, while its power can also be deflated when prior talk does not project the relevance of unpacking the emotional dimension of an experience. Its interactional workings may translate to other helping contexts as well

Using conversation analysis to explore feedback on resident performance

Feedback on clinical performance of residents is seen as a fundamental element in postgraduate medical education. Although literature on feedback in medical education is abundant, many supervisors struggle with providing this feedback and residents experience feedback as insufciently constructive. With a detailed analysis of real-world feedback conversations, this study aims to contribute to the current literature by deepening the understanding of how feedback on residents’ performance is provided, and to formulate recommendations for improvement of feedback practice. Eight evaluation meetings between program directors and residents were recorded in 2015–2016. These meetings were analyzed using conversation analysis. This is an ethno-methodological approach that uses a data-driven, iterative procedure to uncover interactional patterns that structure naturally occurring, spoken interaction. Feedback in our data took two forms: feedback as a unidirectional activity and feedback as a dialogic activity. The unidirectional feedback activities prevailed over the dialogic activities. The two diferent formats elicit diferent types of resident responses and have diferent implications for the progress of the interaction. Both feedback format

Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy.Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, &lt;0.001) and DM-risk (49% vs 30% vs 21%, p &lt; 0.001) and decreased DFS (42% vs 55% vs 69%, p &lt; 0.001) and OS (62% vs 76% vs 81%, p &lt; 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.</p