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Peer-Facilitated Virtual Action Learning: Reflecting on Critical Incidents During a Pediatric Clerkship. Plack MM et al. Academic Pediatrics 2010 10:146-152

Submitted by: Margaret Golden MD MPH; Pediatric Clerkship Director SUNY Downstate College of Medicine; 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203.

What was the study question?
This was an exploratory study to see if medical students will engage in reflective and critical thinking about troublesome incidents using a computer-based, peer-facilitated discussion board, dubbed "virtual action learning."

How was the study done?
The authors used as a convenience sample, the pediatric clerks during three consecutive pediatric clerkships (n=70). The students were oriented to this exercise on the first day of the clerkship, and randomly assigned to 3-4 member discussion groups. One student each week was assigned to describe a critical incident; the other students were prompted to respond with thought-provoking questions, after which the posting student wrote an essay on his/her reflections, analysis and insights. All postings were kept anonymous. The responses were analyzed qualitatively for evidence of reflective/critical thinking, and for content themes of the critical incidents.

What were the results?
The majority of the students-56/70, showed evidence of reflection on their critical incidents, some of them (12/70) at a fairly high level. Most of the incidents dealt with communication challenges and role identification; a number dealt with concerns about medical treatment, and a significant number dealt with the student's lack of power/voice. The authors provide a complete transcript of one incident, discussion thread and reflective essay to give the reader a real flavor of the responses.

What are the implications of the findings?
These authors have shown the feasibility of using the web, and of tapping the wisdom of student's colleagues, to address an important but neglected facet of medical learning—namely, reflection on troubling incidents which students encounter during clinical rotations. Because this was an uncontrolled study, the authors could not measure whether actual learning resulted from this exercise, but suggest that it could form the backbone of a longitudinal process with faculty input and formal assessments at various times over the 4 years. I was impressed with the quality of the student comments in the fully reported incident; it makes the case that the students themselves are an important resource for helping each other. I wish I had had such a program as a student and as a resident.

(Editor's note: This article highlights some difficult issues that our trainees might struggle with during their pediatric clerkship rotations. By participating in the study's exercise, the students achieved two things: developing some degree of reflection skills and supporting their colleagues as they dealt with these challenging issues. Both are essential components of becoming a professional.)

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