The ‘black box’ of reflection: a discursive approach to collaborative reflective practice in medical education

Mario Veen & Anne de la Croix, Erasmus MC, Department of General Practice, The Netherlands

Background
Reflective practice in medical education is often approached from a cognitive perspective. However,  learning in a group is an interactional achievement. We therefore feel it is relevant to study the sequential nature of group interaction in collaborative reflection.

Purposes
In The Netherlands, all General Practice training programs contain regular sessions in which GP trainees share their experiences.  Despite this being common practice, we found no previous research into the structure and process of these sessions. The purpose of this study is to describe the structure and interactive characteristics of group reflection. Attention will be given to the role of the tutor, the GP resident who reports a case for discussion, and other participants.

Methods
Between 2010 and 2011, 47 experience-sharing sessions of 13 different groups were recorded and transcribed verbatim.  Conversation Analysis (CA) has been used to study the reflection meetings, focusing on the structure of the sessions and the way in which the group interaction develops. As is tradition in CA, turn taking and negotiation of interactional sequences are studied carefully.

Results
Four elements were identified in each case discussion: 1. Incident, 2. Reason for sharing, 3. Learning Issues, and 4. Learning Uptakes.  Transitions between these elements were conversationally complex, with visible negotiations between group tutor(s), narrator, and group about the way in which the group conversation move forward. The role of the tutor in the transitions between the elements is very important as the tutor’s interactional behavior is part of the hidden curriculum.

Conclusions
Even without a formal format in which experiences are shared, common elements were found in each case discussion. CA focuses on the interaction in group learning and shows how the interaction is part of what is learned and how the learning takes place.