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Because professional ethical engagement is essential to the delivery of high-quality healthcare services, health professions education programs must have effective instructional practices to train future healthcare providers of various disciplines to practice ethically. As research has found reflection to be an effective instructional practice for educating adult learners and teaching professional ethics, promoting health professions students' tendency to reflect by boosting their reflective capacity may be helpful. Therefore, the study sought to examine the relationships between reflective capacity and professional ethical engagement to offer quantitative evidence for the significance of reflection in professional ethical engagement among health professions students. Correlational analyses revealed a strong, positive relationship between reflective capacity and professional ethical engagement in health professions students. Reflective capacity, specifically reflection-on-action and self-appraisal, could predict professional ethical engagement in health professions students. These findings provided insights into the reflective capacity and professional ethical engagement in health professions students. However, further research on the relationship between reflective capacity and professional ethical engagement in adult learners of health professions is needed. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to assess the effectiveness of short-term dynamic mentalization-based therapy on maternal reflective capacity and the mother-child relationship. Methods and Materials: The research design was a quasi-experimental pre-test, post-test with a control group. The population consisted of all mothers with children aged 2 to 6 who attended counseling centers in Ahvaz in the year 2023. Forty participants were selected from this population using a convenience sampling method. From these, two groups of twenty were randomly formed, one as the intervention group and the other as the control group. The intervention protocol used was based on the short-term dynamic mentalization-based therapy protocol by Mousavi and Bahrami (2020). Data were collected using the Parental Reflective Functioning Questionnaire by Luyten et al. (2017) and the Mother- Child Relationship scale by Robert M. Ross (1961). Data analysis was conducted using descriptive and inferential statistics (analysis of covariance). Findings: Results from the analysis of covariance, adjusted for pre-test effects, showed significant differences between the experimental and control groups in terms of maternal reflective capacity and its components, and the mother-child relationship. The results indicated that the intervention improved both maternal reflective capacity and the mother-child relationship. Conclusion: Based on the findings of this study, it can be concluded that shortterm dynamic mentalization-based therapy can serve as an effective therapeutic method for enhancing maternal reflective capacity and the mother-child relationship in counseling settings. [ABSTRACT FROM AUTHOR]

• The [State] Model of IECMHC was successfully implemented in diverse early childhood settings, including community-based childcare and school-based pre-K. • Using a longitudinal, matched comparison group design and direct observations of teachers, we found a significant positive effect on teachers' observed abilities to foster socially and emotionally healthy climates in early childhood classrooms in the Directions and Rules domain and the Equity auxiliary dimension on the CHILD observational tool. • On the Equity dimension, White teachers in the intervention group had significantly lower scores than Black and Hispanic teachers who received the intervention. • Although a core competency of infant and early childhood mental health consultation is the ability to work effectively throughout diverse cultures and communities, qualitative interviews with consultants working with teachers revealed that they often did not feel fully prepared and confident to address racial and cultural inequities they perceived with program staff or administrators. Through relationship building and collaboration, Infant and Early Childhood Mental Health Consultation (IECMHC) aims to increase early childhood professionals' capacity to promote children's mental health and reduce the use of exclusionary discipline practices. We conducted a three-year pilot study of a cross-system, embedded model of IECMHC to address gaps in the literature regarding provider and classroom outcomes. Using a matched-comparison group design, the study examined differences between staff in intervention and comparison programs in their ability to create classroom climates that promote children's social and emotional development and explored factors associated with classroom climates. A sample of 120 teachers participated in surveys over a 21-month implementation period. A subsample of teachers participated in classroom observations (n = 28) using the Climate of Healthy Interactions for Learning & Development (CHILD) tool (Reyes & Gilliam, 2017) and semi-structured interviews (n = 30). Regression analyses revealed a significant relationship between the intervention and classroom climate in two domains, directions and rules and equity. Interview data supported these findings and provided further evidence of changes in teacher attitudes and behaviors. We conclude that teachers who received the IECMHC model showed improved ability to establish certain aspects of healthy social and emotional classroom climates. We also recommend further study of this model using matched-comparison group designs and direct observations of teacher practice. [ABSTRACT FROM AUTHOR]

Abstract Background Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students’ willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of “Reflective Capacity Scale” in Iranian medical education. Methods This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS. Results “Reflective Capacity Scale” includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98. Conclusion The translated and validated “Reflective Capacity Scale” provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students.

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow‐up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry. [ABSTRACT FROM AUTHOR]

Reflective supervision and consultation (RS/C) is regarded as best practice within the infant/early childhood mental health field. Benefits of RS/C on the early childhood workforce and children and families have been demonstrated through case studies, conceptual pieces, and individual research studies. However, findings across studies have not been summarized using gold‐standard methodology, thus the state of existing empirical support for RS/C is unclear. This systematic review examined the collective evidence for RS/C across diverse early childhood‐serving programs. Electronic databases were searched to identify studies investigating associations between RS/C and professionals' reflective capacity and well‐being, child/family outcomes, and implementation factors. Twenty‐eight papers were identified. Studies showed positive associations between RS/C and early childhood‐serving professionals' reflective capacity and well‐being, with qualitative studies reporting more consistent results than studies using quantitative methods. Many methodological limitations were identified, including incomplete reporting of study designs and participant characteristics, variability in outcome measures, and lack of randomization and comparison groups. Furthermore, few studies examined child and family outcomes. Therefore, while RS/C shows great promise, it was difficult to ascertain its overall effectiveness from an empirical standpoint. Establishing RS/C as an empirically supported approach will be possible with more rigorous research. [ABSTRACT FROM AUTHOR]

Background: Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students' willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of "Reflective Capacity Scale" in Iranian medical education. Methods: This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS. Results: "Reflective Capacity Scale" includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98. Conclusion: The translated and validated "Reflective Capacity Scale" provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students. [ABSTRACT FROM AUTHOR]

Abstract Background Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition. Methods In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20. Results The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, “active self-appraisal (SA)” and “reflective with others (RO)” had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students’ critical thinking disposition. Conclusion The relationship between students’ reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.

Background: Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition. Methods: In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20. Results: The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, "active self-appraisal (SA)" and "reflective with others (RO)" had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students' critical thinking disposition. Conclusion: The relationship between students' reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition. [ABSTRACT FROM AUTHOR]

Infant and Early Childhood Mental Health Consultation (IECMHC) aims to improve early childhood professionals' abilities to promote children's mental health through relationship building and collaboration. Using a longitudinal, matched‐comparison group design, a 3‐year pilot study of a cross‐system, embedded model of IECMHC assessed teachers and home visitors in intervention and comparison programs in reflective capacity, burnout, and perceptions of children's behavior. A sample of 136 staff (n = 72 intervention group; n = 64 comparison group; 21% Black; 51% White; 28% Latina/Hispanic) participated in surveys over a 21‐month implementation period. A subsample of staff (n = 26) participated in interviews that included a narrative measure of reflective capacity; and a smaller subsample of teachers only (n = 21) completed assessments of children. Staff in the intervention group significantly increased reflective capacity after 21 months. For the staff interview subsample, receiving the intervention predicted lower levels of burnout at 12–15 months post‐baseline. Among teachers completing child assessments, those with higher reflective capacity rated children's behaviors more positively than teachers with lower reflective capacity. We conclude that this IECMHC model successfully improved reflective capacity in staff. Future research should investigate reflective capacity as a potential mechanism of change for IECMHC. [ABSTRACT FROM AUTHOR]

This study aimed to describe self-rated reflective capacity in students enrolled in post-registration specialist nursing education at the advanced level. We applied a non-experimental and cross-sectional design. A survey of 156 specialist nursing students at two universities in Northern Sweden was conducted. Data were collected in 2019 using a web-based questionnaire assessing self-rated reflective capacity through the Reflective Capacity Scale of the Reflective Practice Questionnaire. Data were analyzed descriptively using frequencies and proportions. Correlations were analyzed using Spearman's rho. Results show that students specializing in psychiatric care and oncological care report a higher reflective capacity than students specializing in other areas. We found no significant correlations between reflective capacity and gender, and reflective capacity in total did not correlate with age or work experience. We conclude that reflective capacity might vary between nursing students in different areas of specialization. Further research is needed to understand causes and impacts of variations in nursing students' reflective capacities. [ABSTRACT FROM AUTHOR]

Background: There is scarcity of literature about factors affecting reflective practices in local context. By focusing on these factors, we can help promote engagement in reflective practices in our culture. Objective: To explore the barriers to and facilitators of reflective practice by post graduate surgical residents. Methods: Using action research study design, qualitative research was conducted in the department of Pediatric Surgery, Mayo Hospital to explore different factors affecting reflective practice in postgraduate surgical residents in their daily practice. A workshop on reflective practices was conducted, followed by weekly morbidity/mortality meetings and case-based discussions deliberating using Gibbs' reflective cycle. After a year, focus group discussion using a heterogenous group of nine residents was conducted to explore the factors affecting reflective practice. It was transcribed and analyzed thematically. Results: Reflective practice was perceived to improve critical appraisal, deeper learning, self-monitoring, and patients' outcomes. There was resistance towards reflective writing. Themes related to factors affecting reflective practice were organization, time allocation, communication, workplace environment, interpersonal relations, guided reflection, and feedback. Involvement of multiple disciplines in 'reflection before action' was identified for future implementation. Conclusion: Provision of guided reflection and constructive feedback were the main facilitators of reflective practice. Generally, improving organization, workplace environment, interpersonal relations, and accommodating individual learning styles can enhance reflective practice in our context, and help developing habit of lifelong learning. [ABSTRACT FROM AUTHOR]

Objectives: The humanities, including narrative arts, are a valuable tool to foster reflection for professionally competent clinical practice. Integrating such study into traditional medical school curricula can prove challenging. A preclinical elective on opera and medicine was developed and piloted at the Warren Alpert Medical School of Brown University for pre-medical and medical students to foster reflective capacity supporting professional identity formation.Methods: Interdisciplinary faculty from the departments of arts and sciences conducted nine facilitated discussion sessions.  A field trip to the Metropolitan Opera, NY complemented students’ operatic studies. Students were asked reflection-inviting questions concerning their emotional response to operatic scenes, characters, and physician-patient interactions throughout the course and given opportunities to discuss how opera reflects and reinforces stereotypes and societal stigma of patients, diseases, and physicians. A final reflective paper prompted analysis of more and less successful patient-provider interactions, exploring how students felt about these relationships, and drawing conclusions about how they would like to ideally act in the future. Formative feedback was provided using a reflection rubric.Results: Course evaluations demonstrated that sessions were well received. Students’ qualitative comments described the influence of the course on the development of their professional identities, as well as the potential impact on their future careers as physicians. Lessons learned and future directions are suggested.Conclusions: This novel curriculum can serve as a model for using opera to enhance reflection and foster professional identity formation at other health profession and liberal arts institutions.

Abstract Aim This study aimed to test the validity and reliability of the Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire in a nursing context. Design Non‐experimental and cross‐sectional. Methods The instrument was translated from English to Swedish using a translation and back‐translation procedure. Data for the validity and reliability analysis were collected from Registered Nurses in specialist education (n = 156) at two Swedish universities. Results The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire is a valid and reliable instrument that assesses the reflective capacity of healthcare practitioners. Our findings suggest a unidimensional structure of the instrument, excellent internal consistency and good reliability. Conclusion The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire has a degree of reliability and validity that is satisfactory, indicating that the instrument can be used as an assessment of reflective capacity in nurses.

Objective: The biopsychosocial (BPS) model has been proposed to take into account the interaction of psychological and social factors in medical practice. Although some studies have explored its application in medical education, little has been evaluated about students' reflection in such courses. This study introduced a BPS model course and aimed to assess changes in students' reflective capacity resulting from this course. Materials and Methods: Eighty-seven written reflections before and after the course were segmented, coded, and rated using the Reflection Evaluation for Learners' Enhanced Competencies Tool rubric, which contains six factors of reflective capacity, namely description of disease experience, presence, attending to emotions, description of conflict or disorienting dilemma, meaning making, and action. Results: After the BPS model course, the overall reflective capacity, as well as the “Presence” and “Meaning making” scores, increased, while scores for “Attending to emotion” decreased significantly. “Description of disease experience,” “Description of conflict or disorienting dilemma,” and “Action” showed no significant change. Conclusion: Pedagogical suggestions are discussed for a BPS model course with reflective training for young medical students.

Abstract Background We sought to determine whether the Reflective Practice Questionnaire (RPQ) is a reliable measure of reflective capacity and related characteristics in medical students. We also planned to learn how the RPQ could be used in medical education. Methods The RPQ is a 40 item self-report questionnaire that includes a multi-faceted approach to measuring reflective capacity. It also includes sub-scales on several other theoretically relevant constructs such as desire for improvement, confidence, stress, and job satisfaction. The reliabilities of reflective capacity and other sub-scales were determined by calculating their Cronbach alpha reliability values. In the present study, the RPQ was answered by 98 graduating fourth-year medical students from an American University, and these RPQ scores were compared with general public and mental health practitioner samples from a prior study using ANOVA and Bonferroni adjusted comparisons. Results Medical students reported a higher reflective capacity than the general public sample, but students were statistically indistinguishable from the mental health practitioner sample. For medical students, reflective capacity was associated with features of confidence, stress, and desire for improvement. Job satisfaction was positively associated with confidence in communication with patients, and negatively associated with stress when interacting with patients. A cluster analysis revealed that around 19% of the medical students exhibited a relatively high level of anxiety interacting with patients, 23% were less engaged, 5% were dissatisfied, and 7% expressed a level of over-confidence in their knowledge and skills that was concerning. Conclusions The RPQ is a reliable measure of reflective capacity (Chronbach’s alpha value = 0.84) and related characteristics (Cronbach’s alpha values from 0.75 to 0.83) in medical students. The RPQ can be used as part of pre-post evaluations of medical education initiatives, to complement student self-reflection activities in the curriculum, and to identify students who might benefit from targeted intervention.

Objective: The biopsychosocial (BPS) model has been proposed to take into account the interaction of psychological and social factors in medical practice. Although some studies have explored its application in medical education, little has been evaluated about students' reflection in such courses. This study introduced a BPS model course and aimed to assess changes in students' reflective capacity resulting from this course. Materials and Methods: Eighty-seven written reflections before and after the course were segmented, coded, and rated using the Reflection Evaluation for Learners' Enhanced Competencies Tool rubric, which contains six factors of reflective capacity, namely description of disease experience, presence, attending to emotions, description of conflict or disorienting dilemma, meaning making, and action. Results: After the BPS model course, the overall reflective capacity, as well as the "Presence" and "Meaning making" scores, increased, while scores for "Attending to emotion" decreased significantly. "Description of disease experience," "Description of conflict or disorienting dilemma," and "Action" showed no significant change. Conclusion: Pedagogical suggestions are discussed for a BPS model course with reflective training for young medical students. [ABSTRACT FROM AUTHOR]

Clinical infant mental health interventions with brain-injured mothers and fathers and their infants is scarcely described in the literature. Further elaboration of this work is required and this paper seeks to add to that literature. This is a single case report describing home-visiting clinical work with a mother with an acquired brain injury focussing on her relationship with her infant over more than 2 years. A range of interventions including family support, developmental guidance, video-replay and holding a reflective stance were delivered throughout the 2-year period. The mother reported that her relationship with her son improved though sometimes strong feelings of ambivalence towards her son remained. Participation in psychological therapy resulted in the mother experiencing significant emotional fatigue. Clinicians should be aware of this possible emotional toll on the person with a brain injury. The relative contributions of the parent's social and emotional experience prior to the acquired brain injury, the effects on the functioning of that injury and the interplay between these factors should be considered. Interventions should be informed by each family's individual needs, begin early in life and a mix of behavioural and psychological interventions may be desirable. The experience of a very young child must also be held in mind. [ABSTRACT FROM AUTHOR]

Effecting a paradigm shift from "reproductive health" to "reproductive justice" within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant‐Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use‐of‐self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well‐being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice. [ABSTRACT FROM AUTHOR]

Introduction Reflection is the intentional evaluation of one's beliefs or understanding in consideration of the available evidence. Reflection has been noted to enhance profound learning and critical thinking and is an essential foundation of experiential learning. The Reflective Practice Questionnaire (RPQ) is a valid and reliable tool for assessing reflective capacity among medical students. It assesses not only reflective capacity but also other psychological constructs relevant to reflective practice, such as job satisfaction, confidence while interacting with patients, stress during patient interaction, desire for improvement, and feelings of uncertainty. The use of RPQ as a diagnostic tool for improving reflective capacity among medical students is scarcely available in the literature. Thus, the present study aimed to utilize the RPQ for identifying discrete action points for training and future improvement in reflective capacity. Materials and methods The present cross-sectional descriptive study was conducted among 300 medical students of a medical college. To identify the clusters or meaningful subgroups within the study population, cluster analysis was done. Inter-correlation between subscales of RPQ was performed by forming Pearson's correlation matrix to understand the dynamics between various subscales of RPQ. Results Five groups were identified in the cluster analysis: typical (25.6%), reflective (27%), non-reflective (16.7%), unconfident (14%), and overconfident (16.7%). This sets the template for specific action points for each group identified above. Reflective capacity was positively correlated with Desire for Improvement (DfI), General Confidence (CG), Communication Confidence (CC), and Job Satisfaction (JS). It was also positively correlated with negative outcomes such as Uncertainty (Unc) and Stress when Interacting with Patients (SiC). Conclusion RPQ can be used as a diagnostic tool in terms of reflective capacity for action research., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Dhurandhar et al.)

Background: We sought to determine whether the Reflective Practice Questionnaire (RPQ) is a reliable measure of reflective capacity and related characteristics in medical students. We also planned to learn how the RPQ could be used in medical education. Methods: The RPQ is a 40 item self-report questionnaire that includes a multi-faceted approach to measuring reflective capacity. It also includes sub-scales on several other theoretically relevant constructs such as desire for improvement, confidence, stress, and job satisfaction. The reliabilities of reflective capacity and other sub-scales were determined by calculating their Cronbach alpha reliability values. In the present study, the RPQ was answered by 98 graduating fourth-year medical students from an American University, and these RPQ scores were compared with general public and mental health practitioner samples from a prior study using ANOVA and Bonferroni adjusted comparisons. Results: Medical students reported a higher reflective capacity than the general public sample, but students were statistically indistinguishable from the mental health practitioner sample. For medical students, reflective capacity was associated with features of confidence, stress, and desire for improvement. Job satisfaction was positively associated with confidence in communication with patients, and negatively associated with stress when interacting with patients. A cluster analysis revealed that around 19% of the medical students exhibited a relatively high level of anxiety interacting with patients, 23% were less engaged, 5% were dissatisfied, and 7% expressed a level of over-confidence in their knowledge and skills that was concerning. Conclusions: The RPQ is a reliable measure of reflective capacity (Chronbach's alpha value = 0.84) and related characteristics (Cronbach's alpha values from 0.75 to 0.83) in medical students. The RPQ can be used as part of pre-post evaluations of medical education initiatives, to complement student self-reflection activities in the curriculum, and to identify students who might benefit from targeted intervention. [ABSTRACT FROM AUTHOR]

Background: Little is known about the development of the hidden curriculum in the medical education system. It refers to a conglomeration of implicit beliefs, attitudes and forms of conduct that are unwittingly transmitted from one generation of teaching physicians to the next. How can we describe this process, what are the potential positive or negative impacts, and last but not least, how can we measure it?Methods: Students of the Medical University of Vienna complete their clinical rotations in Vienna and in other accredited, mostly central European hospitals. They were subsequently invited to evaluate their rotations in an online questionnaire regarding dimensions, such as professionalism, teaching, integration and appreciation.Results: In total, 133 students participated in this pilot study and the average response rate was 10.1%, similar to evaluations conducted prior to that. Although the evaluation results on average were positive, several experiences of deprecation and less professional conduct were present in each evaluated rotation. Giving the students the opportunity to reflect upon their experiences could be seen as an intervention and investigation at the same time.Conclusions: This survey serves as a precursor to a qualitative interview-based study, accompanying the implementation of case-based learning designed by collaborating residents and medical students. The findings of this pilot-study support the necessity of fostering a reflective capacity in the education of medical students, enabling them to speak up and live up to the expected professionalism despite shortcomings within the hidden curriculum. [ABSTRACT FROM AUTHOR]

This paper focuses on successful adoptive parents and domestically (in-country) adopted Romanians during adolescence. Data were collected on 55 adoptees, 19 boys (34.5%) and 36 girls (65.5%), aged 11-16 years old at the time of assessment, and 55 adoptive mothers. The research was undertaken within the "Factors which Influence Successful Adoption" project with funding from the Romanian Ministry of Education. The data presented in this paper are based on the Friends and Family Interview for adolescents (FFI) and the Parental Development Interview (PDI). Successful adoption is defined as an adoptee having a secure attachment and adoptive parents keeping the joy/pleasure towards their child and adoption. Results suggest some significant differences between the securely attached adolescents and their parents and the insecurely attached ones and theirs. Implications for adoption practice are discussed. [ABSTRACT FROM AUTHOR]

Several characteristics are necessary to have a flourishing workplace: one is organisational learning. Modern workplaces call for individual responsibility, ability, and willingness to share expertise, as well as continuous learning. However, critical elements of the process of organisational learning – participating, knowing, cooperating and reflecting – are only partly ‘visible’. We propose that to cope with the pressure of renewal and to facilitate organisational learning, organisational structures and processes should be made more visible through reflective practice. The concept of reflective practice is analysed via its elements of reflective capacity, reflective dialogue, reflective experiment, and reflective management control systems. We investigate how reflection can be triggered and supported in real-life organisations, as a part of everyday work. Reflection is not studied as a hidden, mental process, but instead as a visible practice directed at past, present, or future objects. Enabling reflective practice, thus making learning more visible in the everyday agendas of the organisation, calls for genuine commitment and appreciation of reflective and dialogic ways of working. Reflective practice calls for a culture that values continuous discovery and experimentation. This appreciation is ultimately realised in reward systems, organisations’ official values and shared norms, thus forming a language and a culture that embrace reflection. [ABSTRACT FROM PUBLISHER]

This article presents a therapeutic approach for patients with severe personality disorders, transference-focused psychotherapy (TFP), a manualized evidence-based treatment, which integrates contemporary object relations theory with attachment theory and research. Case material is presented from a narcissistic personality disorder (NPD) patient in TFP whose primary presenting problems were in the arena of sexuality and love relations, and whose attachment state of mind showed evidence of oscillation between dismissing and preoccupied mechanisms. Clinical process material is presented to illustrate the tactics and techniques of TFP and how they have been refined for treatment of individuals with NPD. The ways in which conflicts around sexuality and love relations were lived out in the transference is delineated with a focus on the interpretation of devalued and idealized representations of self and others, both of which are key components of the compensatory grandiose self that defensively protects the individual from an underlying sense of vulnerability and imperfection. [ABSTRACT FROM AUTHOR]

Reflective capacity has been described as an essential characteristic of professionally competent clinical practice, core to ACGME competencies. Reflection has been recently linked to promoting effective use of feedback in medical education and associated with improved diagnostic accuracy, suggesting promising outcomes. There has been a proliferation of reflective writing pedagogy within medical education to foster development of reflective capacity, extend empathy with deepened understanding of patients' experience of illness, and promote practitioner well-being. At Alpert Med, "interactive" reflective writing with guided individualized feedback from interdisciplinary faculty to students' reflective writing has been implemented in a Doctoring course and Family Medicine clerkship as an educational method to achieve these aims. Such initiatives, however, raise fundamental questions of reflection definition, program design, efficacy of methods, and outcomes assessment. Within this article, we consider opportunities and challenges associated with implementation of reflective writing curricula for promotion of reflective capacity within medical education. We reflect upon reflection. [ABSTRACT FROM AUTHOR]

Background: Reflective practice is associated with improved accuracy of medical diagnosis and superior performance in complex situations. Systematic observation of trainees' reflective capacities constitutes a basis for an effective support of reflective practice within the training paradigm. We set out to examine the reflective capacity among anesthesiology trainees in a tertiary referral hospital., Methods: We invited 61 anesthesiology trainees in Cork University Hospitals, Ireland, to participate. Each trainee was invited to respond to 2 investigator-written vignettes prepared by the investigators and suitable for evaluation using the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) and to produce and then respond to a written vignette based on their own experience. All responses were assessed by 2 independent assessors who had undergone training in the application of the REFLECT rubric, which gives quantifiable scores. Interrater reliability was assessed by weighted kappa coefficient. Association between years of training in medicine and level of reflective capacity was examined using correlation and multiple regression analyses, controlling for age., Results: Twenty-nine trainees agreed to participate, the overall REFLECT Level was 2.16 (SD 0.7), corresponding to "thoughtful action," indicating low to moderate reflective ability. Cronbach's alpha for the 5 items of the REFLECT scale was excellent (r = 0.92). Weighted kappa was very satisfactory (k = 0.81). A strong association was demonstrated between years in medicine and scores on REFLECT, controlling for age of participant (F = -2.57, Beta coefficient = -0.30). Respondents with less experience had greater mean REFLECT scores than respondents with more experience (F = 5.5, P = .02; post hoc mean difference = 0.7, P = .03 for ≤32 months vs ≥99 months). There was a significant effect for gender (t = -4.3, P = .001), with women's responses receiving greater REFLECT scores than men's responses (mean difference = 0.67, P = .001)., Conclusions: Overall, participants demonstrated low to moderate reflective capacity, as assessed by the REFLECT rubric. Reflective capacity of the anesthesiology trainees appears to decrease as years of medical training progress. However, our respondents were not sampled over time to fully support this conclusion. Further research is needed on the psychometric properties of the REFLECT rubric and the generalizability of our findings., Competing Interests: Conflicts of Interest: The work was done in the Department of Anesthesia and Intensive Care, Cork University Hospital, Cork, Ireland. The authors have no conflicts of interest to report., (© 2022 Society for Education in Anesthesia.)

Increases in compassionate behavior improve patient outcomes and reduce burnout among healthcare professionals. We predicted that selecting and performing service-learning projects by teams of prospective medical students in a Medical Humanities course would foster students' compassion by raising their reflective capacity, empathy, and unconscious bias mitigation. In class, we discussed difficulties in communication and implicit bias. In this observational study, teams wrote individual and team critical reflections on these class discussions and their service-learning experiences, and we analyzed these reflections for dissonance, self-examination, bias mitigation, dissonance reconciliation, and compassionate behavior. Thirty-two students (53% female) completed the Reflective Practice Questionnaire and the Jefferson Scale of Empathy before the course in August 2019 and after it in December 2019. In December, students were surveyed concerning their attitudes toward team service-learning projects and unconscious bias. The students reported changes in their behavior to mitigate biases and become more compassionate, and their reflective capacity and empathy grew in association with discussions and team service-learning experiences in the course. Virtually all students agreed with the statement "Unconscious bias might affect some of my clinical decisions or behaviors as a healthcare professional," and they worked to control such biases in interactions with the people they were serving.