Brief, Real-Time Reflections: An Efficient, Contextual, and Familiar Variation of Narrative Medicine: A Mixed Methods Analysis

Abstract Background: Narrative medicine is a widely used pedagogic tool but can be detached from the clinic context and unfamiliar to students. Brief real-time reflections could be a method of narrative medicine that is contextual, familiar, and convenient. Methods: Fourth year medical students completed 280-character reflections immediately after patient interactions while rotating in a primary care clinic serving complex patients. Three researchers used qualitative methods to develop a codebook to describe the reflections and an independent auditor verified codebook application. Student feedback regarding their experience writing reflections was elicited on a Likert scale to understand student perspectives on the tool about ease of use, empathy, and remembering patient interactions. Results: Eighteen students completed 131 reflections during 64 clinics; an average of 2.04 reflections per clinic and spent an average of 4.39 minutes on each reflection. Three codes were elicited to describe the content of reflections: descriptive, emotional, and cognitive. The most frequently identified code was cognitive (n = 84, 41%), with descriptive (n = 69, 33%) and emotional (n = 53, 26%) being less frequent. Reflections could contain one or a combination of codes. The most common reflection was cognitive-only (n = 43, 33%) followed by a combination of descriptive and emotional (n=24; 18%). Most students agreed or strongly agreed that reflections helped them think more deeply about (9/9, 100%) and remember (8/9, 89%) patient interactions and were a good use of their time (7/9, 78%). Conclusions: Brief, real-time reflections are a tool that allow medical students to reflect upon their clinical experiences in a complex and cognitive way and was well-received by students.