The Reflection Competency: Using Narrative in Remediation

Abstract

Reflection is critical to experiential, lifelong, self-directed learning. The practice of medicine is characterized by complexity, uncertainty, emotional intensity, values conflicts, and ethical challenges. It has been proposed that the capacity to reflect masterfully is required to work effectively in such complex settings. Many physicians eventually master this capacity, most struggle somewhere along the way, and some manifest significant trouble reflecting accurately and efficiently enough to achieve clinical competence. In this chapter, the author reviews conceptual models highlighting the critical nature of reflection and demonstrates through case examples that reflective capacity can be enhanced through structured writing exercises. While narrative exercises have value for most physicians, students who will benefit most from a narrative-based remediation strategy are those who lack insight into their own problems and deficits, especially those who are insensitive to the perspectives of others and or who hold unexamined biases and attitudes that negatively impact clinical competence.