Family medicine residents' reactions to introducing a reflective exercise into training

Teaching residents how to reflect and providing ongoing experience in reflection may aid their development into adaptable, life-long learning professionals. We introduced an ongoing reflective exercise into the curriculum of a family medicine residency program. Residents were provided 15 minutes, three times a week, to complete these reflective exercises. We termed these reflective exercises "clinical blogs" since they were entered into a web-based computer portfolio, though they were not publicly available. The aim of this study is to explore family medicine residents' responses to the introduction of an ongoing reflective exercise and examine strengths and challenges of the reflective process.

We invited a cohort of family medicine residents (8 residents) who had all participated in the reflective exercises as part of their residency to participate in one of two offered focus groups to share their experience with the reflective exercise. An investigator not connected to the training program led each focus group using minimal structure in order to allow for the breadth of residents' experiences to be revealed. The focus groups were audio recorded, and the recordings were transcribed verbatim without identifying participants. We used a grounded theory approach, using open coding to analyze the focus group transcripts and to identify themes.

Four residents participated in each focus group. We identified four main themes regarding family medicine residents' responses of the reflective practice exercises: (1) Residents viewed blogging (reflecting) as a method of enhanced personal and professional self-development; (2) Despite the reflective exercises being valued as self-development, residents see an inherent conflict between self-development and professional duties; (3) Residents recognize their emotional responses, but writing about emotional issues is difficult for some residents; and (4) Clinical blogging in our residency has not reached its potential due to the way it was introduced.

The themes indicate that future efforts at integrating reflective practice should further test the methods through which regular reflective practices are introduced. Identified themes provide evidence for reflection as enhancing capacity for self-development and suggest the potential for clinical blogging as a method to build a cornerstone for the capacity for reflective practice in medicine.