Small but mighty: the photo/tiny story, a tool for reflection in medical education

Reflective practice is associated with personal and professional development, including enhanced well-being and improved quality of patient care. Although medical education typically relies on narrative or text-based exercises for reflection, the visual arts are well suited to fostering reflective practice in ambiguous learning environments, such as medical school. Incorporating the visual arts with written reflections can enhance creativity and observation while engaging metacognitive skills, such as perspective-taking and self-awareness of biases. The authors describe an innovative reflection tool that integrates photographs with brief written reflections on meaningful learning from early clinical encounters in undergraduate medical education.

The authors developed a health humanities reflection tool-the Photo/Tiny Story (PTS)-that combines taking a photograph with writing a corresponding 55-word story. Introduced in a first-year course at the University of Rochester School of Medicine and Dentistry, the tool facilitates students to critically reflect on their experiential learning from one meaningful clinical encounter and represent this in a PTS. Students subsequently discussed their assignments in facilitated small groups. Assignment evaluations from May of the academic year 2021 to 2022 were examined, and the PTSs were thematically analyzed using an inductive approach.

Seventy-six of 102 students (75%) reported that the PTS was a valuable tool for reflection, with 72 (71%) reporting that it helped them examine assumptions and biases. Additionally, 91 (89%) acknowledged its effectiveness in facilitating reflection on the affective elements of their patient encounter. Qualitative analysis of the PTSs identified 4 key themes: clinical challenge of biopsychosocial practice, awareness of uncertainty, recognizing discrepancies between clinical expectations and reality, and skills application.

Results indicate that the PTS is an effective, resource-efficient tool for reflecting on experience and complex skills acquisition in emotionally charged clinical environments. Next steps include analyzing PTS assignments across all 4 years of undergraduate medical education.