The Power of Reflection

A structured learning experience that combines:
 Community Service
 Explicit Learning Objectives
 Preparation
 Reflection
Seifer, S.D.,
(1998)

Why Community Service Learning in Medical School ?
The Changing World of Healthcare

Away from hospitals - into the community

Increased emphasis on prevention - in community

Multidisciplinary Teamwork

New technologies

More Cultural Diverse population

Broadened definition of health


Initiative, Motivation, working in a team
 Communication (peers, professionals, clients)

Cultural Competence

Recognizing needs of vulnerable population
 Impact of health policy on communities

Professional Behaviours

Personal management and self development

How Does UBC CSL work?

Downtown Eastside Women’s Center
Senior’s Residence
Hospice
Safe House
Crisis Line
Refugees
Safe Injection Site

David Kolb 1984
Concrete
Experience
Testing in new situations
Observation
&
Reflection
Forming
Abstract
Concepts

Testing in new situations
Concrete
Experience
Forming
Abstract
Concepts
Observation
&
Reflection
Concrete Experience
 DPAS Plenary
 Course Readings
 Agency Visits
 Agency Supervisor
 Clients
 Other Students
 Staff

DPAS Tutor as Social
Mediator

Reflective Journals

Face-to-face meetings
Testing in new situations
Concrete
Experience
Observation
&
Reflection
Forming
Abstract
Concepts

“The process of reflection is just as much concerned with the organism’s active transformation of reality and the representation of reality, as with the reception of reality”
J.V. Wertsch (1985)
Vygotsky and the Social Formation of Mind

Some Guiding Principles for a CSL Tutor
 Perezhivaniji – Reflective Journals are a lens through which to view students lived or emotional experience
 Create a safe environment – Relationship building
 Tone of writing
 Face to Face meetings (including student group)
 Construct new knowledge
 framework for journals – Learning Outcomes
 reflective questions asked by tutor – not simply a narrative
 Invoke meaningful future activity

The front desk volunteer was angry at me because I had accidently done something that was against the policy of the
Centre. The women who use the center were angry with me because they got a worse place on the list even though they had followed protocol. Even though I tried to remedy the situation, I felt like the damage had been done.
With this experience , I realized that no matter how comfortable I have started to feel at the Centre, I still cannot truly
understand what life is like for these women.

[responding to Tutor’s Comment]
…This was a very useful comment to me, as it made me realize that I wasn’t really learning a lot about victims of abuse, and wasn’t comfortable probing for information about the history of abuse. This really made me shift focus from what I was doing was learning about myself and fine tuning my skills as a physician to create open and relaxing atmospheres for my patients to open up . I had to take a incontinence history from a 5 year old and her mom in family practice a few weeks ago, and I chose to open the interview by sitting on the foot stool at the same height as the child, and asking the child about the jacket she was wearing. We spent 20 seconds discussing how pretty it was, and that it was reversible, and that the blue side was both our favourite side. Then, we talked about how school was going, what her teachers name was, who her friends were, and then if she used the bathroom at school or at home, and the interview was well on the way. My preceptor provided feedback that I saved time by conducting the interview that way, and the child was more at ease during a physical exam.

In a recent reflective journal, I described making a mistake which elicited much anger from the women. I had assumed they were angry for practical reasons: they would have to wait longer, people ahead of them may take the clothes they wanted, and I had not followed normal protocol. My tutor asked me to think more about what the clothing room may represent for these women. As a result, I started to think about some of the reasons why the women often use the clothing room, and how this could have affected their reaction. Many of the women using the clothing room are looking for simple items that I may take for granted: bras, underwear, socks, shoes, and other items. I started to think that, similar to so many aspects of their lives, these women were desperate for basic necessities. After waiting in the cold, sometimes having slept outside all night, to receive a meal they didn’t choose but desperately needed, and then being at the mercy of a stranger to receive basic clothing, I imagine that many of the women were most upset over their lack of control of the situation. They were once again at the mercy of someone else and perhaps once again treated from their perspective, unfairly. Thinking of future interactions in this context will help me take these situations less personally, and
interpret the reactions of the women with more empathy.

Eyler, J.S, Giles, D.E., Stenson, C.M., Gray, C.J.(2001) At a glance: what we know about the effects of service-learning on college students, faculty, institutions and communities,1993-2000: Third Edition. Vanderbilt University.
Kolb, D.A.(1984) Experiential Learning: Experience as a Source of Learning and Development.
Englewood Cliffs, JF: Prentice-Hall.
Mahn, H. & John-Steiner, V. (2002). The gift of confidence: A Vygotskian view of emotions. In
G.Wells & G. Claxton (Eds.), Learning for life in the 21 st century: Sociocultural perspectives on the future of educatin (pp.46-58). New York, NY: Blackwell
Seifer, S.D. (1998). Service-learning: Community-campus partnerships for health professions education. Academic Medicine , 73(3):273-277.
Wertsch, J.V. (1985). Vygotsky and the social formation of mind. (pp. 188-189). Cambridge, MA:
Harvard University Press.
Shugars, DA, Vernon, TM, Richardson, O’Neil, EH, Bader, JD. (Winter 1991) Is health professions education part of the solution? Health Affairs, 280-282.