“…A Little thing that makes a Big difference” Reflection Techniques in Addiction Psychiatry Training

Bruce Ballon B.Sc. MD FRCPC

To incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values and beliefs related to working with people with substance use and other addictive disorders.

BACKGROUND

Training in Addiction Psychiatry has been recognized as an essential part of psychiatric practice .

1,2,3. It is much easier for psychiatry residents to acquire technical knowledge and skills than it is to develop professional attitudes and empathic capacity for working effectively with people with Substance Use Disorders and Pathological Gambling. Attitudinal factors impact on professionalism, communication, scholarship and collaboration capacities that in turn effect treatment of patients 4,5,6

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Addiction psychiatry has long Been cloaked in various false-beliefs, stigmas and faulty assumptions 7,8

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be able to properly treat individuals suffering from addictive disorders, a professional attitude and understanding one’s own biases is necessary to appreciate the true nature of addictive disorders as chronic conditions To similar to other physical and mental health conditions. One major focus is on helping residents identify their attitudes via reflective techniques, to help ground the knowledge and skill acquisition 9,10,11,12 . Reflection facilitates the development of awareness and examination of our unconsciously held values and beliefs about our practice that drive our learning and interactive clinical behaviors – and thus is a perfect method for having students become aware of all their attitudes towards addiction psychiatry. Reflective concept fit well with adult learning theories such as Kolb’s experiential learning cycle 13 , which posits our understanding of reality is built upon our experiences that in turn shape our ideas about what is valued as knowledge.

RESULTS:

40 nodes were identified using N-Vivo (see Table A). Many comments contained within the nodes are repetitive but illustrate slightly different themes within the data. Numerous constructs emerged that demonstrated the attitudes, beliefs, stereotypes and stigmas learners have regarding addictive disorders. Many constructs also highlighted that learners felt much more comfortable dealing with addictive disorders due to the training and would treat individuals with these conditions in a more effective manner. Please see analysis document for further details (attached next to poster).

Wayne Skinner MSW RSW

Assistant Professor of Psychiatry, University of Toronto

The analysis of the reflection papers demonstrates the many themes and the transforming factors that helped residents acquire knowledge, skills and most importantly attitudes in regards to addiction psychiatry. Residents endorsed the reflective elements as important and crucial for the rotation’s overall successful training experience. Therefore, the reflection techniques embedded within the rotation will remain a key feature to the addiction rotation at the authors’ site and be used as a template for other rotations and other programs to use in their own settings. Reflective educational techniques have the potential to be extended in many areas of psychiatric training. Their use encourages constructive self reflection not just about attitudes, values and beliefs, but practice skills, interpersonal processes,and environmental and structural factors that shape professional comportment, whatever the context. These are hallmark characteristics of lifelong learning. A limitation to the analysis of the papers include that they are self-reports and that the learners knew they would not be anonymous when handing it in for the supervisor to read. This may have influenced them to write what they thought the supervisor wanted them to write. Despite that, many papers contained very powerful admissions of self-discovered biases and stigmas and the writers were very open with struggles they had in the ambiguous world of psychiatric practice. The very nature of creating an environment for people to share reflections is built upon trust. However, the true impact of the reflection techniques will be seen over time if students continue to perform them.

METHODS:

This has been a qualitative project but the next step would be for the development of a quantitative method to observe change in attitudes and professionalism as residents continue on through their training.

Reflection discussion times, reflection journaling, and mandatory end-of rotation reflection papers for submission were embedded into a core PGY I addiction psychiatry postgraduate training block (see course material exhibits and sample reflection papers attached next to poster).

14,15 After 1 year of this new curriculum, 28 reflection papers from PGY I psychiatry residents were collected and analyzed for themes. Content analysis using “open coding” was conducted in order to determine themes that emerged from the papers submitted 17,18 . The papers were coded twice; once manually, and once using N-Vivo software. As a final note, the authors wish to share that by creating a learning climate of trust and discovery where reflections can be discussed, the educational experiences are not only enriched for the students but for the teacher as well. Often the teacher will also share reflections and be able to gain valuable insight into the actual teaching program from the students’ perspectives often unseen and unheard by the traditional feedback techniques. The interactive opportunity this provides optimizes the learning experience for both learner and mentor.

References

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10 Jarvis P. Reflective Practice and Nursing. Nurse Education Today. 12:174-181. 1992 11 Tate S, Sills M. The Development of Critical Reflection in the Health Professions. http://www.health.ltsn.ac.uk/publications/occasionalpaper 12 Greveson G. Guidelines for reflective diary and examples of diary entries. Master in Clinical Education program. School of Medical Education Development. University of Newcastle upon Tyne.

13 Kolb, D. A.

Experiential Learning

, Englewood Cliffs, NJ.: Prentice Hall. 1984.

14 Ballon, B. Addiction Psychiatry Training, University of Toronto 2004-2006 curriculum and resources. Addiction Psychiatry Division, Department of Psychiatry, University of Toronto. Toronto, Canada.

15 Lieff, S. Education Scholars Program 2004-2006 curriculum and resources. Centre for Faculty Development, Faculty of Medicine, University of Toronto. Toronto, Canada 16 Epstein, R. Mindful Practice. JAMA

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282: 833-839;1999 17 Strauss, A and Corbin, J.. Basics of qualitative research:grounded theory procedures and techniques. Newbury Park, CA:Sage.1990

18 Chamberlain, K. Using grounded theory in health research: practices, premises and potential. In M.Murray and K. Chamberlain (eds) Qualitative health psychology: theories and methods. London:Sage, pp.183-201. 1999