Teaching of reflection in higher education: a narrative review.

Background: Healthcare professional students (HCPs) are encouraged to utilise reflection during and after their study programmes as a part of their life-long learning skill and professional competencies. However, the way in which the concept of reflection is taught and its' influence students' capacity to reflect have not been fully explored. This narrative review aimed to explore how the concept of reflection is taught in higher education and how the teaching of reflection influences HCP students' capacity to reflect. Methods: Articles that were published during 2014-2024 within three databases, PubMed, CINAHL and ERIC were searched. 1929 articles were eligible for screening. 93 articles were further assessed for eligibility. Results: 18 articles were included. The included articles were geographically well-distributed in both the Global North and Global South countries, indicating universal interest in the topic. Eight articles had qualitative study designs; six had quantitative designs and four had mixed-method designs.Conceptually, the teaching of reflection could be categorised as a spectrum, ranging from: i) structured format (reflective templates or debriefing); ii) semi-structured format (physical/virtual small group discussions, video recordings, AI generative arts, in-verse reflection and concept mapping) and iii) flexible and creative (art-based pedagogy or narratives).All included articles indicated students actual and perceived better understanding of reflection. This claim is supported both quantitatively and qualitatively via either validated instruments or narratives and themes based on students' textual outputs. Conclusions: This review identified several teaching methods that help facilitating students' capacity to reflect. Findings are unable to recommend the most efficient way to teach reflection since it depends on students' progress in their programmes. However, a more relational approach to teaching of reflection is recommended. Students might begin their reflective journey with a structured format of teaching of reflection then gradually move to less-rigid format of the teaching to empower students' autonomy.

Exploring the palliative care ecosystem in Thailand: a protocol for a scoping review and bibliometric analysis.

INTRODUCTION: Palliative care is an approach that aims to holistically improve the quality of life, care and death of people living with life-limiting conditions as well as their families. In Thailand, palliative care became one of its national strategies as of 2014. However, the access to as well as the quality of palliative care being delivered still varies across the nation, due to multiple factors spanning multiple levels. Consequently, there is a need to comprehensively understand the current palliative care ecosystem in Thailand. This review aims to explore, map and conceptualise the literature available on the palliative care ecosystem in Thailand, and how the service being delivered influences the quality of life, death and care of people living with life-limiting conditions alongside their families. METHODS AND ANALYSIS: This review will consist of two stages. First, a scoping review guided by the Joanna Briggs Institute methodology for scoping reviews will be initially conducted. A systematic literature search using Medical Subject Heading and text words related to palliative care will be performed in PubMed, CINAHL and Thai Citation Index from 2013 to 2023. Grey literature will be searched via alternative sources: Google keyword searching and stakeholders consultation. References of included sources will be handsearched to identify further resources.The population, concept and context framework is used to frame the inclusion and exclusion criteria. This will be further refined after the initial search, reflecting the iterative nature of a scoping review. Articles will be independently screened by three reviewers. A Microsoft Excel spreadsheet will be used as the data extraction tool. Data will be extracted and presented using a narrative synthesis approach.Second, included articles from the scoping review will be further analysed and visualised using a bibliometric analysis technique. This stage involves a computational method, including statistical analysis and content analysis of the articles' bibliographic details. ETHICS AND DISSEMINATION: This paper describes a protocol for a scoping review and bibliographical analysis. As such, ethical approval was not required. Information relating to the review will be stored with Open Science Framework Registries. The findings of this proposed scoping review will be distributed through a peer-reviewed publication, academic seminars, conferences and patients and public involvement groups.

Using Zoom and Card Game to Conduct Advance Care Planning Classes: An Innovative Practice.

BACKGROUND: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic. AIMS: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying. METHODS: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used. RESULTS: Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.

Enhancing nursing students' reflection through Padlet: an action research.

Background: Reflective practice is encouraged amongst healthcare students, including nursing students. However, students do not have a 'safe space' to practice reflection before being assessed. Padlet is an interactive platform that can potentially facilitate students' reflection via its features that enables anonymous participation, asynchronous participation and collaborative learning environment. This study aims to explore the influence of current reflection teaching method on students' reflective practice and how Padlet can facilitate students' reflective practice. Methods: An action research was undertaken with 22 first year nursing students from Feb to May 2023. Participants answered questions anonymously pre-class and post-class in two Padlet boards. The researcher gave constructive feedback and signposted good examples of reflection to participants thus enabling 'champion' students to emerge during the process. Anonymous texts from two Padlet boards were analysed using reflexive thematic analysis technique. Results: Three themes were generated: i) Unpacking variation in students baseline understanding of reflection; ii) Co-constructed understanding of reflection and iii) Prompting reflective practice through tools and triggers. Students joined the study with different presumptions and understanding of reflection, ranging from descriptive understanding of the concept, a total misunderstanding of the concept and in-depth understanding of reflection. They all indicated a changed understanding of reflection post-class and emphasized the benefits of a socially constructed learning process. Participants suggested the use of reflective tools (via reflective models) and triggers (via probing questions and feedback) as useful to facilitate their reflection. Conclusions: This study indicates that the current teaching materials enable students to enhance their understanding of reflection. Nevertheless, students could potentially benefit from tools and triggers that will initiate and support their reflection. To that end, Padlet proves a promising tool to enhance students' reflection via its function to enable anonymity, asynchronous participation and socially constructed learning environment.

Factors Influencing Job Retention and Quality of Life amongst Nasopharyngeal Carcinoma Patients.

OBJECTIVE: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL. METHODS: This study was based on secondary data from a cross-sectional study that aimed to develop the Thai version of functional assessment of cancer therapy with nasopharyngeal cancer subscale demographic data, clinical information of participants, and Functional Assessment of Cancer Therapy with Nasopharyngeal cancer subscale (FACT-NP) were utilized. Data were analyzed using Student's t-test, rank-sum test, variance analysis, and the Kruskal-Wallis test. Multiple linear regression with the stepwise model was used to determine multiple variable analysis. Statistical significance was defined at p-value < 0.05. RESULTS: Two hundred and thirty NCP were included in the study with a mean age of 50.3±12.4 years. According to our findings, 68.3% were male, 81.7% were married or living with a partner, and 86.1% were Buddhism had the Eastern Cooperative Oncology Group (ECOG) performance status between 0-2 (95.2 %). The employment status, education level, economic status, ECOG, stage , and disease status significantly influenced patients' QoL. Patients who had active treatment and received prophylactic percutaneous gastrostomy  were also impacted by the FACT-NP score. In the multivariate analysis, employment status, ECOG, and disease status were shown to be significant factors that were associated with their QOL in the final model. CONCLUSION: Employment status was a socioeconomic factor that led to positive QOL amongst NCP.

A narrative review of facilitating and inhibiting factors in advance care planning initiation in people with dementia.

PURPOSE OF THE REVIEW: To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD). METHODS: A narrative review was conducted. A keyword search of Medline, CINAHL PsycINFO, and Web of Sciences databases produced 22,234 articles. Four reviewers independently applying inclusion/exclusion criteria resulted in 39 articles. Discrepancies were settled in discussion. RESULTS: Twenty-eight primary studies and eleven review articles remained. Narrative analysis generated five categories of facilitating and inhibitory factors: people with dementia, family orientation, healthcare professionals (HCP), systemic and contextual factors, and time factors. Key facilitators of ACP initiation were (i) healthcare settings with supportive policies and guidelines, (ii) family members and HCPs who have a supportive relationship with PwD, and (iii) HCPs who received ACP education. Key inhibitors were: (i) lack of knowledge about the dementia trajectory in stakeholders, (ii) lack of ACP knowledge, and (iii) unclear timing to initiate an ACP. CONCLUSION: This review highlighted the main challenges associated with optimal ACP initiation with PwD. To encourage effective ACP initiation with PwD, succinct policies and guidelines for clinical commissioners are needed. ACP also needs to be discussed with family members in an informal, iterative manner. More research is required on initiation timing given the disease trajectory and changing family dynamics.

Reflective and feedback performances on Thai medical students' patient history-taking skills.

BACKGROUND: Reflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face different learning barriers compared to learners in the West, where RP originated. METHODS: In this retrospective study, we assessed RP and feedback performances on Thai medical students' patient history-taking skills. We applied RP and peer feedback, along with feedback from the instructors, during the history-taking sessions of the ten-week introduction course for fourth-year medical students. Twelve history-taking sessions were used for the analysis. Two instructors assessed students' reflective performance and categorised them into one of the six stages of Gibbs' reflective cycle; their feedback performances were analysed using Pendleton's model. We investigated the correlations between students' overall grade point average (GPAX) and patient history-taking scores on the Objective Structured Clinical Examination (OSCE). Students' opinions of the RP teaching method were also collected. RESULTS: All (n = 48) students participated in our study. The students' mean age was 21.2 ± 0.5 years. The majority of the students were female (64.6%). The data indicated that 33 and 4% of the participants were categorised into the evaluation stage and action plan stage of Gibbs' reflective cycle, respectively. In addition, 22 and 15% of the participants were able to state what their peers did well and suggest how peers could improve their skills, respectively. All students passed the minimum passing level of four history-taking OSCE stations. Participants agreed that RP was a useful tool (mean 9.0, SD 0.1), which enhanced their thought processes (mean 8.4, SD 0.2) and future performances (mean 8.2, SD 0.2). However, there was no correlation between the students' highest Gibbs' reflection levels and their history-taking OSCE scores. CONCLUSIONS: RP, together with feedback, proved to be a useful technique to help fourth-year Thai medical students improve their reflection skills, enhance their medical knowledge, and improve patient history-taking skills. Further study with longer monitoring is required to further explore negative and positive influential factors affecting students' achievement of better reflection performances.

The Meaning of Spirituality and Spiritual Well-Being among Thai Breast Cancer Patients: A Qualitative Study.

CONTEXT: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came from a different cultural background and was heavily based on Buddhism approach. AIMS: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background. SETTINGS AND DESIGN: Descriptive qualitative phenomenology design. SUBJECTS AND METHODS: In-depth interview with stratified purposive sampling method. The interviews took place in the oncology outpatient unit department and participants' home. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psychological disorder. STATISTICAL ANALYSIS USED: Descriptive statistic. RESULTS: From October 2016 to February 2018, 16 women joined the study. Three themes emerged with five subthemes: (1) feeling life worthwhile, (2) sense of belonging in the community, and (3) feeling connected to the nature. CONCLUSIONS: For Thai women, who have breast cancer, their spirituality focuses on family, mainly their children. They also have better SWB if they have good family relationship, social support, or feeling connected with nature or higher being in a religious or nonreligious way. Future survey design needs to be broader in a secular view and on another perspective rather than the religious approach.

Body image transformation after breast cancer diagnosis and treatment in southern Thai women.

OBJECTIVE: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. METHODS: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. RESULTS: Participants' body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. CONCLUSION: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.

Relieving total pain in an adolescent: a case report.

BACKGROUND: Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an adolescent who suffered from total pain and how his healthcare team and peers helped to relieve it. CASE PRESENTATION: A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan. CONCLUSIONS: This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.

Life unlocking card game in death and dying classroom for medical students.

This article was migrated. The article was marked as recommended. Introduction: Advance Care Planning (ACP) is a part of comprehensive palliative care but there are challeges for its implementation. In Thailand, undergraduate medical curriculum also has not implemented palliative care and ACP as a core teaching topic for the medical students yet. Life Unlocking Card Game is an end-of-life conversation card game that aims to bridge this gap. Objective: To assess second year medical students' attitude of death by using Life Unlocking Card Game and its effectiveness to teach about death and dying. Methods: Non-equivalent quasi-experimental design with convenience sampling method. All (48) of second year medical students participated in an end-of-life conversation game (8 games in total with one facilitator within each group). After that, each group formed an after-game focus group interview. Seven students also joined individual semi-structured interviews. We used content analysis approach along with investigator triangulation and methodological triangulation methods for the qualitative analysis. Results: Participants (n = 48) were second-year preclinical medical students. 26 of them were male (54.2%), 22 were female (45.8%), with the mean age of 20 years (SD 0.6). Five primary themes regarding the card game emerged: 1) Safe space to disclose personal issues 2) Seeing the world through different views 3) Surprise elements 4) Death distant closure 5) Changed behaviour. Conclusions: Life Unlocking Card Game proves to be an effective tool to teach death and dying issues and also ACP in second year medical students. Further study in clinical year students or postgraduate students are recommended.

Breast Conserving Therapy and Quality of Life in Thai Females: a Mixed Methods Study.

BACKGROUND: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). MATERIALS AND METHODS: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. RESULTS: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. CONCLUSIONS: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.