Professional development of medical students - piloting a longitudinal curriculum at Jena University Hospital (LongProf).

Background: Professionalism is an important prerequisite for the quality of medical care with specific competencies anchored in the National Competence-Based Learning Objectives Catalogue Medicine 2.0. To date, there are hardly any explicit teaching formats at German universities to achieve these. A longitudinal curriculum for the development of medical professionalism (LongProf) has now been developed, implemented and evaluated at Jena University Hospital. Methods: The target group of the four-semester-curriculum were medical students from the fifth semester onwards. After a nine-month conception phase, a total of nine courses (6 teaching units each) took place from the winter semester 2021/22. Students also had the opportunity to interact with experienced doctors in mentoring sessions. The courses were evaluated by the participating students (n=23) in terms of acceptance and individually perceived professional development through quantitative surveys and qualitative focus group interviews. Results: The qualitative and quantitative evaluation revealed mostly positive feedback (mean >7/9). Students stated that the courses had provided them with lasting support in developing their own medical professionalism and in coping with the demands of their studies. The personal and long-term relationship building between students and teachers was considered particularly helpful. Discussion and conclusion: A multi-semester curriculum opens up ways for implementing the development of medical professionalism in medical studies. A trusting relationship between students and teachers, made possible by the longitudinal structure, is seen as conducive to the development of an individual medical identity. The curriculum is a useful complement to regular medical studies.

Bearing witness: Medical education and reflecting on the Holocaust then and now.

Background: Despite advocacy from the Association of American Medical Colleges (AAMC) and The Lancet Commission on medicine, Nazism, and the Holocaust, Holocaust education is lacking in medical education. To address this gap, students at Geisinger Commonwealth School of Medicine (GCSOM) viewed an Association of American Medical College (AAMC) webinar about medicine during the Holocaust as part of the required curriculum for first year medical students introduced in 2022. Methods: As part of their doctoring course, Physician and Patient Centered Care (PPCC), students viewed the AAMC webinar "The legacy of the role of medicine during the Holocaust and its contemporary relevance" and participated in two structured reflections: a written reflection on how webinar topics inform students' professional development and a verbal reflection on learning from the Holocaust to develop a sense of moral courage, advocacy, and activism in medicine. Researchers conducted qualitative analysis of written reflections and analyzed session surveys to determine key themes and impact of the session. Results: Of the 108 enrolled in PPCC, 59 (54.6%) completed a post session Likert scale survey assessing the impact of the webinar on their personal and professional development. As an average, respondents moderately agreed that the webinar impacted their personal and professional development, with 91% slightly, moderately, or strongly agreeing. Additionally, thematic analysis of required written reflections indicated a majority of students (62.5%) identified the need for additional medical humanities education about the Holocaust and its relevance to medicine. Conclusion: Holocaust education encourages medical students to bear witness to past medical atrocities and critically assess the profession and their personal-professional growth. Continued structured integration of the Holocaust in medical education supports critical self-reflection and the development of morally courageous physicians who endorse and practice social accountability in medicine.

A Resident Narrative Medicine Curriculum to Promote Professional Identity Development: Story-Based Sessions Grounded in Narrative Learning Theory.

Introduction: Empathy, reflection, and social connectedness are important skills for physician identity development and are increasingly challenged by burnout. Humanities-based interventions like narrative medicine (NM) are emerging in medical education to promote these skills. Only 17% of such initiatives target graduate medical learners. Furthermore, interventions are inconsistent in approach and theory representation. NM uses story-based learning to promote reflection and group discussion. Inspired by narrative learning theory, we developed NM sessions for residents to foster healthy identity development. Methods: Ninety-minute sessions were integrated into curricula for PGY 1-PGY 3 internal medicine-primary care residents at two large academic centers. Sessions involved engagement with a narrative source (stories, poems, art), personal reflection, and group discussion. Topics ranged from burnout to difficult patients. Participants completed anonymous postsession surveys assessing satisfaction, attitudes, and skills. Results: Fifteen sessions occurred from 2021 to 2023, with three to 10 residents per session. Fifty residents completed between one and four sessions, with 68 survey responses (response rate: 88%). Over 95% ranked 4-5 out of 5 for overall impression (n = 67) and personal value (n = 65) of sessions. Sessions were highly enjoyable (M = 4.8), with mean scores of >4 out of 5 for impact on wellness, appreciation of work values, social connectedness, and patient care. Discussion: NM sessions demonstrated measurable improvements in several domains of professional performance including wellness, job satisfaction, and patient care, while promoting camaraderie and emotion processing. Our materials offer tremendous potential for promoting healthy identity formation.

A tripartite taxonomy of character strengths & virtues: toward professional identity formation in medical students & physicians.

BACKGROUND: There are limited comprehensive descriptions of character strengths and virtues specific to the professional identity formation of medical students in the literature. This absence of a satisfactory summation of virtues has stimulated us to attempt a conceptual framework utilizing a tripartite taxonomy. This taxonomy reflects recent interest in and importance of justice and care of the self. METHODS: Our taxonomy is grounded within a perennial tradition of medical ethics that focuses on the moral "excellences" or "virtues" that form the character of a good doctor, as acquired over time within a community of practice. Character refers to the whole set of excellences of a practitioner as a member of the medical community. RESULTS: We propose a tripartite taxonomical classification of virtues as Other-Regarding Virtues, Self-Regarding Virtues, and Equal-Regarding Virtues. Though synergistic, each category is readily distinguishable with regard to a fundamental mindset. To thrive, a medical student must develop character strengths that encompass all three categories. CONCLUSIONS: Our goal in introducing this tripartite taxonomy is to provide a framework of virtues to contribute to the definition of professional identity. We envision the taxonomy will provide a structure for professional identity formation curriculum development and organize the ever-elusive assessment of professionalism in learners. This taxonomy can also be viewed as an aspirational roadmap for practicing physicians and educators, and as a compass for their daily consciousness. We believe that this taxonomy will enhance the well-being and development of physicians and medical students, and the patients in their care.

Development and implementation of a Community Pharmacy "Bootcamp" activity - A pilot study.

OBJECTIVE: The objectives of this study are to describe 1) the implementation of and 2) student performance and perceptions during an innovative classroom activity. METHODS: The Bootcamp was designed as an exercise in productive failure for second-year PharmD students enrolled in a community pharmacy elective course. A prescription verification exercise was introduced; however, students were intermittently interrupted with common community pharmacist tasks. To simulate these tasks (e.g.: receiving a phone call, counseling a patient, administering a vaccine, checking controlled prescription monitoring database etc.), students were directed by the instructor to perform other physical activities (e.g. walking around the classroom, doing jumping jacks, sending an email, etc.). After the activity, accuracy was assessed and each student uploaded a video reflection which were analyzed with content analysis. RESULTS: The activity was delivered in person in 2021 and virtually in 2022 during a two-hour class period. Of the 63 students, 86 % fully completed all 12 prescription verifications in the allotted time; however, the average accuracy was 53 %. Content analysis of video reflections generated three themes: unique and fun activity, importance of attention to detail, and enhanced understanding of pharmacy workflow from the pharmacist's perspective. CONCLUSIONS: The Community Pharmacy Bootcamp was a fun and engaging way to expose students to the realities of daily practice in the community pharmacy setting. This activity was effective in helping students discover the need for development of further skills in addition to clinical expertise. This novel activity may be adapted to other environments including integration into required coursework.

The Impact of a Study Trip to Auschwitz: Place-based Learning for Bioethics Education and Professional Identity Formation.

There are increasing calls for coverage of medicine during the Holocaust in medical school curricula. This article describes outcomes from a Holocaust and medicine educational program featuring a study trip to Poland, which focused on physician complicity during the Holocaust, as well as moral courage in health professionals who demonstrated various forms of resistance in the ghettos and concentration camps. The trip included tours of key sites in Krakow, Oswiecim, and the Auschwitz-Birkenau concentration camps, as well as meeting with survivors, lectures, reflective writings, and discussions. In-depth interviews and reflective writings were qualitatively analyzed. Resulting themes centered on greater understanding of the relationship between bioethics and the Holocaust, recognizing the need for moral courage and social awareness, deeper appreciation for the historical roles played by dehumanization and medical power and their contemporary manifestations, and the power of presence and experiential learning for bioethics education and professional identity formation. These findings evidence the significant impact of the experience and suggest broader adoption of pedagogies that include place-based and experiential learning coupled with critical reflection can amplify the impact of bioethics and humanism education as well as the process of professional identity formation of medical students.

The assimilatory impact of professional Identity formation on racial and ethnic minority doctor of pharmacy students.

The ideology of professional identity formation (PIF) is trending in pharmacy education. Therefore, we must initiate conversations about how the PIF framework impacts minoritized students. PIF is applied at default through the white racial frame, which is why making PIF inclusive is difficult. The concept of PIF itself is Eurocentric and relies on normative colonial systems, order, and viewpoints. Due to white centering, the PIF framework then becomes a tool of assimilation. This socially conditions marginalized and minoritized individuals to participate in the dominant culture's society according to those norms. Here we review the capitalistic angles of PIF, how PIF encourages assimilation, the interplay of role modeling on student development, and how to adjust the PIF framework to be more inclusive for minoritized learners.

A systematic scoping review on group non-written reflections in medical education.

BACKGROUND: Medical education is tasked with shaping how medical students and physicians think, feel and act as professionals, or their Professional Identity Formation (PIF). This process has traditionally rested upon imparting knowledge; integrating sociocultural, professional and organizational expectations and codes of conduct; inculcating program and practice beliefs, values and principles (belief systems); and imbuing shared identities - quintessential elements that, together, comprise the socialization process. Key to supporting this socialization process is reflective practice. However, regnant approaches to mobilizing reflective cycles are faced with resource, personnel and time constraints, hindering efforts to nurture PIF. Group non-written reflections (GNWR) - broadly defined as facilitator-led discussions of shared reflective experiences within groups of learners - may prove to be an effective compromise. To address diverse approaches and a lack of effective understanding, we propose a systematic scoping review (SSR) to map the current use of GNWR in medical training and its role in shaping PIF. METHODS: Guided by the Systematic Evidence-Based Approach (SEBA)'s constructivist ontological and relativist epistemological position, this SSR in SEBA searched for articles on GNWR published in PubMed, Embase, Psychinfo, CINAHL, ERIC, ASSIA, SCOPUS, Google Scholar, Open Grey, GreyLit and ProQuest databases. The data found was concurrently analyzed using thematic and direct content analysis. Complementary themes and categories identified were combined, creating the domains that framed the discussion. RESULTS: Of the 8560 abstracts and 336 full-text articles reviewed, 98 articles were included. The four domains identified were: (1) Indications of use and their value; (2) Structure and how they can be used; (3) Models of reflective practice in GNWR; and (4) Features of communities of practice and the socialisation process. CONCLUSION: This SSR in SEBA concludes that GNWR does impact PIF when effectively structured and supported. The Krishna-Pisupati Model for PIF platforms a model that explains GNWR's effects of PIF and advances fourteen recommendations to maximize GNWR use.

How do mandatory emergency medicine rotations contribute to the junior residents' professional identity formation: a qualitative study.

BACKGROUND: This study aims to investigate the impact of short-term mandatory emergency medicine rotations on professional identity formation of Japanese junior residents. Using situated learning theory as a theoretical framework, we explore how this rotation, which is part of a two-year Junior residency in the transition period from students to qualified physicians. METHODS: We conducted a qualitative study conducting semi-structured face-to-face interviews with Year 1 postgraduate residents in the 2020-2021 classes of the junior residency program in Okinawa Chubu Hospital, Japan (n = 10). The data obtained from the interviews were analysed using inductive thematic analysis to identify the themes regarding professional identity formation. RESULTS: Four main themes regarding professional identity formation emerged from the data analysis: patient care, teamwork, role models, and peers. Junior residents said they had the opportunity to participate in the emergency department community and experience training in authentic clinical contexts. Clinical exposure influenced the professional identity formation of the junior residents. Nurses and peers played a crucial role in this. Junior residents see the training in the emergency department as the beginning of their careers. CONCLUSION: Short-term mandatory rotations enabled junior residents to integrate into the emergency department community, demonstrating autonomy and responsibility. These experiences fostered their professional identity by helping their socialisation within the community of practice.

Who you are and who you want to be: a pilot study of dental hygiene students' professional identity formation.

BACKGROUND: Dental hygienists play a crucial role in providing successful community-based healthcare for patients. They should perform expected roles to address various tasks, in response to changing social contexts and needs. The value created by the role of a dental hygienist closely relates to job satisfaction, which is formed through daily clinical experiences, and in the process of professional identity formation, learners must internalise a value system. This study examined how dental hygiene students developed their professional identities during their undergraduate education. METHODS: This study adopted a case study approach based on an interpretivist paradigm. Ten dental hygiene students in their final year were selected, and semi-structured interviews were conducted regarding changes in their views on dental hygienists and their identities as health professionals. The data were analysed using a thematic analysis approach to identify the components of their professional identities and the factors influencing identity formation. RESULTS: Students pre-professional identities were transformed into inter-professional collaborators with a more patient-centric and generalist perspective. The following three aspects of professional identity were identified: their own roles in promoting oral and general health, broadening the perspectives on professional competencies of dental hygienists, and the context of inter-professional collaborative practice. Additionally, this study identified some key factors influencing their identity formation, namely role models, clinical experiences, health care system, and social relationships with others. Among these factors, role models and clinical experiences were the most influential. CONCLUSIONS: This study suggests that recognition of professional roles during preclinical education, and collaborative opportunities in clinical education are necessary to promote professional identity formation. Such learning opportunities enable students to reflect on the kind of dental hygienist they want to become. Moreover, for the students to continuously pursue their profession with a sense of fulfilment, educators need to gain a deeper understanding of the challenges the students would encounter as they transition from their undergraduate degrees to employment. This understanding is essential for developing and supporting communities where dental hygienists connect, help, and learn from each other.

Caring for terminally Ill patients: the impact on oncologists.

BACKGROUND: Journeying with patients throughout their cancer trajectory and caring for them at the end of life can lead to emotional and moral distress in oncologists, negatively impacting their personal and professional identities. A better understanding of how transitions in care goals affect oncologists can shed light on the challenges faced and the support required. This study explored the impact of care transitions on oncologists' professional identity formation (PIF). METHODS: From September to December 2023, semi-structured interviews were conducted with oncologists in a palliative care center in Singapore. The Ring Theory of Personhood (RToP) was used as a framework to capture the effects of experiences with patients transitioning from curative to palliative care on the oncologists' sense of self and identity. Data were analyzed using both inductive and deductive qualitative analysis. RESULTS: Participants included six female and six male physicians, aged 30 to 53 years (mean 38 years), with an average of 9.75 years of experience as oncologists. The main domains identified were 1) challenges faced in transitioning patients to palliative care, 2) the impact of dealing with dying patients on oncologists, and 3) coping mechanisms. CONCLUSION: Oncologists experience self-doubt and moral distress as they manage transitions in care. The PIF of oncologists can be supported through reflection and introspection, peer support, and interventions to promote self-care - ultimately enabling them to make meaning of their experiences, renew family ties, and reaffirm their commitment to the profession.

Medical students' initial experiences of the dissection room and interaction with body donors: A qualitative study of professional identity formation, educational benefits, and the experience of Pasifika students.

The first experience of medical students in the dissecting room (DR) likely influences professional identity formation (PIF). Sparse data exist exploring how exposure to the DR and body donors without undertaking dissection influences PIF, or how culture may influence this experience. This qualitative study explored students' first, non-dissection DR experience to determine how this contributes to PIF, including the impact of culture through a Pasifika-student lens. It also explored student perspectives on what learning opportunities are unique to this experience. Medical students with no prior DR experience were recruited and then interviewed after initial engagement with the DR and body donors. Questions included participant experiences, cultural perspectives, and how the DR differed from other teaching experiences. Interviews were recorded, transcribed, and analyzed thematically. Twenty students were interviewed (mean age 22 years, 12 females; 8 Pasifika) resulting in 520 min of audio recording (mean 26 min). Four primary themes were identified: professional identity formation, educational elements, death and spirituality, and cultural perspectives. Three subthemes including student experiences, behaviors, and environment were developed within each theme. Findings indicate development of PIF likely occurs from a single engagement with body donors without undertaking dissection, including recognition of professional role. Culture can play an important role for students, with several Pasifika students viewing the DR as a "cultural purgatory". Unique learning experiences are identified, such as cultural awareness around behaviors with the dead. The experience is an educational "threshold concept" where students likely undergo substantial developments in PIF, and educational initiatives to support students are outlined.

Moses's Code.

In this narrative essay, a happenstance encounter with a journal article rekindles the author's intense memories of a cardiac resuscitation 25 years earlier during internship. Recollections of observations, emotions, and professional interactions around this event prompt reflection about the painful experiences from training that remain seared into memory and the value of  these formative moments across a professional lifetime.

Extending Professional Identity Formation to develop academic faculty for a new medical school.

Academic health centers have a responsibility to foster professional development approaches and engagement environments for faculty to elevate both knowledge and sense of belonging as medical educators. This new educational methods submission depicts faculty development and engagement initiatives implemented at a single institution that were created and influenced by the psychological framework of Professional Identity Formation. The authors suggest ways that academic medical centers can draw upon the formation of these programs to best serve their faculty for cultivating development and engagement for professional growth.

Being, becoming, and belonging: reconceptualizing professional identity formation in medicine.

Over the last decade, there has been a drive to emphasize professional identity formation in medical education. This shift has had important and positive implications for the education of physicians. However, the increasing recognition of longstanding structural inequalities within society and the profession has highlighted how conceptualizations of professional identity formation have also had unintended harmful consequences. These include experiences of identity threat and exclusion, and the promotion of norms and values that over-emphasize the preferences of culturally dominant groups. In this paper, the authors put forth a reconceptualization of the process of professional identity formation in medicine through the elaboration of 3 schematic representations. Evolutions in the understandings of professional identity formation, as described in this paper, include re-defining socialization as an active process involving critical engagement with professional norms, emphasizing the role of agency, and recognizing the importance of belonging or exclusion on one's sense of professional self. The authors have framed their analysis as an evidence-informed educational guide with the aim of supporting the development of identities which embrace diverse ways of being, becoming, and belonging within the profession, while simultaneously upholding the standards required for the profession to meet its obligations to patients and society.

Peer mentorship and professional identity formation: an ecological systems perspective.

BACKGROUND: Mentoring can help shape how medical students think, feel, and act as physicians. Yet, the mechanism in which it influences this process of professional identity formation (PIF) remains poorly understood. Through the lens of the ecological systems theory, this study explores the interconnected and dynamic system of mentoring relationships and resources that support professional development and growth within the Palliative Medicine Initiative (PMI), a structured research peer mentoring program. METHODS: A secondary analysis of transcripts of semi-structured interviews with peer mentors and mentees and a review of their mentoring diaries was conducted to explore the impact of participation in a longitudinal peer mentoring program on both mentees and peer mentors on their personal and professional development through the lens of the mentoring ecosystem model. The Systematic Evidence-Based Approach was adapted to analyze the data via content and thematic analysis. RESULTS: Eighteen mentees and peer mentors participated and described a supportive community of practice within the research program, with discrete micro-, meso-, and macro-environments that are dynamic, reflexive, and interconnected to form a mentoring ecosystem. Within this ecosystem, reflection is fostered, and identity work is done-ultimately shaping and refining self-concepts of personhood and identity. CONCLUSION: This study underscores the nuances and complexities of mentorship and supports the role of the mentoring ecosystem in PIF. A deeper understanding of the multiple factors that converge to facilitate the professional development of mentees can help educators develop and implement structured peer mentorship programs that better support reflective practice and identity work.

The Impact of COVID-19 Service Learning on Medical Student Professional Identity Formation.

OBJECTIVE: The COVID-19 pandemic affected in-person educational activities and required medical schools to adapt and enrich their curriculum to ensure ongoing professional development. During the height of the COVID-19 pandemic, students expressed a significant desire to contribute and continue their medical education. Service learning promotes experiential learning and Professional Identity Formation (PIF). This study examines the impact that a service-learning elective had on medical students' education and PIF. METHODS: Offering a service-learning elective allowed students to remain engaged in educational activities and pandemic-relief efforts. We conducted a qualitative analysis of 132 written reflections by medical students who completed a 2- or a 4-week service-learning elective to assess for major themes and impact on PIF. RESULTS: Participation in service learning had a favorable impact on PIF as expressed by the personal qualities student identified as having developed or improved upon because of their participation. Enhancement of communication skills, teamwork skills, compassion, and empathy were major themes conveyed in student reflections. Qualities of resilience were also portrayed through the write-up as students noted how the elective allowed for active engagement in community pandemic-relief efforts and created opportunities for overcoming obstacles related to service learning projects they participated in. CONCLUSIONS: Service learning in medical school has a dual purpose of providing community support while imparting significant learning opportunities for PIF in medical students.

Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program.

BACKGROUND: There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI. OBJECTIVE: Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles. METHODS: IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory. RESULTS: 14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles. CONCLUSIONS: LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.

Assessment of Student Pharmacists' Co-Curricular Professionalization Using an Impact Scale.

Co-curricular participation is a required component of the pharmacy program. Assessment of co-curricular activities has proven challenging due to lack of manpower to address the workload of reviewing multiple critical reflections. This project documented the professionalization impact of co-curricular involvement and secondarily explored the utility of our assessment tool, the Co-curricular Impact Scale (CIS), developed to streamline the assessment process. First- through third-professional-year students (P1, P2, P3) participated in five co-curricular domains: (i) professional development/education; (ii) patient care service; (iii) legislative advocacy; (iv) leadership/service to the pharmacy profession; and (v) healthcare-related community service. For the CIS, 16 questions were developed and mapped to 11 educational outcomes and included assessing the impact of immersing in an authentic learning experience, collaborating with healthcare professionals, and preparing for the pharmacist role. A group of 296 students rated the impact of participation as low, moderate, or significant for five events annually. Based on 717 entries, the two attributes deemed most impactful were: "Activity immersed me in an authentic learning experience" (95% ≥ Moderate Impact) and "Activity improved my self-confidence" (93% ≥ Moderate Impact). P1 students found slightly less impact in co-curricular participation (83.5%) than P2 (88.4%) and P3 (86.8%) counterparts. The CIS proved to be an efficient method to collate impact of co-curricular involvement upon student professionalization.

An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171.

There is a long and impressive scholarly history evidencing why it is important to address professional identity formation (PIF) in medical curricula. In this AMEE Guide, the authors present an evidence-informed pedagogical approach to assist educators in developing educational practices to foster a healthy PIF in medical students. The authors first describe the theoretical framework that underpin this approach. At the core of this framework is the recognition that, for a healthy PIF, students need to become aware that they have the autonomy, but also responsibility, to form their professional identity in a way that fits both their personality and their (future) professional role. In other words, students need to learn to navigate the interplay between socialization and subjectification. Next, the authors outline the six-step structure of their pedagogical approach, designed to help students: (1) undergo a PIF-related experience, (2) observe their responses to the experience, (3) externalize their reflections, (4) share their reflections, (5) broaden their perspective, and (6) explore their freedom of choice through experimentation. The authors also describe six conducive conditions to facilitate the implementation of the pedagogical approach. These conditions include (1) creating a setting that enables students to slow down, (2) adopting a longitudinal approach, (3) making it part of the formal curriculum, (4) refraining from grading, (5) establishing an interdisciplinary expert team, and (6) providing teacher training. The authors conclude that the theoretical framework leads to a coherent and consistent pedagogical approach that, when implemented according to the conducive conditions, enables students to gradually internalize the reflective process and help them to cultivate a reflective attitude towards their PIF.