OSUCOM PowerPoint Template

Portfolio and Coaching OrientationJack Kopechek, MDDirector of Portfolio and CoachingThe Ohio State University College of Medicine

Hello. This is Dr. Jack Kopechek, director of the Portfolio and Coaching Program. In this module, I will orient you to the purpose, structure and expectations of the Portfolio and Coaching program. 1Learning ObjectivesProvide students an overview of the purpose and structure of the Portfolio and Coaching ProgramProvide students the expectations for the Portfolio and Coaching program during each part of the LeadServeInspire curriculumHere are the learning objectives for this module. The first section will provide an overview of the Portfolio and Coaching program. The following sections will provide specific details and expectations for each part of the LeadServeInspire curriculum.2Purpose of Program To enhance student reflective practice and self directed learning skills in order to promote excellence in our future physicians.

Lets start with a brief look at the purpose, objectives and goals of the Portfolio and Coaching Program. The primary purpose of this program is to help students develop their self directed learning skills, especially reflective practice. These skills are highly associated with excellence in medical practice and will help you become the best doctor you can be.3Purpose of ReflectionWhat is Reflection?

The process of analyzing, reconsidering and questioning experiences and of making an assessment for the purposes of learning.(Wald, et. al. 2009)

So what exactly is reflection. Reflection is a tool that we can use to promote our learning and personal growth. 4Purpose of ReflectionPractitioners should have a stethoscope in one pocket and reflective practice in the other.

Hedy S. Wald, PhD Clinical Associate Professor of Family MedicineWarren Alpert Medical School of Brown University5Hedy Wald is a prominent medical educator at Brown University who is highly published in the field of reflective practice. This quote highlights the important role that reflection plays in medical practice.5Purpose- Potential BenefitsThe potential benefits of reflective practice include improved:

Learning from experiencesCritical thinking skillsDiagnostic reasoningProfessionalismCommunication skillsEmpathy and humanismPersonalwell-beingAttitudes associated with patient-centered careResilience against burnoutOther medical educators have suggested that reflective practice may benefit physicians in a number of ways including improving thinking and reasoning skills, professionalism, communication skills and even personal well being.Purpose- Learning ObjectivesThe graduate is able to identify ones own strengths and weaknesses and limits by:seeking and responding appropriately to performance feedback ( CEO 3.4)maintaining an appropriate balance of personal and professional commitments (CEO 3.4)seeking help and advice when needed (CEO 3.4)The graduate is able to identify and utilize professional role models as a means of growth (CEO 5.4.1)

The learning objectives for the Portfolio and Coaching Program are derived verbatim from the College of Medicine Core Educational Objectives. Participation in this program should help you better identify your own strengths, weaknesses and limits and utilize portfolio coaches and other role models to assist you in your professional growth.7Purpose- GoalsStudents will be able to reflect on their performance Students will be able to reflect on their experiencesStudents will be able to document and showcase their progress towards meeting the Core Educational ObjectivesAfter completing the Portfolio and Coaching Program, we expect that students will be able to effectively reflect on their performance and their various experiences. We also expect that students will be able to document and showcase their progress towards meeting the Core Educational Objectives. More on this later in the module.8Structure of Reflection

Model of common elements describing the reflection process (Koole, et. al. 2011)

This diagram visually depicts the reflection process. Reflection is a reasoning process that is analytical and structured. It begins with an experience of some sort. This can be an encounter with a patient, a peer, a faculty or staff member, or other people. Or it can be an encounter with a procedure, health care system, educational activity or other event. The reflective process often starts with a "trigger event," which is an experience that provokes a personal reaction. This may be either positive or negative. Alternatively, the situation may seem puzzling or ambiguous. It may be something that causes surprise or catches a person off guard. The first step is simply to describe the situation and be able to identify these feelings. The next step is to analyze the experience by asking searching questions. Many of these questions will be developed by looking at objective external evidence that can shed light on the situation. Additional questions will focus on trying to understand the situation from the point of view of other people or institutions involved. Processing of these questions should lead to some new insights or perspectives. These are the take-home points from your reflection. Finally, you will want to apply your new insights to a similar situation in the future and then reflect on the resulting experience.

9Structure of ReflectionReflective WritingCan the reader cohesively recount the experience?Can the reader recount key points and related thoughts or emotions? Can the reader identify any questions you considered in order to understand underlying causes or issues?Can the reader recount your answers to these questions and do they include any outside evidence or perspectives other than their own?Can the reader identify any "take home" messages?Can the reader/listener recount specific, time bound, measurable goals and plans that you decided on?

Adapted from: Koole S, et. al. Using video-cases to assess student reflection: Development and validation of an instrument. BMC Med Educ 2012, 12:22.

Many students choose to reflect through writing. Here are some self assessment questions that mirror the previous diagram. You can use these questions to determine the adequacy of your reflective writing. An example of a well written reflective essay is available in the E-Portfolio Section of Vitals.For further assistance with reflective writing see the Medical Student Guide to Reflective Writing also available to you in Vitals or talk with your portfolio coach.10Educational PortfoliosThe Portfolio is the venue in which students track and reflect upon their personal development as a physician-in-training.The portfolio is the story of the development of the learner

So lets talk now about the role of your portfolios. Your portfolios are tools that will help you reflect on your development into a physician. It will also help you to tell this story to your coach and others.

11Educational Portfolios- BenefitsWhy use Portfolios?Improve knowledge and understanding, especially the ability to integrate theory with practiceLead to greater self-awareness and engagement with reflectionImprove faculty feedback to students and faculty awareness of student needsHelp students to cope with uncertain or emotionally demanding situationsPrepare students for the postgraduate setting and reflective practice

(Buckley, 2009)

12This review of the literature on portfolios in medical education highlights the benefits of using this tool in medical schools.12Educational Portfolios- Goals

The goals of using the portfolios are to:

improve self-assessment skills and performanceenhance career achievement and satisfactionestablish a pattern of lifelong self-directed learning

13

We believe the portfolios will help you to assess your skills and performance more accurately, enhance your career achievement and satisfaction and establish a pattern of lifelong, self-directed learning.13Educational PortfoliosLearning PortfolioVenue for practice and coaching of reflectionAccess limited to you, your coach and Portfolio AdministratorsContents:Performance DataReflective PostsArtifacts of Accomplishments

Showcase PortfolioVenue for demonstrating your development as a physician in training and sharing your accomplishments with othersContents:Artifacts of Accomplishments ( exported from Training Portfolio)Reflections on Progress in the Core Educational ObjectivesYou will create two separate portfolios during the course of your medical school career. Your first portfolio will be the Learning Portfolio. This is a secure blog that will contain your performance reports, reflections and artifacts of your accomplishments. Artifacts are digitalized items you collect during medical school that illustrate your progress in the Core Educational Objectives. Artifacts in archeology help tell the story of progress in ancient civilizations. Artifacts of your accomplishments will help tell the story of your progress towards becoming a physician. The Learning portfolio is an opportunity for you to record your reflections and discuss these with your faculty portfolio coach. This portfolio will be your primary portfolio during Part One and Part Two of the curriculum.The second portfolio, the Showcase portfolio, will be used primarily during Part 3. In this portfolio, you will share evidence of your accomplishments during medical school and your reflections and plans for future growth during residency. The Showcase portfolio will be assessed during Part 3 for evidence of competency in reflective learning and if done well, could also provide significant enhancement to your residency applications.14Learning PortfolioCategories

Here is the landing page for the Learning Portfolio. Consider each of the six Core Educational Objectives and the Career Development category to be the chapters in your story. You will begin each chapter with some reflective posts during Part 1 and build on these with further reflections in Part 2. Your coach will also add their comments below each of your posts to help you increase the effectiveness of your reflection.

You will also store your artifacts in the appropriate categories making them easy to find when developing your Showcase Portfolio in Part 3.15Showcase Portfolio

Here is an example of a landing page for the Showcase Portfolio.16Portfolio Coaching

Let's now discuss the coaching component of the Portfolio and Coaching Program. This is one of the perks of the LeadServeInspire curriculum.17Portfolio Coaching- PurposeWhy Portfolio AND Coaching?

The effectiveness of learning is enhanced when a mentor supports the portfolio process. Mentorship requires a substantial time investment but is crucial for the successful use of portfolios.

(Tartwijk and Driessen, 2009) The literature clearly supports the need for coaching in portfolio learning. Here at Ohio State, we have chosen to supply this important support by providing each student with a one-to-one relationship with a faculty portfolio coach.18Portfolio Coaching- PurposeIdentify ones own strengths and weaknesses and limits (CEO 3.4)Seek and respond appropriately to performance feedbackMaintain an appropriate balance of personal and professional commitmentsSeek help and advice when needed

Identify and utilize professional role models as a means of growth (CEO 5.4.1)Another look at the core educational objectives highlights the need for students to have feedback, support, advice and role models. The portfolio coaches will help to meet these needs.19Portfolio Coaching-Roles of CoachesHelp students develop reflective and self directed learning skillsHelp students interpret their performance reportsSupport student career exploration and developmentSupport student life balance and wellnessConnect students with appropriate resourcesServe as a role modelThe main task of the portfolio coach is to help students develop their reflective and self-directed learning skills but they can also help with these other needs as well.20Portfolio Coaching- A Safe PlaceWill involve coaching and feedback, NOT judging or gradingAre intended to be a safe harbor for reflection and personal growthAre intended to span all four years of medical school

Your coach will not be grading you. This should be a safe relationship where you can confidently share your reflections and grow professionally and personally.21Portfolio Coaching- ApproachCoaches may ask you..What is going well for you?What are you finding challenging?What do you want to work on?What are your current goals and next steps?What help or resources do you need to achieve your goals?

You, the student, are in the drivers seat for this relationship. Coaches should do more asking than telling. Here are some of the types of questions your coach may ask you.22Portfolio and Coaching Expectations

Lets now go over the specific expectations for each part of the LeadServeInspire Curriculum.23Part 1- Reflective Assignments

Here are the eight reflective assignments for Part One. There are two assignments for the Medical Knowledge and Skills category and one for each of the other six categories. 24Part 1- Reflective AssignmentsTo Meet PB&LL Competency for each block:Post your reflective assignment to your portfolio with the correct tag and category by the given deadline. (Monday of the 4th week of the block at 8 AM)The reflective essay must meet or exceed the minimum standard for reflection. (See next slide)It will be important for you to complete these assignments on time and to not miss your portfolio coach meetings. There are also minimum standards for what is acceptable for reflective essays. Failure to complete these tasks on time will result in Not Meeting the Practice-Based and Lifelong Learning Competency for the block.The first reflection is due during orientation. The others are due by the fourth week of the block. Specific dates and times can be found in Vitals.25Part 1- Reflective AssignmentsMinimum Standards for Reflection

For Part 1, Year 1: demonstration of an ability to describe an experience, identify essential elements and describe own thoughts and feelingsFor Part 1, Year 2: In addition to the standards listed for Year 1, demonstration of an ability to ask searching questions, answer searching questions and be aware of the relevant frames of reference

We expect students to demonstrate a minimum standard of reflection in order to receive credit for reflective assignments. These follow the reflective process outlined earlier in this orientation. Those reflections not meeting minimum standards will need to be redone. Coaches can assist students with this.

26Part 1- Reflective AssignmentsPortfolio entries must be consistent with the professional standards of the collegeDo not include any patient identifying information. (HIPAA)

As with all your professional activities, you must be sure to post entries consistent with the professional standards of the college and to avoid anything that could identify a patient.27Part 1- Coaching MeetingsTo Meet PB&LL Competency for each block:

You must attend your scheduled formal meeting with your coachStudents who cannot attend a formal meeting with their coach will need to submit an Absence Approval form to the Academic Program at least two weeks in advance of the meeting date or in case of emergency, as soon as possible afterwards.

It is expected that you will be meeting with your coach both formally and informally. Formal meetings are required at the conclusion of each block and will be scheduled by the Portfolio and Coaching Program. Informal meetings are optional and are scheduled by each student as needed. If you cannot attend one of the formal meetings, an excused absence can be requested by submitting the Absence Approval Form at least two weeks prior to the meeting. This form is available on Vitals.

28Part 1- SummaryPost all required reflections with correct tag by the due dateAttend all required meetings with coachStay in touch with your coach and seek help and advice from them as needed

Here is a summary of the expectations during Part 1.29Part 2- Reflective AssignmentsSix reflective assignments (Two for each ring)One for each of the following categories:Patient CarePractice-Based and Life Long LearningInterpersonal CommunicationsSystems-Based PracticeProfessionalismCareer DevelopmentChoose an appropriate category for each postUse the tag provided with the assignment and post by due date in order to get creditPortfolio Coaches will review and comment on these

In Part 2, there will be six required reflective assignments, two for each ring. One should be posted to each of the seven portfolio categories except for Medical Knowledge and Skills. (You should already have posted two assignments to this category during Part One). By the end of Part 2, all of your categories should have a minimum of two reflective posts. You will need to decide which category is most relevant for each of your posts. Referring to the Core Educational Objectives will be helpful for this. It will be important that you also add the appropriate tags to your posts so that the program coordinator can easily verify that your assignment was completed on time and give you proper credit. These tags will be provided to you by the program coordinator.Your portfolio coach will review and comment on your posts as they did in Part 1.

30Part 2- Reflective Assignments One required by each of the following ringsUnderstanding Patients with Surgical and Reproductive Needs (UPRSN)Understanding Patients with Specialized Medical Needs (UPSMN)Two of the rings in Part 2 will be assigning their own reflective assignments. Each of these should be posted in your portfolio and will count toward your six required posts for Portfolio and Coaching.31Part 2- Reflective Assignments Four additional required reflections selected by studentsAny topic related to a portfolio categoryMay also select a prompt from the Part 2 Menu of Reflective Prompts Alternate modes of reflection are permissibleThe other four required posts can be on any topic you choose as long as they are related to the portfolio categories. For those students who would like some suggestions, a menu of reflective prompts is provided in Vitals. You may also choose whatever mode of expression you prefer for these reflections. Examples include narratives, poems, sketches, cartoons, concept maps, music or music scores, case reports, photography, drama.

32Part 2- Reflective AssignmentsMinimum Standards for Reflection

Evidence of Self-Awareness includes own thoughts and/or feelingsEvidence that searching questions and relevant frames of reference have been consideredEvidence that some conclusion has been drawn along with relevance or application to future work or experiences

By this point in the curriculum, you should be able to provide a thorough reflection. Those reflections not meeting minimum standards will need to be redone. Coaches can assist students with this.33Part 2- Reflective Assignments

Timing of Completion

One by 8 AM Monday of Week 10 of the ringOne by 8 AM Monday of Week 15 of the ringAlso post a summary of your Week 6 Mid-Ring Feedback session to your Portfolio by 11:59 PM Friday of Week 7

During each ring you will need to post at least one reflection by Week 10 of the ring. The second reflection must be posted by Week 15 of the ring. Specific dates can be found in Vitals. In addition, you must post a summary of each Week 6 Mid-Ring Feedback session that you have with the Ring faculty. You and your coach will follow up on this at your Mid-ring meeting with your portfolio coach during Week 10.34Part 2- Artifact CollectionBest essaysWritten reports or research projectsWritten reflections on professional growthSamples of evaluations of performanceVideos of interactions with patients or with peersRecords of procedures undertakenAnnotated de-identified patient recordsLetters of recommendationsCVCertificationsResearch AbstractsCommunity Education Posters(Ben-David, et. al. 2001)In addition to reflective posts, it will also be important that you begin collecting artifacts of your accomplishments and posting these in your portfolio. This will prepare you for development of your Showcase Portfolio in Part 3. These should be items that provide evidence of your progression towards meeting competence in the Core Educational Objectives. These artifacts should be initially collected in your learning portfolio. You will export some of these artifacts to your Showcase Portfolio during Part 3. Some examples of possible artifacts are listed here however you are not limited to these.35Part 2- Artifacts and ReflectionsPortfolio entries must be consistent with the professional standards of the collegeDo not include any patient identifying information. (HIPAA)

Again, as with all your professional activities, you must be sure to post entries consistent with the professional standards of the college and to avoid posting anything that could identify a patient.36Part 2- Coaching Meetings

Three will occur in the middle of each ringStudents will be excused from clinical assignment to attendStudents on campus will meet with their coach in personStudents off campus will meet virtually with their coach using iPadThree will occur after the completion of each ring (during ground school of the next ring)Lets now discuss expectations for meetings with your portfolio coach during Part 2. There will be six required meetings during Part 2. One during the middle of each ring around Week 10 and one after the completion of each ring. There will also be an orientation meeting with your coach during your first ground school. For the mid-ring meetings, you will temporarily be excused from your clinical responsibilities so that you can meet with your coach. Students who are on campus will meet with their coaches in person. Those off campus, may need to meet with their coaches virtually using their I- pads. End of Ring meetings will occur on the Friday of ground school for the following ring. Informal coaching meetings are also encouraged as needed and can be initiated by the student.37Part 2- Coaching Meetings

Preliminary schedule will be drafted by the Portfolio and Coaching ProgramStudent requests for schedule alterations will be managed by each coach and permitted if coach approvesThe coach will submit a final meeting schedule to the Portfolio and Coaching program All meetings must be completed within one week of the original meeting datesIf a meeting will not be able to be accomplished during this time frame, the student will need to submit an Absence Approval form to the Academic Program at least two weeks in advance of the meeting date or in case of emergency, as soon as possible afterwards.In order to provide a bit more flexibility in Part 2, coaches will be permitted to make alterations in their meeting schedules when needed and to submit their final schedule to the Portfolio and Coaching program. However, please note that all meetings must be completed within one week of the meeting dates listed on the previous slide.If the meeting cannot be accomplished in this time frame, the student will need to seek approval from the academic program by completing the Absence Approval Form38Part 2- PB &LL CompetencyTo meet the Practice-Based and Lifelong Learning Competency for each ring you must do the following:

Post six reflective assignments to a relevant category in the portfolio with the appropriate tag by each due date.Post summary of Week 6 Mid-Ring Feedback by the due dateAttend all six required (formal) meetings with portfolio coach

In order to meet the competency requirements for Practice-Based and Lifelong Learning in Part 2, students will need to post and appropriately tag the six required reflective assignments and the Week 6 Mid-Ring Feedback Summary by their due dates and attend all six of their required meetings with their portfolio coach.39Part 2- SummaryPost all required reflections with correct tag by their due datePost summary of your Week 6 Mid-Ring Feedback by the due dateAttend all required meetings with coachCollect artifacts of your progress towards the CEOs Stay in touch with your coach and seek help and advice from them as needed

Here is a summary of your Portfolio and Coaching activities for Part 2. We believe that these activities will enhance your learning and professional development. Please do not hesitate to contact us with any questions. 40Part 3- Portfolio Functions

Lets now discuss expectations for Part 3. Portfolio functions usually include some combination of learning, assessment or professional development. In Part 1 and Part 2, the Portfolio functioned primarily as a learning portfolio. In Part 3, the Showcase Portfolio will function more as an assessment and professional development portfolio, though reflection will continue to be included.41Learning PortfolioShowcase PortfolioWordPressU.OSU.EDULimited sharing (higher security)Broader sharing (lower security)Part One and Part TwoPart ThreeShared with Portfolio CoachShared with portfolio coach, faculty assessors residency programs (optional)Performance Reports and ReflectionsArtifacts of Accomplishments with ReflectionFormativeFormative and SummativePart 3- Portfolio ComparisonsThe Showcase portfolio will involve a different platform with lower security so you can share it more easily. Artifacts of Accomplishments with reflection will be the central feature for this portfolio. Part 3 will also include a summative assessment of the Showcase Portfolio for evidence of competency in reflective learning.42Part 3- Summative Portfolio AssessmentWhat will be assessedAbility to collect and cite adequate external evidenceAbility to adequately reflect on current level of progress for each competency Ability to define goals and plans for further development of these competencies during residency

Here is a list of what will be assessed.43Part 3- Portfolio Assessment RubricWork in ProgressMeets ExpectationExceeds ExpectationCites adequate evidencePortfolio does not contain relevant artifacts for several of the required CEOS Portfolio contains at least one relevant artifact for all or nearly all of the required CEOsPortfolio contains several artifacts for most of the CEOsReflects on progress towards each competencySelf -assessment narrative omitted for several of the CEOsSelf- assessment narrative included for all or nearly all of the CEOsSelf- assessment narrative included for all of the CEOS with additional details or description for mostReflects deeply and with insight on progress towards each competency

Reflection lacks insight for the majority of postsReflection demonstrates some insight for the majority of postsReflection demonstrates exceptional insight for the majority of posts Defines goals and plans for further development of these competencies during residencyNarrative contains no goals and plans for the majority of the CEOsNarrative contains goals and plans for the majority of the CEOsNarrative contains goals and plans for the majority of the CEOs. Specific details are provided for the majority of goals and plans.This rubric will be used by faculty to assess your Showcase portfolio towards the end of Part 3. It should be useful for understanding what is expected for this project.44Part 3- Summative Portfolio AssessmentTwo faculty assessors (not the portfolio coach)

Review the portfolio and rate independently

Interview student together Assessors discuss and form consensus and provide a grade and narrative feedback

Grades: Exceptional(Honors)/Pass/ Remediate

Showcase portfolios will be assessed by two faculty members who will rate the portfolio independently, interview the student together and then meet together to form a consensus and provide a grade as well as some narrative feedback for the student.45Part 3- Summative Portfolio AssessmentThe Director of Portfolio and Coaching and at least one Assistant Dean will be consulted when:

When coaches cannot reach consensus on a grade

When any student is judged to be in need of remediation

If the raters recommend remediation or cannot agree on a grade, the Portfolio and Coaching Director and at least one assistant dean will be consulted. 46Class of 2016- at least one objective in each domainClass of 2017- at least three objectives in each domainClass of 2018 and following - all CEOSPart 3- Number of CEOs to AddressSince the Showcase Portfolio is a new project, the expectations for how may Core Educational Objectives need addressed will be phased in gradually.47Why did you select what you did?

How does this reflect your skills and abilities?

What are your next steps for further developing this competency?Part 3- Reflective comments

These questions should help you formulate your reflective entries for each artifact.48Do not include PHI (protected health information) in your posts without your patients written consent

Patient identifiers include but are not limited to:NameAgeGenderMRNImages

Part 3 Remember HIPAA!

Again, please be sure not to include any patient identifiers in your artifacts or reflective posts.49Part 3- Coaching MeetingsFormal Meetings with Coaches

Meeting One: Discussion of career choice, MSPE personal statement, Step 2 preparation (may be a virtual meeting)

Meeting Two: Formative portfolio assessment with goals and plans for meeting criteria

Meeting Three: Summative portfolio assessmentThere will be three required coach/student meetings during Part 3. It is expected that coaches and students will also meet informally to work on the Showcase Portfolio and again for closure at the end of the year.50Part 3: Other Resources DocumentationShowcase portfolio users guideu.osu.edu videosShowcase BuilderSite template\One-on-One Sessions withMobile ServicesPortfolio CoachExample sitehttp://u.osu.edu/vmsportfolio/

Here is a list of available resources to help you create your Showcase Portfolio. 51Thank you for completing this moduleWe wish you a very successful and fulfilling year of learning!

Questions? Contact:

Cheri Bardales - Program Coordinator Cheryl.Bardales@osumc.edu614-685-5605

Jack Kopechek MD- Director of Portfolio and CoachingJack.Kopechek@nationwidechildrens.org

Thank you for listening to this orientation. Please feel free to contact me or our program coordinator with any questions. We appreciate the opportunity to witness your development into the best of physicians.52ReferencesFriedman Ben David M, Davis MH, Harden RM, Howie PW, Ker J, Pippard MJ. AMEE Medical Education Guide No. 24: Portfolios as a method of student assessment. Med Teach. 2001 Oct;23(6):535-551.Buckley S, Coleman J, Davison I, Khan KS, Zamora J, Malick S, Morley D, Pollard D, Ashcroft T, Popovic C, Sayers J. The educational effects of portfolios on undergraduate student learning: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 11. Med Teach. 2009 Apr;31(4):282-98Koole S, Dornan T, Aper L, De Wever B, Scherpbier A, Valcke M, Cohen-Schotanus J, Derese A. Using video-cases to assess student reflection: Development and validation of an instrument. BMC Med Educ 2012, 12:22.Koole S, Dorman T. Aper L, Scherpbier A, Valcke M, Cohen-Schontanus J, Derese A. Factors confounding the assessment of reflection: a critical review. BMC Med Educ. 2011 Dec 28;11:104Mahant S, Jovcevska V, Wadhwa A. The nature of excellent clinicians at an academic health science center: a qualitative study Acad Med. 2012 Dec;87(12):1715-21.Van Tartwijk J1, Driessen EW. Portfolios for assessment and learning: AMEE Guide no. 45. Med Teach. 2009 Sep;31(9):790-801Wald HS, Davis SW, Reis SP, Monroe AD, Borkan JM.Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback. Acad Med. 2009 Jul;84(7):830-7

53