Background
Program design
Program duration | 6 weeks to align with the length of the student’s clinical placement |
Tutorial frequency | Weekly |
Tutorial duration | 2‑hour tutorial, final tutorial 2 ½ hrs |
Students | Third-year students in a graduate medical program undertaking clinical placements in geriatric medicine, palliative care, rehabilitation medicine, and refugee health |
Tutors | Generalist clinicians working in different clinical workplaces to the students’ clinical placements and not directly involved in students’ clinical assessment. This assists in minimising power-differentials and fostering an open tutorial environment |
Number of students | 6–9 students per tutorial group, one tutor per group |
First tutorial | Includes introductions and formulation of group rules. The tutor leads all tasks in the first tutorial. This helps students understand the tutor’s expectations for the task and allows tutors to bring their patients, challenges, and reflections into the tutorial space which helps establish safety and models vulnerability and openness |
Check-in, debrief | Each tutorial provides protected time for students and tutors to bring interesting observations, challenges, or concerns from their week of clinical placement or work for sharing in the tutorial space |
Rostered tasksa | Description |
Tutorial opening | Tutorials open with a general reflection of the previous week or if the group desires, a guided mindful meditation chosen by the person rostered to lead the task (max. 5 min ) |
Lead for question of the week discussion | Each week a question is provided for discussion. For example: What forms of vulnerability do you find difficult to be near? How can you care for yourself when you are near that form of vulnerability? |
Lead for book reading | Published reflections written by doctors or excerpts from such reflections, e.g. ‘Perspectives’ from the New England Journal of Medicine, Kitchen Table Wisdom by Rachel Remen, excerpts from a range of novels written by doctors |
Lead for ethical scenario discussion | Short ethical scenarios are provided focusing on professional boundaries, microaggressions and threats to professionalism |
Lead for understanding the person discussion | Students summarise and reflect on their experience of conducting an in-depth interview with a patient in preparation for the tutorial. In this interview students aim to understand the person through exploring current circumstances, important life events, values, beliefs, what provides meaning, healthcare experiences, impact of illness on the patient and loved ones, and social and structural determinants of health. The student usually needs to meet with the patient several times and is careful to only discuss content the patient is comfortable discussing. Permission is sought from the patient to share their story within the tutorial group |
Tutorial closure | The tutorial closes with the rostered member of the group sharing an image or text from the humanities or creative arts that is meaningful to them or connects with their experiences in the previous week |
Creative-reflective contribution | During the 6 weeks of the program, group members (including the tutor) draw on their reflective, analytical, or creative skills and talents (particularly those they may have neglected due to their studies or work) to develop an individual reflective contribution. A wide range of media can be used, for example, poetry, short story, visual arts (drawing, painting, sculpture, craftwork, photograph/montage, collage etc.), creative short film, music composition/performance, game design and dramatic performance or experiences of cooking, physical pursuits, or gaming. In the final tutorial this creative work is shared with the group. The sharing must not exceed 5 min but must include an explanation of how the work articulates and reflects what vulnerability means to them |
Impact on student learning and experience
The road less travelled
I like that it is a breath of fresh air discussing the biopsychosocial model of medicine and not just the medical part. I enjoy the ethical discussions, the wide variety of ideas from my peers, and I enjoy that it is a non-judgemental space (2019, student 54).
Openness and candour
I loved that it gave us an outlet to talk about our vulnerabilities, stressors, and fears in a safe space. These are all the things we’re expected to just do and deal with as a doctor, but they are never talked about (2020, student 38).
Self-care and being cared for
The environment … allowed time for us to mentally sort through the emotionally overwhelming experiences and derive protective mental health coping strategies (2020, student 41).
Connection and collegiality
Felt like I was on equal ground and being treated as such … encouraged everyone to be more open about their own experiences in a comfortable way (2019, student 8).By having tutors have an active role it was helpful in comparing my level of reflection and effort to what can be potentially reached (2019, student 15).
Being able to hear and discuss with other students about their experiences … helped me to reflect more deeply on my own … helped me feel less alone (2020, student 13).
Creative-reflective contributions
[The tutorials] reminded me of the other aspects that make up me … those tucked-away creative parts of me which I realised I had been living without (2020, student 14).
Impact on clinician-tutors
I was definitely aware of entering an unfamiliar territory. You know, I’ve given a number of different tutorials over the years, but this was something different (Tutor 1).
I’ve been touched by how poignant and thoughtful the students have been in response to the process (Tutor 2).I feel like it’s required much less selling from me … than I’d anticipated (Tutor 3).
They can sense the privilege of this time … with people who are caring, you know, seem to be caring personally for them … you can see them almost steeling themselves towards the time in their practice when they won’t get to do this … when they become a doctor (Tutor 2).