Perception Regarding Narrative and Reflective Writing among Fellowship Candidates
Darshana Tote1, Alka Rawekar
1 Associate Professor, Department of Surgery, JNMC, Wardha, Maharashtra, India.
2 Professor, Department of Physiology, JNMC, Wardha, Maharashtra, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Darshana Tote, Shree Hospital, Bachelor Road, Near Lok Vidyalay, Wardha-442001, Maharashtra, India.
E-mail: drtotedarshana@gmail.com
Introduction
Research is an integral part of medical field including medical education. Medical report writing is a specialised technique in the field of clinical research. Narrative and reflective way of medical report writing is an individual perception. Narration helps in expressing the situation while reflection of situation helps in reciprocating it well.
Aim
To assess perception regarding narrative and reflective writing in fellowship candidates.
Materials and Methods
Forty candidates enrolled for fellowship course were assessed in a prospective study for perception regarding narrative and reflective way of medical report writing of their allotted projects. Assessment was done on the basis of questionnaire based score (Likerts scale). Software used in the analysis was SPSS 22.0 version to assess the percentage of various score against a specific question.
Results
Maximum participants were in the age group of 36-40 years (45%). A total of 80% candidates were of the opinion that narrative and reflective way of research writing is applicable in the current research writing; 50% percent candidates strongly agreed that reflective writing is better in analysing the situation; 80% candidates experienced that it is useful in gaining self-knowledge and understanding the topic better.
Conclusion
Narrative and reflective writing is an effective way to describe the research methodology and its results. Also, reflective writing helps in framing future applications of the research.
Introduction
Medical Education is a field with new inventions and innovations. These innovations are because of the continuous research going on in this field. Research is a systematic and focused enquiry trying to find out the truths that can be transferred beyond the setting in which they are generated [1]. Research is going on to discover new concepts in practice as well as in medical education. These researches have to be reported systematically; here comes the need for proper research report writing. Medical report writing is a specialised technique in the field of clinical research [2].
Bruner described two forms of expressing the research results: “logico-scientific” (science of concrete) and “narrative” (science of imagination) [3]. Logico-scientific reasoning explains the facts based on evidences present in the literature. These evidences are presented as IMRAD (Introduction, Method, Result and Discussion) to come to any conclusion. Till date this format is widely used in the conventional research.
Narrative writing seeks to understand this phenomenon in terms of human experiences. This is a way of reporting the research findings as a personal experience of the researcher in a format of story that explains all the sequence of events in chronological order [2]. Similarly, reflecting these experiences by applying them in medical practice and writing a report is also found to be an effective way.
Reflective writing is an extension to the knowledge gained by research which is explained by narrative writing. Reflective writing applies the gained knowledge to the current situation and tries to generate new knowledge or interpret how gained knowledge will be applied for future studies/interventions. It allows reciprocating on the knowledge gained and its further application. Reflective writing helps to analyse the past events and helps to apply the knowledge gained in future events [2,4].
Narrative way of report writing is a way to explain research work in a story pattern following sequence of events. Reflective way of writing expresses the research results on basis of its applicability and the knowledge gained from the research. Both the ways are known to researchers but are not applied during research report writing.
Hence, the need was felt to assess the understanding about narrative and reflective way of writing a research report among the researchers. This may help us in utilising narrative and reflective way of research report writing regularly. The targeted study group had to do a short term research project during the fellowship course. The present study was framed to access the perception regarding narrative and reflective writing amongst the fellowship candidates.
Materials and Methods
This was a prospective observational study conducted at AVBRH, Sawangi (Meghe), Wardha over a period of 8 months (July 2018-March 2019). After approval from Institutional Ethical Committee the study was started. Ethical Committee Clearance was obtained with reference number DMIMS(DU)/IEC/2018-19/7530. The study included 40 candidates enrolled for fellowship course under various faculties of Medicine, Dental, Nursing, Ayurveda and Physiotherapy. All the fellowship candidates were oriented to narrative and reflective way of research writing by a didactic lecture taken by the primary investigator over a period of 2 hours. They were briefed about the various patters of research writing, pattern of narrative and reflective writing and various components of the same. They were asked to write a narrative and reflective log on basis of research project assigned to them. After completely filling the format the candidates were given a preformed questionnaire to assess their perception regarding narrative and reflective writing.
Questionnaire was prepared by the primary investigator of this project and was approved by the scientific scrutiny committee of the Institute. Answers to all questions were sought in 0-5 scale. Scoring regarding every question was assessed. Percentage of the score was calculated and inference was sought.
Statistical Analysis
Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and software used in the analysis were SPSS 22.0 version to assess the percentage of various score against a specific question.
Results
The present study included 40 participants with age distribution as shown in [Table/Fig-1]. Maximum participants were in the age group of 36-40 years (45%).
Age distribution of the forty participants.
| Age | Frequency | Percentage |
|---|
| <30 years | 4 | 10 |
| 31-35 years | 16 | 40 |
| 36-40 years | 18 | 45 |
| 41-45 years | 2 | 5 |
| Total | 40 | 100 |
| Mean±SD | 10±7.07 |
The present study comprised of 60% males (n=24) and 40% females (n=16).
Maximum participants were from the medicine faculty 12 (30%). The distribution of participants presented in [Table/Fig-2].
Faculty distribution of the forty participants.
| Faculties | Number | Percentage |
|---|
| Medicine | 12 | 30 |
| Dental | 10 | 25 |
| Ayurveda | 6 | 15 |
| Nursing | 8 | 20 |
| Physiotherapy | 4 | 10 |
| Total | 40 | 100 |
| Mean±SD | 8±2.82 |
Among all participants, 57.5% strongly agreed in the opinion that critical analysis of topic is useful in planning the progress of content [Table/Fig-3]. The questionnaire was validated by experts with 90% validity by Average Conguency Percentage (ACP) score.
Questionnaire analysis of all the participants.
| Sl No. | Questions | Strongly agree (%) | Agree (%) | Equivocal (%) | Disagree (%) | Strongly disagree (%) |
|---|
| 1 | Current technique of medical report writing connects with the concept of narrative and reflective writing of research. | 30 | 50 | 17.5 | 2.5 | 0 |
| 2 | Narrative writing is an effective way to understand the applicability of the concept. | 40 | 40 | 20 | 0 | 0 |
| 3 | Split of narrative writing under four heads helps in explaining the concept well.* | 32.5 | 57.5 | 10 | 0 | 0 |
| 4 | Critical analysis of topic is useful in planning the progress of content. | 57.5 | 25 | 17.5 | 0 | 0 |
| 5 | Narrative way of research writing is helpful over logico-scientific technique of research report writing in understanding the topic better | 30 | 52.5 | 17.5 | 0 | 0 |
| 6 | Reflective writing helps in analysing the situation better | 50 | 30 | 17.5 | 2.5 | 0 |
| 7 | Reflective log helps to explore the learning gained from the situation | 37.5 | 50 | 12.5 | 0 | 0 |
| 8 | Narrative and reflective log enables to gain self-knowledge by analysing situation | 40 | 40 | 17.5 | 2.5 | 0 |
| 9 | Reflective writing helps in analysing the outcome of study in different way | 40 | 50 | 10 | 0 | 0 |
| 10 | Sub division of reflective writing: Reflection in action and reflection on action analyses the situation better** | 37.5 | 45 | 17.5 | 0 | 0 |
Narrative writing was split in four sections* to elaborate the work as per categorised questions.
Background: who, where, when
incidence and stimulating factor: what and why
action taken place:
critical analysis of action plan
Reflection in action and reflection on actions** are two aspects of reflective writing where reflection in action means the assessment and necessary changes done in research process when the research is still going on. While reflection on action means retrospective analysis of the research to assess limitations or flaws in the research process.
On basis of open ended question about their opinion, they felt that narrative and reflective technique is difficult to incorporate in routine. Whereas some were of the opinion that this pattern of research writing needs to be applied more to understand it better
Discussion
Narrative writing though introduced long years back it is limited to history and medical report writing. In today’s research world this pattern is tried to be reintroduced but it still remains difficult to understand. Hence this study helps to find the level of knowledge and understanding about this technique in research report writing.
Jorwekar GJ quoted that Reflective writing helps you to analyse the research situation and personal reflection to various aspects of research [4]. Reflection writing helps to assess day to day experiences in an analytical way. Similarly, in present study 80% of fellows agreed that narrative and reflective writing is an effective way to understand applicability of the concept that has to be researched.
Critical analysis in reflective writing played a vital role in expressing the reflective thinking well. 57.5% strongly agreed, 25% agreed while 17.5% were equivocal in the opinion that critical analysis of topic is useful in planning the progress of content. Micallef C also stated that researcher should adopt a skeptical attitude to their studies [5]. Thus, research goes beyond the positive approach during application of null hypothesis. According to him researcher should always be analytical towards research, whether it be his/her own or of anyone else so, that they get a scientific perfection and the truth.
Jasper MA stated that reflective writing develops the researchers’ critical thinking and analytical abilities, enhances their cognitive development and encourages creativity [6]. Similarly in present study majority strongly agreed that reflective writing helps in analysing the situation better. Only 2.5% were against this opinion which may be because this group found reflective writing difficult than standard form of research writing.
Present study group felt that reflective log helps to explore the learning gained from the situation to which most of the candidates agreed. Song P and Stewart R stated that reflection helps learners become better physicians in terms of medical and humanity and thus enhances personal growth [7]. They felt that reflective writing assignments are must in medical school education as reflection has taken home message from patient encounters.
Helsing D et al., stated that reflective practice helps an individual to analyse the situation/practice on basis of past experiences and its implication to improve future performances [8]. Reflective practice ensures maximum learning gain from any situation. Using reflection in day to day practice and research is a type of self-directed learning which is a mean of adult learning in current medical education field. Records maintained using reflection could act as a source of feedback which can be utilised in future. Reflection helps us to avoid past mistakes, guide about self-learning and apply this knowledge for future research and plans.
Similarly, in present study fellows perceived that narrative and reflective writing enables to gain self-knowledge by analysing the situation better. Also, they felt that reflective writing helps in analysing the outcome of study in different way.
In the present study reflection was divided under two heads like reflection in action and reflection on actions which was found to be useful in analysing the situation better. Similar was the finding by Sanders J that reflection happens before during and after the process of research and helps in understanding the situation better so that in future this knowledge is applied in better way [9]. Important aspects of reflection include its use before, during and after experiences as it is metacognitive process.
Davies S realised that though the process of reflection has huge applicability but its utilisation is limited [10]. This may be due to lack of understanding the process or discomfort in evaluating one’s own practice. In this study, also there was a group that felt that reflective writing does not connect with current technique and doesn’t help in analysing the situation better. The reason may be failure to understand the reflective process.
Limitation(s)
The current study was done on a small population which was a limitation to put forth the outcome parameters. Similar study has to be done on bigger population.
Conclusion(s)
To conclude narrative and reflective way of research writing is easy to understand and apply in research process. We can connect to this type of format easily and can be used routinely in research writing. Reflective practice is based on the principles of adult and experiential learning and can ensure deeper understanding. Exact role of reflective practice in present day’s medical education needs further application and research.
Future recommendation is to apply this mode of research report writing on routine basis and should be part of indexed journals as publication.
Narrative writing was split in four sections* to elaborate the work as per categorised questions.
Background: who, where, whenincidence and stimulating factor: what and whyaction taken place:critical analysis of action plan
Reflection in action and reflection on actions** are two aspects of reflective writing where reflection in action means the assessment and necessary changes done in research process when the research is still going on. While reflection on action means retrospective analysis of the research to assess limitations or flaws in the research process.On basis of open ended question about their opinion, they felt that narrative and reflective technique is difficult to incorporate in routine. Whereas some were of the opinion that this pattern of research writing needs to be applied more to understand it better
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