Picture yourself in your future role as a CNM or WHNP.  In addition to time pressures in the clinic and gaining knowledge and experience, what do you anticip

Please reflect on the following questions. Use the rubric below and respond substantively and succinctly in about 2 paragraphs per answer. Be sure to read the rubric associated with this assignment and compare your responses to the rubric before submitting.   Download this form, type your responses into it, and upload it to the drop box by the close date.

Remember that there is much choice about what you write, and if a topic feels too tender to address, choose a different approach to the question instead.  The ideas to consider are only that—ideas you can use if you’re feeling stuck with your writing.  You may want to think about the question first on your own and read those ideas only if you aren’t sure where to go with the question.

 

Students sometimes tell us they write what they think we faculty want to hear, or they are just making things up.  Remember that coming up with ideas from your own mind is where reflection starts— and there is no right or wrong way to feel about these questions.  Please feel free to say what you think, and then elaborate: how did your thinking evolve over the term, or during your program so far?  What questions do you still have about these topics—what are you still curious about?  What are you wondering? 

For full credit, be sure that your answers do not overlap with one another, but that each answer is unique.

1.     Picture yourself in your future role as a CNM or WHNP.  In addition to time pressures in the clinic and gaining knowledge and experience, what do you anticipate your biggest challenge(s) might be in providing gynecologic care? Why? What are the points of discomfort that you may need to “lean into” to become an excellent clinician? (1 point)

How might you prepare yourself to manage the identified challenge before you practice independently? Be specific–describe both the challenge and the preparation fully. (1 point)

2.     At this point in the term, you have worked through all 6 Integration Cases.  Please reflect on your own development regarding your clinical reasoning skills.  Clinical reasoning processes include selecting data elements to collect, filtering and interpreting information, prioritizing, synthesizing, arriving at a diagnosis, deciding on management plans, and evaluating the results.

a.     What are you proud of that happened this term regarding your clinical reasoning skills? Why?  (1 point)

b.     What kinds of things were frustrating or difficult in these Integration Case Studies regarding your clinical reasoning skills, if any? Explain (1 point).  Remember this is not about the structure of the cases, but about any challenges you’ve identified for your own development going forward.  If nothing was frustrating or challenging, describe more about how your reasoning has evolved during the term

3.     Integration Cases and OV Simulations involve a different kind of thinking than taking an exam.  Reflect on how and why these assessments felt different, beyond the format, focusing on the thinking involved. What did you learn about your own thinking from applying your knowledge to office visits, beyond feeling new at this? We are NOT interested in a restatement of the assignment’s purpose: we want to hear your own words about how applying knowledge feels different from memorizing facts.  Please provide at least two specific examples about your own thinking processes (2 points).  

Here are some things to consider writing about: 

·        Student clinicians often have mental “lists” they plan to ask a patient, in a certain order.  What happens when clinicians and patients actually interact?  

·        Students sometimes wrestle with when objective findings are required and when subjective information is enough to work from.  Has that happened to you during these cases? How does it feel to work from the patient’s subjective report alone? 

4.     It can be tempting for new clinicians to land too soon on a diagnosis, not considering the full range of likely differentials.  Did you feel this was happening to you at any point? What was that like? How did it work out in that ins

4.       In module 6, you learned about a variety of approaches to breast cancer and cervical cancer screening, including evidence that supports or challenges current guidelines.  Please address how you would approach one (1) of the two practice dilemmas outlined below, with your rationale for choosing that approach.  Consider how to balance client rights, evidence-based guidelines, and institutional norms (that is, what the practice typically does for these situations).  (2 points).  How will you open the discussion with your preceptor, specifically?  Remember that you are a guest in the clinical setting, so diplomacy is important.  Consider writing out how you would approach your preceptor step by step, setting the stage for a successful conversation.

Dilemma 1: You have noticed during your first weeks in clinicals that your primary preceptor orders screening mammograms yearly on all patients aged 40 and older without discussion and recommends formal monthly self-breast exams for everyone over 30.  How-to posters explaining formal SBE hang in each exam room.

Dilemma 2: You have noticed that your clinical site serves several transmen, and that your primary preceptor is not recommending cervical cancer screening to these individuals.  When you ask about Paps and HPV testing, your preceptor replies “I don’t want to make them uncomfortable, and I feel like they will tell me if they want to have one.

5.     Reflect on the term and the integration case studies that you have participated in. You will soon prepare to begin clinicals. Consider your own development as a clinician to date.  Describe, based on your current understanding of your own role transition, what specific advice you will give to yourself as a beginning practitioner or clinical student. Include advice about developing your knowledge, skills, and professional role in your answer.  Consider this an opportunity to chart your own course: what do you personally want to learn more about, or get better at, or embody?  How will you get there from here? (2 points).

 Module Integration Reflection Rubric (1)

Criteria	Ratings	Pts
Q1 Leaning in: What do you anticipate your biggest challenge may be, and how will you prepare yourself?	2 ptsFull MarksThe most anticipated challenge and preparation to meet the challenge are both fully described, with specificity and rationale. No overlap with other answers.   1.5 ptsModerate ReflectionMost anticipated challenge and preparations to meet it are addressed with some description and explanation but without rich detail or specificity. Or, some overlap with other answers.   1 ptsSome ReflectionMost anticipated challenge OR preparation to meet the challenge are fully described and explained. OR, considerable overlap with other answers.   0.5 ptsMinimal ReflectionAnticipated challenge and/or preparation are addressed; faculty must work to infer meaning from text.   0 ptsNo MarksResponse does not address question prompts	2
Q2  Clinical Reasoning Skills: How have your clinical reasoning skills developed? What are you proud of? What has been frustrating?	2 ptsFull MarksClearly describes one point of pride and one point of frustration about own reasoning skills, with reasons fully explained and expanded upon. No overlap with other answers. If no frustration or challenges are identified, a discussion of the student’s evolution in reasoning is present with rich description.   1.5 ptsModerate ReflectionDescribes one point of pride and one point of frustration about own reasoning skills, with some explanation or expansion about the reasons. Rich description and rationale is not present. OR some overlap with other answers. If no frustration or challenges are identified, a discussion of the student’s evolution in reasoning is present with some description.   1 ptsSome ReflectionClearly describes one point of pride OR one point of frustration about own reasoning skills, with some rationale provided. OR considerable overlap with other answers   0.5 ptsMinimal ReflectionPoints of pride or frustration are described without rationale, or frustrations focus on the structure of the assessment rather than student’s own clinical reasoning   0 ptsNo MarksResponse does not address question prompts
Q3 Applying Knowledge to Practice: What did you learn about your own thinking from applying your knowledge to an office visit?	2 ptsFull MarksAt least TWO specific points are clearly described and expanded, including examples of the student’s own thinking processes. Clear explanations are present about how knowledge for practice differs from knowledge to pass exams. No overlap with other answers   1.5 ptsModerate ReflectionAt least one key point is clearly identified, including examples of students’ own thinking processes, and 1 additional point is implied but not clearly explained. Clear explanation is present about how knowledge for practice differs from knowledge to pass exams. OR some overlap with other answers   1 ptsSome ReflectionPoints are implied by not clearly explained; examples are not evident. OR considerable overlap with other answers   0.5 ptsMinimal Reflection1 point is addressed; faculty must work to infer meaning from text.   0 ptsNo MarksResponse does not address question prompts
Q4 Clinical Dilemma	2 ptsFull MarksApproach to one practice dilemma is clearly delineated with rich description and rationale, including how to balance client rights, evidence-based guidelines, and institutional norms. How to approach the preceptor is included.   1.5 ptsModerate ReflectionApproach to one practice dilemma is clearly delineated with rich description and rationale, including how to balance client rights, evidence-based guidelines, OR institutional norms. How to approach the preceptor is included.   1 ptsSome ReflectionApproach to one practice dilemma is described simply with some description and rationale, OR only addresses patient care and not preceptor communication.   0.5 ptsMinimal ReflectionApproach to one practice dilemma is described; faculty must work to infer meaning from text.   0 ptsNo MarksResponse does not address question prompts
Q5 Advice to yourself as a new clinician	2 ptsFull MarksSpecific and personalized advice to the self, based on a current evaluation of strengths and challenges, is present and includes rich description and specific examples of next developmental steps for knowledge development, skill acquisition, AND professional role transition. No overlap with other answers.   1.5 ptsModerate ReflectionSpecific and personalized advice to the self is present and includes rich description and specific examples of next developmental steps for knowledge development, skill acquisition, OR professional role transition. Or, some overlap with other answers.   1 ptsSome ReflectionSpecific and personalized advice to the self is present and includes some description of next developmental steps for knowledge development, skill acquisition, OR professional role transition. OR, considerable overlap with other answers.   0.5 ptsMinimal ReflectionSpecific and personalized advice to the self is present; faculty must work to infer meaning from text.   0 ptsNo MarksResponse does not address question prompts.