Using Reflective Writing to Explore Resident Resilience during Global Health Electives

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  • 1 Division of Hospital Medicine, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;
  • | 2 Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;
  • | 3 Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio;
  • | 4 Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin;
  • | 5 College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, Ohio;
  • | 6 Division of Emergency Medicine, Cincinnati, Children’s Hospital Medical Center, University of Cincinnati College of Medicine, and Department of Family and Community Medicine, Cincinnati, Ohio

Pediatric residents participating in global health electives (GHEs) report an improved knowledge of medicine and health disparities. However, GHEs may pose challenges that include cost, personal safety, or individual mental health issues. The objective of this study was to describe the use of guided reflections to understand resident resilience during GHEs. Forty-five residents enrolled in two pediatric training programs were asked to respond in writing to weekly prompts during a GHE and to complete a post-trip essay. Analysis of the reflections and essays, including an inductive thematic analysis, was completed. Two coders performed a second analysis to support classification of themes within the Flinders Student Resilience (FSR) framework. Four themes emerged from the initial analysis: 1) benefits, 2) stresses and challenges, 3) career development, and 4) high-value care. Analysis using the FSR framework revealed the following themes: acknowledgment of personal limitations, importance of relationships in coping throughout the GHE, and discernment of career focus. Reflective writing provided insight into how residents mitigate GHE challenges and develop resilience. Despite statements of initial distress, residents focused on their personal benefits and growth during the GHE. The FSR framework revealed the residents’ robust self-awareness of limitations and that strong relationships on the ground and at home were associated with perceived benefits and growth. Programs should consider helping residents to identify healthy coping practices that can promote personal resilience during GHEs as part of pre-departure preparation and debriefing, as well as providing for supportive communities during the GHE.

Author Notes

Address correspondence to Amy R. L. Rule, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave. MLC, Cincinnati, OH 45229. E-mail: amy.rule@cchmc.org

Authors’ addresses: Amy R. L. Rule, Division of Hospital Medicine, Perinatal Institute, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, E-mail: amy.rule@cchmc.org. Stephen Warrick, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, E-mail: stephen.warrick@cchmc.org. David Rule, Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, E-mail: woodyrule@gmail.com. Sabrina M. Butteris and Sarah A. Webber, Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, E-mails: sawebber@wisc.edu and sbutteris@pediatrics.wisc.edu. Lynne Smith, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, OH, E-mail: drsmifff@gmail.com. Chuck Schubert, Division of Emergency Medicine, Cincinnati, Children’s Hospital Medical Center, University of Cincinnati College of Medicine, and Department of Family and Community Medicine, Cincinnati, OH, E-mail: chuck.schubert@cchmc.org.

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