How Medical Student-­Led Debrief Interviews of Hospitalized Families Influence Learning and Reflection

Purpose: To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection, empathy, and learning. Methods: We conducted a multi institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from July 2016 February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience. Control students completed a written reflection on a memorable patient encounter. Three blinded authors scored written reflections according to the 4-level REFLECT rubric to determine depth of reflection. Inter-rater reliability was examined using kappa. REFLECT scores were analyzed using a chi-squared test while the essay content was analyzed using qualitative interpretive methods. Results: 80% of eligible students participated. 189 essays (89 control, 100 intervention) were scored. 37% of the control group attained reflection and critical reflection, the two highest levels of reflection, compared to 71% in the intervention group; 2% of the control group attained critical refection, the highest level, compared to 31% in the intervention group (χ2 (3, N=189) = 33.9, P < 0.001). Of the seven themes, three focused on physician practice and four were patient-focused themes. Though all themes were seen across both groups, the intervention group focused more on patient-centered topics and themes while the control group focused more on concepts of doctoring and physician practice issues. Conclusions: Medical student-led patient debrief interviews offer a unique approach to build medical student empathy and deepen self-reflection through the creation of direct dialogue and the opportunity for exploration of patient-caregiver experiences during hospitalization.