title: Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis.
abstract: BACKGROUND
  Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students' experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students' ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency.
  
  
  METHODS
  Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity.
  
  
  RESULTS
  Reflection on real difficult clinical communication situations appears to increase medical students' ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer.
  
  
  CONCLUSIONS
  Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students' overall communicative competency.
authors.affiliation: Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313, Herdecke, Germany. gabriele.lutz@uni-wh.de.|Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany. gabriele.lutz@uni-wh.de.
authors.forename: Gabriele
authors.identifier: http://orcid.org/0000-0001-5044-8485
authors.initials: G
authors.lastname: Lutz
authors.affiliation: Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313, Herdecke, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Roling
authors.affiliation: Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Witten, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Berger
authors.affiliation: Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313, Herdecke, Germany.|Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Edelhäuser
authors.affiliation: Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313, Herdecke, Germany.|Department of Internal Medicine, Clinical Education Ward for Integrative Medicine (CEWIM), Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheffer
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003405:Creativity; D004504:Education, Medical, Undergraduate; D004644:Emotions; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D058996:Quality Improvement / Q000592:standards*; D013337:Students, Medical / Q000523:psychology*
keywords: Communication; Creativity; Medical education; Reflective practice