No abstract

Reflective capacity is an essential characteristic of professionally competent clinical practice. Use of interactive reflective writing (IRW), ie. student writer/faculty feedback provider dyad and/or collaborative reflection in small group, to augment reflective practice instruction is well documented. IRW-enhanced reflection on experience contributes to meaning-making, leading to transformative learning within professional identity formation. Written formative feedback to trainees' reflective writings can include personal anecdotes from faculty to enrich the educational value of feedback, used judiciously and subjected to a "filtering" process. We provide an exemplar of a third year Family Medicine clerkship student's reflective writing about a clinical care experience that "mattered" as well as the faculty written feedback which included sharing a personal narrative resonating with themes emerging from the student's reflective writing. Dual, mutually reinforcing identities/roles of medical educator and family cancer caregiver as educator emerged within the feedback. We include some post-IRW exercise student and educator reflections on the experience and impact of such sharing within an educational context. In this example, faculty drawing from both personal and professional experience to craft feedback supporting the becoming of a physician was experienced by the student writer as making the feedback more "real" and engaging, leading to perceived enhanced value of the educational exercise.

Background: The objective of this investigation is to examine the effect of postoperative therapy after routine carpal tunnel release. Our hypothesis was that supervised hand therapy does not improve outcomes after routine carpal tunnel release. Methods: Patients with carpal tunnel syndrome were randomly assigned to one of 3 groups based on the last digit of their medical record numbers to one of 3 groups: standard 6-week postoperative rehabilitation (standard therapy), expedited one-session postoperative rehabilitation group (expedited therapy), and no postoperative rehabilitation group (no therapy). The primary outcome measures were Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and return to work. The outcome questionnaire was completed preoperatively, at the 2-week follow-up visit, and monthly to 6 months after surgery. Results: All 3 treatment groups had similar mean QuickDASH scores preoperatively. At 1- to 6-month follow-up, all 3 groups had similar QuickDASH scores at each visit, and all showed a significant decline from baseline (preoperative) QuickDASH score. Overall, QuickDASH score decreased significantly from a preoperative visit mean of 42.7 to a final postoperative (visit 8) mean of 6.69. There was no significant difference in the mean QuickDASH score among all 3 groups at 6-month follow-up. There was no significance in the time of return to work among the 3 groups (standard therapy, 21.8 days; expedited therapy, 20.9 days; no therapy, 16.6 days). Conclusions: This investigation adds evidence that supervised hand therapy does not improve the outcomes of routine carpal tunnel surgery as measured by QuickDASH and return to work.