Reflective Practice and Leadership in Medicine and Medical Education Basic Components of the RP&L Method: An Overview

Just as with the biomedical aspects of their profession, physicians must be trained to methodically address the psychological and social aspects of their daily experiences. The RP&L method is one such systematic approach.

Rather than telling their trainees what to do and think, the best clinical educators use their knowledge and experience to help trainees develop their own reasoning skills and identify patterns in the data that are “hidden in plain sight.” The structured RP&L method helps clinical educators teach trainees how to identify the psycho-social challenges they face as care providers, teachers, colleagues, or administrators as well as how to gain a deeper understanding of those issues, clarify their thinking, and map out potential plans for action.

The Six Components

In this section, we illustrate a six-component RP&L method based on our experiences in the bi-monthly seminar for fellows in Pediatric Hematology/Oncology (See list of the Basic (Original) Goals for the fellows’ seminar). The example of the RP&L method illustrated here provides the necessary elements to translate the method to other specialties and types of professional development (e.g., residency, CME). You can also visit the Alternative Designs section for examples of other techniques for teaching RP&L (e.g. one-time workshops, quarterly seminars, etc.)

Seminar discussions include 6 key components:

1. Presentation of a Challenging Case and Framing the Question
2. Reflection on (Systematic Analysis of) circumstances
3. Formation of Working Hypothesis (Diagnosis)
4. Development of a Plan for Strategic Action
5. Summary and Evaluation of discussion

Faculty Review

Although the seminars always begin with a description of a challenging situation, the systematic analysis, hypothesis formation do not occur in a lock-step fashion. Rather, as in the formulation of a biological diagnosis and treatment plan, participants ask questions, offer additional data or tentative explanations and suggest interventions in an iterative fashion. The task of the faculty is to make sure that that the evidence and reasoning implicit in such discussions becomes explicit and available for consideration and critique by all participants.

A common and reasonable question about this method is: “How do you prevent it from becoming a gripe session?” Coming to a clear hypothesis and a logically derived plan of action is essential for the utility and sustainability of the seminar. The Example Facilitative Responses drawn from actual seminars of learner-faculty interactions for each component may be helpful to you.