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"Attitude is a Little Thing That Makes a Big Difference": Reflection Techniques for Addiction Psychiatry Training*

Received September 7, 2006; revised December 15, 2006, June 5, 2007, and July 4, 2007; accepted July 17, 2007. The authors are affiliated with the Department of Psychiatry at the University of Toronto in Ontario. Address correspondence to Bruce C. Ballon, M.D., Psychiatry, University of Toronto, CAMH, 33 Russell St., Toronto, Ontario M5S 2S1, Canada; bruce_ballon{at}camh.net (e-mail).

OBJECTIVE: The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with substance use and other addictive disorders. METHODS: Reflection discussion times, reflection journaling, and mandatory end-of-rotation reflection papers were embedded into a core addiction psychiatry postgraduate training block. Qualitative analysis of 28 reflection papers was performed to determine key factors and constructs that impacted on the development of attitudes and professionalism. RESULTS: A number of constructs emerged that demonstrated the attitudes, beliefs, stereotypes, and stigmas students have regarding addictive disorders. Some constructs also highlighted that students felt much more comfortable dealing with addictive disorders after the training and would treat individuals with these conditions in a more effective manner. CONCLUSION: Reflection techniques were endorsed as extremely valuable by students, especially in the development of professional attitudes that will help clinicians effectively engage and provide appropriate care for individuals suffering from addictive disorders. The authors suggest that reflective practices be used more extensively in psychiatric training in order to build and establish reflexive self-awareness as a core professional competence essential to work effectively in clinical practice, especially in the most demanding contexts.

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