PURPOSE: Reflection is increasingly being used in higher education, but the criteria to assess the depth of reflection in student essays are difficult to define. This article tested the hypothesis that a good reflective essay contains more terms indicating mental processes. METHODS: The authors selected two essays written by first year medical students at The University of Hong Kong, after their first encounter with cadavers in their dissection class. The two essays were perceived by teachers as having different depths of reflection. The transitivity system in Systemic Functional Linguistics was adopted to compare the two essays in terms of percentage occurrence of different process types (mental, material, relational, verbal, behavioral, existential). RESULTS: The analysis showed that the essay with deeper reflection had a higher percentage occurrence of mental and relational processes and a low percentage occurrence of material processes. The other three processes accounted for only a low percentage of processes in both essays. CONCLUSION: From the transitivity analysis of the two reflective essays, the hypothesis that a good reflective essay contains more terms indicating mental processes is supported. The transitivity system in systemic functional linguistics can thus be used as an objective framework for assessing the depth of reflection in written essays.
Cadaver ; Education, Medical ; Hong Kong ; Humans ; Linguistics ; Mental Processes ; Students, Medical

Stroke is a major cause of death and disability in Singapore and many parts of the world. Chronic disease management programmes allow seamless care provision across a spectrum of healthcare facilities and allow appropriate services to be brought to the stroke patient and the family. Randomised controlled trials have provided evidence for efficacious interventions. After the management of acute stroke in a stroke unit, most stable stroke patients can be sent to their family physician for continued treatment and rehabilitation supervision. Disabled stroke survivors may need added home-based services. Suitable community resources will need to be harnessed. Clinic-based stroke nurses may enhance service provision and coordination. Close collaboration between the specialist and family physician would be needed to right-site patients and also allow referrals in either direction where necessary. Barriers to integration can be surmounted by trust and improved communication. Audits would allow monitoring of care provision and quality care enhancement. The Wagner model of chronic care delivery involves self-management support, shared clinical information systems, delivery system redesign, decision support, healthcare organisation and community resources. The key and critical feature is the need for an informed, activated (or motivated) patient, working in collaboration with the specialist and family physician, and a team of nursing and allied healthcare professionals across the continuum of care. The 3-year Integrating Services and Interventions for Stroke (ISIS) project funded by the Ministry of Health will test such an integrative system.
Delivery of Health Care, Integrated ; organization & administration ; Evidence-Based Medicine ; Humans ; Ischemic Attack, Transient ; Medicine ; Middle Aged ; Models, Organizational ; Neurology ; Primary Health Care ; Rehabilitation Nursing ; Singapore ; Specialization ; Stroke ; nursing ; Stroke Rehabilitation