A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51

Abstract

Introduction: Reflection is thought to be an essential skill for physicians. Although much has been written about it, there is little concurrence about how to best teach reflection in medical education. The aim of this review was to determine: (i) which educational interventions are being used to develop reflection, (ii) how is reflection being assessed, and (iii) what are the most effective interventions.

Methods: Inclusion criteria comprised: (i) undergraduate medical students, (ii) a teaching intervention to develop reflection, and (iii) assessment of the intervention. A review protocol was developed and nine databases were searched. Screening, data extraction, and analysis procedures were performed in duplicate. Due to the heterogeneity of studies, a narrative synthesis approach was performed for the study analysis.

Results: Twenty-eight studies met the inclusion criteria. The interventions in these studies had at least of two of the following components related to reflection: (i) introduction, (ii) trigger, (iii) writing, (iv) guidelines, (v) small group discussion, (vi) tutor and (vii) feedback. Three validated rubrics were used to assess reflective writing in these studies.

Conclusions: The strongest evidence from studies in this review indicates that guidelines for, and feedback on, reflective writing improve student reflection.

Acknowledgments

We would like to acknowledge the irreplaceable expertise of Ms. Grainne McCabe and Mr. Paul Murphy, the information scientists who contributed to this review. We would also like to thank the BEME team for their guidance through the course of the review.

Disclosure statement

The authors have no declarations of interest to report. This BEME review was completed without funding.

Additional information

Notes on contributors

Jane Uygur

Dr. Jane Uygur, MD, CCFP, MClSc, is a Clinical Competency Tutor in the Department of General Practice, RCSI, Dublin, Ireland. She is also a PhD candidate in the Western Family Medicine program, London, Canada.

Ellen Stuart

Dr. Ellen Stuart, MB, BCH, BAO, BSc (Physiotherapy), MICGP, DME, DipWH Grad Dip (Clinical Education), Grad Cert (Palliative Care), is a Clinical Lecturer in the Department of General Practice, RCSI, Dublin Ireland.

Muireann De Paor

Dr. Muireann De Paor, MB, BCh, BAO, BMedSc, MICGP, DOWH, DMSM, is a Clinical Lecturer and Research Fellow in the Department of General Practice, RCSI, Dublin, Ireland.

Emma Wallace

Dr. Emma Wallace, MB, BAO, BcH (Hons), BMedSci (Hons), MICGP, PhD, HDip(Clin Ed), DCH, is a Senior Lecturer in the Department of General Practice, RCSI, Dublin, Ireland.

Seamus Duffy

Dr. Seamus Duffy, BCom, MB, MCh, BAO, LRCPSI, is a Clinical Lecturer in the Department of General Practice, RCSI, Dublin, Ireland.

Marie O’Shea

Marié T. O’Shea, BA, M.Sc, is a Primary Research Officer in the Health Professions Education Centre, RCSI, Dublin Ireland.

Susan Smith

Professor Susan Smith, MD, MSc, MB, BCh, BAO, DCH, MRCPI, MRCGP, is a Professor in the Department of General Practice, RCSI, Dublin, Ireland.

Teresa Pawlikowska

Professor Teresa Pawlikowska, BSc, MB, BS, MSc, PhD, MRCP, is the Director of the Health Professions Education Centre, and BEME Coordinator for the BEME International Collaborating Centre, RCSI, Dublin, Ireland.