Reflective writing in social sciences: challenges and opportunities for medical students

ABSTRACT

An application of Bologna Process parameters in the classroom setting requires new skills on the part of students. One of these significant skills is the ability to reflect upon one’s learning path, which provides an opportunity for students to enhance their knowledge, and, moreover, make pivotal changes in their professional field. Thus, students would benefit greatly from reflective learning skills being harnessed at the early stage of their learning. Aim. This study aims to explore students’ reflections and interpretations of their learning through writing essays. Methodology and research methods. This study employed a survey design with open-ended questions in which 14 out of 23 students participated. In addition, two individual inter-views were conducted, and 345 weekly essays and 23 final student reflections were analyzed. Results. Research results found that over 50% of respondents indicated that they had ac-quired reflective skills as they reflected on their content learning and writing and reading skills. Indeed, 96% of respondents demonstrated a positive understanding of the structure of the essay; however, their reflections remained at the descriptive level, in contrast to an expected change in their learning approach.

KEYWORDS:

• reflective learning
• writing essay
• challenges
• opportunities
• students

Introduction

Reflective learning is a rarely-used practice in the Kazakhstani education system, where the most prevalent types of learning methods used in the classroom include team-work, project work, and problem-based learning. In fact, the reason why reflective learning is neglected remains unclear. This may be due to the present focus being on the application of diverse forms of innovative learning. However, how those changes are perceived by students, what they have learned, and their overall feedback are as yet undiscovered.

Students who attended schools where innovative learning did not form part of the curriculum depend on teachers’ authority. Due to their generation, at school, they learn under the rather dated practices of teachers and obtain executive skills. In contrast, innovative learning sets a student at the core of the learning process. Accordingly, it requires students’ creativity, additional work, and accountability. Hence, not many students possess the necessary skills that would benefit them at university.

Reflective learning promotes analytical thinking skills in students as by reflecting on tasks they have performed they can question themselves, and by practicing this daily they can improve this skill. In fact, this is not only the student’s responsibility. In order to make this experience more productive and helpful, the support of a teacher, supervisor, and/or advisor is crucial.

In a Medical University in Kazakhstan, diverse teaching and learning approaches have been practiced. Students have been taking part in group work, mind mapping and action research with great interest. However, despite their possession of such skills, they lack the essential analytical thinking skills to compose their own learning approach. Moreover, medical students often disregard the potential benefits of the social sciences for their career path and studies. Therefore, this study was designed to challenge students to find a solution to their confirmed belief about the limitations of social sciences. The research question is: How do international students reflect upon and interpret their own learning through the writing of essays?

Literature review

Early background

The idea of reflective learning takes its roots from Schön’s work done in 1983. A research and subsequent analysis of the term ‘profession’ revealed that professional practice is a prerequisite for updating scientific knowledge, which serves as an engine of growth for the professions (Schön, 1999). Since then, scholars and educators have employed reflective learning practices in their classroom activities to increase the professional skills of their students. Medicine was one of the three professions considered by Schön as generating knowledge. We consequently decided to facilitate this learning among medical students here in Kazakhstan through the reflective learning method.

Teacher/student role in a reflective practice

Teachers play a significant role in the promotion of reflective learning as they possess the ability to influence student learning (Brockbank & McGill, 1998). It is through the competence of teachers that the tacit knowledge of students is transformed (Schön, 1999) into professional experiences as they engage this knowledge in actual practice (Alsina & Mula, 2020). Meanwhile, self-reflecting students face different challenges, which can even include their choice of a field of study (Bubnys, 2020) or ambiguities during field-work (Diaz-Iso et al., 2020); hence, they need the support of their teachers. These emerging issues highlight the necessity of teachers providing clear instructions to avoid students’ becoming confused (Fullana et al., 2016).

Students’ experiences reflecting on their practices indicate the development of critical thinking skills (Archer-Kuhn et al., 2020); their employment of learned skills beyond the classroom (Calvo et al., 2020); enhanced collaborative learning (Canabate et al., 2020); and the presence of independent learning skills (Colomer et al., 2013). Thus, an assessment of reflective learning is instrumental in highlighting the impact of faculty feedback and the exchange of students’ peers as key elements in their learning progress (Peltier et al., 2005).

Although scholars state that reflective learning occurs when a learner is engaged in deep learning, this is a process that could take years (Moon, 2004). Students who have related their experiences in writing journals over their first practices with reflective writing refer to insufficient time allocated to reflect rather than to merely describe (Kuklick et al., 2015). Indeed, it was found that in reflective writing, the focus is generally oriented on learning rather than on change (Thelin, 2020).

A reflective practice in a learning process

In addition, when incorporated into the curriculum, reflective learning requires reflection throughout the learning process to explore the conceptual understanding of students (Ryan & Ryan, 2013). Designing a real-world task as a game taken on by students helps to assess their gained knowledge (Beranic & Hericko, 2020; Grant et al., 2020), and the nurturing of skills necessary for social life (Gonzalez et al., 2020).

Writing reflections have been employed to assess students’ online learning progress (Henderson et al., 2004). Through such reflections, it was found that students gain knowledge despite the teaching and learning approaches employed. Similarly, a review of literature on students’ mobile learning experiences published by African scholars has also revealed the significance of students’ reflective learning (Kaliisa & Picard, 2017).

Frameworks in a reflective practice

Scholars have developed diverse frameworks to facilitate reflective learning and render it productive. Some scholars have identified three ways a student may use reflections to enhance their learning: (a) at a subjective level when a learner decides what was learned; (b) at a personal level when a learner examines their ways of learning; and finally, (c) at a critical level when a learner analyzes the importance and feasibility of the learned material (Hedberg, 2009). Others propose a frame to nurture reflective learning (Yang, 2015). The frame entails three stages whereby the first stage focuses on the development of students seeking, solving, and exploring skills in their given field; the second stage is oriented towards the employment of diverse teaching methods to bring students together; and the final stage is aimed at fostering critical thinking skills through the analysis of one’s own challenges (Yang, 2015).

Hence, theoretical and event-based research has helped highlight the significance of reflective learning. In this respect, reflective learning nurtures the necessary transferable skills in students that are helpful for their future profession and maintains and further enhances their competency in their field. The core support of reflective learning lies in the development of the type of scientific knowledge that supports the professions that serve the prosperity and well-being of humankind.

Methods

The current pandemic has forced educators to revise their teaching approaches. Due to technical issues, such approaches have been restricted to playing games, dividing students into groups and teams, and discussing issues and listening to others without interrupting them. Considering this, in a Medical University in Kazakhstan, the reflective learning process was carried out within the frame of the Social Sciences. The timeframe of the class was one hour and twenty minutes. Students presented (eight-minute per student) their ideas written as an essay related to a specific topic through a shared screen. In this way, it was expected that they would be engaged in the discussion after having organized their thoughts in written form. In addition, this was aligned with a shift of the assessment form from testing to writing. Hence, it was significant in developing students’ capacities to express their ideas clearly and concisely within a limited time and a word length.

The duration of the course was fifteen weeks, lasting from September, 2020 to December 2020. A total of 23 second-year international students − 15 male and 8 female students – who were enrolled in the Faculty of General Medicine participated in the study. They all wrote one essay per week, totaling 345 essays. These essays were related to the works of philosophers (see Appendix 1A, Appendix 2). First, they read a chapter of philosophers’ work adapted for students. Second, based on that reading they crafted an essay either agreeing or disagreeing with the stated main idea. The essays were limited to 250–300 words. It is worth mentioning that students originated from a South Asian country and that their first language is native to their country with English being their second language. Their levels of language proficiency was diverse, due to the enrollment of students on a payment base that lacks a language proficiency requirement.

Students received feedback related to the structure of their essays from a faculty member during the first five weeks. In the following five weeks the feedback focused on the content and their engagement with the literature. During the remaining five weeks students’ peers, were involved in providing feedback. A peer-review was provided orally right after the presentation. Moreover, to facilitate the engagement of students, they were tasked with identifying themselves a peer reviewer among their group members. They were also asked to grade each other; however, they overestimated their peers’ grade and were overly lenient regarding their work. As a consequence, their assessment was combined with a faculty member’s and averaged into the grade. An observation was conducted to reveal a possible mismatch or disparity between what was presented in an advanced written essay and how this was done. Fortunately, it reduced cases of plagiarism among students and increased their self-confidence in composing authentic work.

In addition, this study applied the responses to eight open-ended questions distributed among these 23 students to a final survey. The questions, which had been employed during an interview with the aim of obtaining elaborate responses, included the following: 1. Describe your experience of writing an essay for an exam. 2.What was the most difficult part in writing this exam? 3.What was the easiest part in writing this exam? 4. Based on your experience of writing such an exam, what kind of skills do you think are necessary to confidently pass this type of exam? 5.What kind of skills you think remain necessary for you to improve? 6. How do you think students should prepare for the development of their skills? 7.What kind of support is needed from faculty members? 8.What would you suggest be improved in future? The survey was conducted anonymously; hence, before launching the survey, the students’ rights were indicated to them. Right after clicking the agreement button, a page to the survey was downloaded. Consequently, out of 23 students, 14, of which nine were male and five were female, completed the survey. Regarding their ages, 13 participants indicated that they were 20–21 years of age, and one indicated 17–19. In addition, students wrote a final reflection on their progress. Then six students signed an informed consent form to participate in a focus group discussion. However, due to the examination period starting at the time of the research, only two students could share their experiences in individual interviews.

This study used a survey design, which serves to identify the opinion of a larger population on a particular issue (Creswell, 2012, p. 375). In this study, it was helpful to explore the gains of students from the reflective learning process and their interpretation of it. The survey design consisted of two instruments, a survey, and an interview (Creswell, 2012, p. 382). Due to this being a new experience for students, it was challenging to predict their answers and develop closed-ended questions. Therefore, both the questionnaire and interview consisted of open-ended questions. The resulting open-ended responses required qualitative analysis instruments such as coding and created themes (Creswell, 2012, p. 243). In other words, students’ open-ended responses were merged into categories according to their content and ideas related to the issue under discussion (see Tables 1 and 2). The limitation of the study was the small scope of participants, whereas a larger number would typically be essential for a survey design.

Table 1. Skills that students need to develop according to them.

	Themes	№	%
1	Topic, reading, thinking	6	43
2	Writing skills	4	29
3	Revision skills	1	7
4	Practice	1	7
5	Vocabulary	2	14
	Total	14	100

Table 2. What students should do in advance of exams according to them.

	Themes	№	%
1	Follow the instruction	2	14
2	Need practice	3	22
3	Prepare exam questions	2	14
4	Read books and enrich vocabulary	7	50
	Total	14	100

Results

The research results are based on data analysis from a survey, individual interviews, class observations, and the final reflection papers of students (Appendix 3).

The reflection papers of students indicated that they have all gained knowledge about essay structure, its length, and the requirements of each section, except very few students (4%) that had copied their responses from the Internet. Most of the students (96%) were confident about upcoming written exams, yet some felt that additional reading prior to the exam would be appropriate. This finding was consistent with the survey responses of students after the exam. As is indicated in Tables 1 and 2, 43% of respondents referred to the benefits of reading books according to the topic, and 50% once again confirmed that they need to read more to enrich their vocabulary as well.

The second most significant agreement in students’ opinion (36%) was the need to practice writing, according to instruction, in the skills they were lacking, which they would correspondingly improve in the future. It seems that students had a vague understanding of the benefits of reflections in their future academic and professional projects. They ultimately indicated that they might use this gained knowledge in medical conferences, debates, and discussions.

After the students had completed their final reflections and the final exam, they received a link to a survey consisting of eight open-ended questions regarding their experiences of written exams. Although most of the students were confident about their performance in exams, in the survey, 50% indicated that they need to read books to enrich their vocabulary and ideas in the future (see Table 2). This idea was consistent with the responses from individual interviews, which confirmed their desire for additional pre-exam readings. For example, as the following extract illustrates: ‘My half an hour, approximately forty-five minutes I was reading, then I am planning what I have to write, and making a sentence then erasing it, making a sentence then erasing it, it was so awful experience, literary not so good experience’ [An_Interview_1_Female_Student_1_Age_20]. Further, 43% stated that they need to read more topic-related books and improve their thinking as a necessary skill to improve for future exams, whereas 36% believed that writing practice would boost their confidence in passing written exams (see Table 1).

Building arguments within an essay was one of the challenging tasks for students. For instance, they built them in a lengthy form, combining more than two ideas within one argument. Moreover, they could put several arguments without explaining any of them in one paragraph.

These students had completed their final reflections prior to the final exam. The following is an extract from a student’s reflection: «I need to improve my argument section by giving clear statement of argument and each argument section explain with examples” [Reflection_Female_Student_3_Group_1]. During the class it took time to revise students’ arguments in order to make them comprehensible. Thus, according to the survey responses, 57% of students challenged the task necessitating the building of arguments during the exam (see Figure 1.). Obstacles created by argument building were mentioned by an interviewee as well: ‘When I was writing the answer, first of all I got in my mind all arguments and the structure that you taught, but when the question came, I could not find any argument on my own, so whenever I felt answering I answered with all knowledge I had about that particular question. I wrote in the paragraph I framed like that but I could not form an argument. I feel a little bit tensed’ [An_Interview_2_Female_Student_2_Age_19].

Figure 1. Students’ responses to a challenging part on the exam (%).

Nevertheless, 50% of respondents found that writing essays during class was helpful for them to prepare for the final exam (see Figure 2.) This was consistent with the responses of interviewees, of which here is an extract: ‘It was helpful, because I have got the pattern of writing. If we have not done this in those fifteen days, if I have not written down anything, I would be confused what I have to write and read’ [An_Interview_1_Female_Student_1_Age_20]. Being practiced in building a structured essay helped students to gather their thoughts. Another challenge in their practice was the word limit. During class they wrote a lot, however, without much logical sense. Discussions helped them to revise, reread and rebuild their ideas rather than copying someone else’s thoughts. Yet, they avoided providing their own examples because they seemed too simple to them.

Figure 2. Writing experience of students during the exam after the course completion (%).

Students easily understood the idea of the introduction and conclusion. According to the structure, the former required that they explain how they were going to present their opinion, and with the latter that they conclude in a similar manner to explain what was found or explained in the essay. Hence, 29% of students mentioned the ease of writing the introductory and concluding sections of the essay (see Figure 3.). In the students’ final reflections 96% of respondents were able to explain what should be included in these two crucial sections.

Figure 3. The easiest part in writing (%).

During the class students wrote their essays according to the reading task, which was based on small chapter of The Philosophers’ work. They were tasked with reading the text, understanding it, and writing their opinion about the posed question. Indeed, philosophical texts were difficult for them to understand, and moreover, to form an idea based on them. To illustrate, here is the extract from the interview: «For example, Dasein theory that was a bit difficult to understand for me and for all of us was difficult to understand. Then was a cognition theory, and the last topic that we had globalization that was also hard, because we have to go in depth and discuss about it, so that was hard” [An_Interview_1_Female_Student_1_Age_20]. Therefore, students mentioned that they lacked the knowledge to write their opinion with ease. Constructing the main body of the text proved even more challenging especially when their ideas were unclear. These are obstacles that were referred to by students after the exam (see Figure 4.). In other words, to possess knowledge about the topic and to subsequently structure their associated ideas was a principal challenge for students. Other small percentages echoed the previously mentioned issues related to argument building, a lack of sufficient vocabulary, and difficulties in expressing own thoughts and ideas.

Figure 4. Reflections after the exam.

Class observations indicated that the wording of the essays were copied from various internet web-sites, although there were some students who employed paraphrasing skills, while others crafted their own sentences. Philosophical ideas were discussed during the class; however, these were rendered quite completed by the students.

Thus, the triangulation of reflections, survey and interview, observation results show that students, through reflecting on their writing experiences were able to identify the tasks that were both challenging and easy for them.

One of the major challenges was reading philosophical work, which was nonetheless in original English that had been adapted for students. Their age also impeded their comprehension of issues related to being, cognition, and globalization.

The second challenge related to their formulating their thoughts in a single sentence, in other words, to express a clear stance, be it either pro or con. Although many students stated that the introduction and conclusion were the easiest parts for them (29% and 29%), most of them (57%) mentioned argument building as the hardest task to complete.

The next difficulty is related to the fact that most students do not understand or realize the practical value of reflective writing in their future profession. This could explain their low motivation for this type of activity. On the other hand, the formed reflection skills provide one with an opportunity to form images, better understand the meaning of life according to them, and helps inform their actions. In fact, reflective writing provides an insight into the past and anticipation of the future. In many ways, it is the degree of development of a person’s ability to comprehend the world around them which allows them to find socially valuable, personally significant, and real ways of realizing themselves in their communications and active life.

In addition, it is worth noting the significant difficulty of students lacking argumentation skills. This indicates the lack of confidence on their part to clearly justify their position, and to give convincing arguments to be understood by their teacher.

As a result, students realized the need to read a lot of texts before the exam. This will help them to formulate an idea on to argue and to improve their vocabulary to explain their thoughts. This is more a strategic approach to reach the completion of the course. Nevertheless, these reflections guided them how to form their own learning strategies in future.

Discussion

The frame of this study could not encompass the core idea of reflective learning coined by Schön (1999). The reason for this was our students’ young age, the difficult philosophical treatises they were asked to work with, and their lack of abilities to view the learning process broadly. Students were provided with feedback during ten weeks by a faculty member, and for the remaining five weeks, peer-feedback was incorporated as in the literature, whereby a teacher’s support was highlighted (Fullana et al., 2016). This study has revealed that 57% of students referred to their weaknesses in argumentation, which confirms the points found in the study by Archer-Kuhn et al., (2020) about the development of critical thinking skills. Despite the intensity of the writing tasks assigned at the end of the course, students’ reflections showed that they simply described things that they had learned rather than to demonstrate a change in their attitude toward their learning: hence, this finding was consistent with the findings of Thelin (2020). To place this study within the frames developed by Hedberg (2009) and Yang (2015), in both cases, students remained at the first stage where, in order to find a solution to achieve a specific goal, they learned to reflect to their learning paths and abilities. Hence, to make this process truly reflective, they still need to go through the second and third stages in future.

Writing reflections have entailed many challenges among international students at a Medical University in Kazakhstan. At this particular stage, it was clear that they were limited in their ability to dig deep within their own reflections. They tried to follow the structure of the essay because they had been informed in advance about the written form of the final exam. They were also required to read philosophical works and reflect upon the content therein to further develop their own thoughts about it. This caused obstacles as they were sophomore students, and hence, yet unable to respond to the posed questions due to their unmatured stage of life. Observation of students during the peer-feedback stage showed that they provided objective and constructive suggestions. However, some of the students tended to be too lenient and praised their peers regardless of the necessary improvements that needed to be pointed out, while others expressed a more solid and substantial opinion.

Conclusion

To conclude, international students, while reflecting on their writing experiences and participating in class discussions, identified the segments of writing that they were both comfortable and uncomfortable with. In this regard, it was easier for them to write the introduction and conclusion to an essay because these are the short and clear parts of such work, whereas writing the main body required that they develop and convey their ideas in an argument, rendering the body more challenging to write. This implies that they yet remained at the early stage of reflection where they could identify their weaknesses; yet without mentioning some ways in which they should change their attitude towards their learning.

Hence, the experiences of the international students who took part in the study indicate that reflections did not take place per se, but were rather replaced by the students declaring what they had learned and had thus done differently from before.

The positive result emanating from this study is that students started to pay attention to their learning strategies. In short, further research could be conducted in this area to highlight the solid connection between reflection and the learning strategy that it represents.

Authors contribution

The authors made an equal contribution to the published work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

G.Y. Akhmetova

Akhmetova Guldana Yegeubayevna– PhD (Doctor of Philosophy in Education); ORCID 0000-0002-6768-6727; Medical University of Karaganda, Karaganda, Kazakhstan. E-mail: [email protected]

L.R. Khaliullina

Khaliullina Liliya Rinatovna – Senior Lecturer, Department of Pedagogy, Elabuga Institute, Kazan Federal University; ORCID 0000-0002-5955-4310; Elabuga, Russia. E-mail: [email protected]

Appendices Appendix

Discipline : Philosophy

Theme : Abay’s Legacy

Date : 18/10/2020

Submitted by : [name of a student]

Group : (2006)

Title : Abay’s Legacy to the philosophy of education, Author : Peter Shon.

According to this article main goal of Kazakhstan is to reform the education for the year 2050 and Kazakhstan includes in top 30 developed countries in world.After reading Abay’s legacy in education, I have two arguments first one is multi lingual education policy useful in every sector and second one is based on capacity of learning.

Multi lingual education is very useful in every sector because it makes communication easier. Abay’s legacy focused on trilingual education. It means give equal importance to all the three language like in Kazakhstan (Russian, Kazakh, English). for example English language (international language) It connect country to country for different purpose like education, business etc.Therefore, Different Languages is necessary in establishing and maintaining relationship with other country.

Secondly, To achieve our target we need to have a stronger ability to learning. So we can memorize quickly. Even in Abay’s legacy he had said that children’s have abilities and capacity to know everything in the world. They have eagerness to know about the new, old, history, geography, social and cultural and everything about the universe. Like A lawer may know everything about the laws and rules and regulations but he or she will still read the articles related to laws from different different countries just to gain more knowledge about their field. Therefore, it is necessary to have a capacity for learning new things in youth.

In last i conclude that, the multi lungual language education policy is very useful in every field and it will spread more in future Or youth have more power of learning or thinking So we can say that Children are blank paper to the world they have more capacity to gain and they have more responsibility for development of a country.

Appendix 2

Discipline- Philosophy

Theme-Meaning of life

Submitted by- [name of a student]

Group: 2006

Date-25 October 2020

The title of the article, Author - MAN’S SEARCH FOR MEANING, The meaning of life, DR. VIKTOR E. FRANKL, 1946.

After reading this article, I got to know that the meaning of life varies from person to person, thing to thing and it doesn’t depend upon one particular thing. So my views on the meaning of life are, first, by what you are in your life and secondly, by being with someone.

The real meaning of life can be known when you know what you are in your life. That means how we shape our lives. Frankl mentioned that when you can answer yourself for your mistakes you get the meaning of life. For example, A famous quote is there “you were born poor it is not your mistake but if you will die poor it is completely your fault”. So everyone has an aim in life but it depends on himself how we decorate our life. Thus, the meaning of life is reflected perfectly by our actions in our life.

By being with someone or loving someone can reflect the meaning of life. That means loving someone can make us do things that we originally Don’t want to do in our lives, but still, we tend to do it. The reason because the person whom we love, loves that. Even Frankl said that the meaning of life can be gained by being with someone. So, eventually, we start to realize what we like and dislike the things which we do for them. Thus, the actual meaning of life is reflected by being with someone.

To conclude, I would say that what we do, what we are, and with whom we are can gain the meaning of life. So, our actions and by being with someone can express the meaning of life.

Appendix 3

Department History of Kazakhstan

Course: Philosophy

Theme: Final Reflection

Date : 09/10.12.2020

Submitted by: [name of a student]

Group: 2006

Final Reflection

What kind of skills I have gained so far? If, NOT, then why I could not gain?

The skills that i have gained from writing the essays are that to how to write in the critical manner, how to write about in ethical manner, in advantage manner and how to write in agreement manner and how to make the argumentation more clearly and how to write in the word limit.

Where do I employ these skills? Or why are they not necessary for me?

These skills i can use in making my medical paper for conferences.

How the process of peer feedback went for you?

The feedback from the peer help me in viewing my essay’s Argument in different perspective. So it give me multiple ideas to write about one thing in different ways for making it more clearer and in more understandable manner.

After writing 15 weeks essay, describe your preparedness to final exam?

I’m Fully prepared for my final exam.

Where do you think you can use writing skills in future?

The writing skills will help me in my future as in my medical paper, will writing my thesis and library dissertation.

Anything you would like to share?

The knowledge i have gained from sessions will surely help me in bringing a good doctor. They have given me a different perspective on viewing the world.