Attention without intention: explicit processing and implicit goal-setting in family medicine residents’ written reflections

Abstract

Background: Reflection, a process of self-analysis to promote learning through better understanding of one’s experiences, is often used to assess learners’ metacognitive ability. However, writing reflective exercises, not submitted for assessment, may allow learners to explore their experiences and indicate learning and professional growth without explicitly connecting to intentional sense-making. Aim: To identify core components of learning about medicine or medical education from family medicine residents’ written reflections. Design and setting: Family medicine residents’ wrote reflections about their experiences throughout an academic year. Method: Qualitative thematic analysis to identify core components in 767 reflections written by 33 residents. Results: We identified four themes of learning: ‘Elaborated reporting’ and ‘metacognitive monitoring’ represent explicit, purposeful self-analysis that typically would be characterised as reflective learning about medicine. ‘Simple reporting’ and ‘goal setting’ signal an analysis of experience that indicates learning and professional growth but that is overlooked as a component of learning. Conclusion: Identified themes elucidate the explicit and implicit forms of written reflection as sense-making and learning. An expanded theoretical understanding of reflection as inclusive of conscious sense-making as well as implicit discovery better enables the art of physician self-development.

Keywords:

• Learning
• mental processes
• thinking
• models
• psychological
• self-assessment
• writing

Acknowledgement

The authors wish to recognise the efforts of Jessica Early, MD, and Randi G. Sokol, MD, MPH, MMedEd for their work with broad conceptualisation connected to this project. The authors also thank Katherine Donahue, who was a student research assistant on this project.