Do medical students value clinical reflection? A mixed methodology study

Dear Sir

Reflective practice is an important part of many healthcare curricula. However, the majority of the research carried out has focused on the difficulties of assessing levels of reflection in students, or on views of faculty (Stewart & Richardson 2000). There has been limited research on the views of the students.

Reflective practice was introduced to our medical curriculum in 2010/2011. The third-year students were asked to record clinical reflections as part of a logbook. In order to assess their views on reflection, we developed a questionnaire containing both qualitative and quantitative questions. The quantitative data consisted of 5- and 4-point Likert scales. The questionnaire was divided into four parts; demographic data, value of reflection to those who had reflected, why reflection might not take place and feelings towards formally recording clinical reflections. Ethical approval was obtained. The questionnaire was distributed after a lecture. Data were analysed using Excel 2007 and qualitative data was analysed using a Grounded Theory approach.

About 75.16% of the cohort returned a completed questionnaire (111 students). Quantitative analysis demonstrated that many of the students value personal reflection (48.65% answered agree and strongly agree) and find it useful (72.97%) in their professional development. The qualitative analysis revealed a preference for informal small group discussions as opposed to a formal written assessment. It was felt that a small group discussion would facilitate feedback and allow the students to learn from each others’ experiences. There was a small group of students who were opposed to the idea of compulsory reflection, feeling that it used up study time. This was demonstrated in both the quantitative and qualitative analyses. However, students in this group were in favour of small group discussions to help deal with difficult or traumatic events. Many of the students commented on the usefulness of reflection when learning new techniques or procedures, as well as helping them to see other peoples viewpoints.

Our conclusions are that medical students value reflection and find it useful. However, a written assessment may not be the best way to facilitate it, with many students expressing a preference for small group tutorials.

S. Fagan, J. Trayer, M. Phillips, A. Patterson, School of Medicine, Trinity College, Dublin, Ireland. Email: [email protected]