Fostering reflective capacity with interactive reflective writing in medical education: Using formal analytic frameworks to guide formative feedback to students’ reflective writing

Dear Sir

As learner (GWA) and educator (HSW) engaging in interactive reflective writing (IRW) for fostering reflective capacity (RC), we read Song & Stewart's “Reflective writing (RW) in medical education” (2012) with interest. We concur with teaching reflection (with IRW) as a “clinically relevant skill” for “medical and humanistic effectiveness”. We however note negative references to student perceptions of RW and to rubrics applied to “reflectiveness of student writing” which “would likely confer a significant burden of time and energy on faculty”. In this regard, we express concern with their omitting salient developments within RW curricula potentially contributing to “buy-in” for such pedagogy (learners/faculty). These include user-friendly formal analytic frameworks (Wald et al, 2010, Reis et al, 2010, Wald et al, 2012) for feedback consistency/effectiveness, i.e. guiding faculty in crafting quality individualized written feedback to RW (hence “IRW”) fostering RC, “priming” participants with student/faculty IRW manuals, and training facilitators for effective small group collaborative feedback to narratives – all geared toward promoting a more in-depth reflective process. Feedback from interprofessional faculty development workshops I (HSW) have conducted on formative feedback to RW using a “cognitive schema” of such frameworks as well as from learners on formative feedback to RW has been positive. Quality formative feedback to learners’ RW can guide “thinking about thinking” rather than the authors’ concern regarding “to try to manage and prescribe the way students think”.

From a personal perspective (GWA), reflecting upon clinical experience with RW (about successful smoking cessation patient counseling over multiple medical visits) served as a nidus for a broader shift in my perspective on personal/professional satisfaction as a medical professional. Through RW, I realized I was beginning to draw satisfaction from patient interactions instead of purely from successful medical treatment/patient outcomes. The act of RW, its use as springboard to collaborative peer reflection in small group (facilitated with personalized feedback – HSW) and gaining further insights through written feedback helped me explore my response to this clinical encounter, challenge preconceptions, and appreciate the value of adding peer perspectives to my own reflective process, skills I plan on utilizing in the future. IRW exercises reinforced my belief in the value of self-reflection in medical practice.

Educators and learners are challenged to foster using a reflective skills “toolkit” with technical skills for reflective professionalism within clinical encounters (in clerkships and beyond) for competent and compassionate patient-centered health care. Effective implementation of IRW as a vehicle for fostering RC through evaluation/interpretation of clinical experience, we assert, can help meet this challenge.