Reflecting on Reflections: Enhancement of Medical Education Curriculum With Structured Field Notes and Guided Feedback
Abstract
The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format. Students generated multiple e-mail field notes in response to structured questions on course topics. Individualized feedback from a physician-behavioral scientist dyad supported the students' reflective process by fostering critical-thinking skills, highlighting appreciation of the affective domain, and providing concrete recommendations. The development and implementation of this innovation are presented, as is an analysis of the written evaluative comments of students taking the Doctoring course. Theoretical and clinical rationales for features of the innovation and supporting evidence of their effectiveness are presented. Qualitative analyses of students' evaluations yielded four themes of beneficial contributions to their learning experience: promoting deeper and more purposeful reflection, the value of (interdisciplinary) feedback, the enhancement of group process, and personal and professional development. Evaluation of the innovation was the fifth theme; some limitations are described, and suggestions for improvement are provided. Issues of the quality of the educational paradigm, generalizability, and sustainability are addressed.
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To achieve CBME outcomes, residents must develop deliberate reflective practice skills, which are necessary for critical thinking, professionalism, and continuous professional development.
“To achieve CBME outcomes, residents must develop deliberate reflective practice skills, which are necessary for critical thinking, professionalism, and continuous professional development [5–8].”
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- Authors
- Wald, H. S., Davis, S. W., Reis, S. P., Monroe, A. D., & Borkan, J. M.
- Affiliations
- Brown University (US)
- Corresponding author
- Wald, Hedy S.
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-07
- Volume
- 84
- Issue
- 7
- Pages
- 830-837
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W2064251880
- Cited by
- 174
- References
- 33
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 7 · 2023: 12 · 2022: 3 · 2021: 12 · 2020: 8 · 2019: 13 · 2018: 6 · 2017: 9 · 2016: 11 · 2015: 18 · 2014: 8 · 2013: 10 · 2012: 16
- FWCI
- 13.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Brown University
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Education › Reflective Practices in Education
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Keywords
- reflective practice, reflective writing, field notes, instructor feedback, medical curriculum, clinical skills training, teacher professionalism, preclinical medical students, small group learning, affective domain, critical thinking, student assessment, curriculum evaluation
- MeSH terms
- Attitude of Health Personnel, Behavioral Medicine, Clinical Competence, Curriculum, Education, Medical, Faculty, Medical, Feedback, Humans, Physician's Role, Thinking, United States, Writing, Interdisciplinary Communication
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