Use of reflection in medical education

Physicians deal with complex and ill-structured problems and must reflect in order to function professionally while adapting to their patients’ needs. This qualitative single case study explores the meaning and use of reflection in the professional preparation of physicians within the medical school of a Midwestern University. Along with a review of the types of reflection assessed (Aukes et al., 2007) and an analysis of Epstein’s (1999) Levels of Mindfulness in guided student reflections, faculty and administrators were interviewed to learn more about their perspectives related to reflection. Assessing reflection in medical education is complicated by a lack of agreement about definitions and goals. Although scientific reflection and clinical reflection are more heavily assessed in written evaluations, faculty tended to discuss personal reflection (learning from experience) more during interviews. Most interviewees focused on one aspect of the phases of reflection (trigger, critical analysis, or outcome) rather than the entire process. Some were particularly uncomfortable with the idea of assessing an internal process. The use of Epstein’s (1999) Level of Mindfulness was useful in assessing quality and focus of students’ written narratives, however the levels do not work well as a continuum for this purpose and proved to be too broad to detect more subtle shifts in thinking across time. In addition, encouraging students to tell stories seems to stimulate deeper reflection. Using common definitions can help facilitate meaningful opportunities for reflection into the curriculum.