Effects of deliberate reflection on students’ engagement in learning and learning outcomes

Abstract

Context Reflection in practice is assumed to enhance interest in knowing more about a topic, increasing engagement in learning and learning outcomes. However, this claim lacks empirical evidence, particularly in medical education. The authors investigated the effects of deliberate reflection upon clinical cases on medical students’ engagement in a learning activity and learning outcomes. Methods A three‐task (diagnostic task; learning activity; test) experiment was conducted in August 2017. Seventy‐two fourth‐year students from UNIFENAS‐BH Medical School, Brazil, diagnosed two clinical cases with jaundice as the chief complaint, either by following a deliberate reflection procedure or making differential diagnosis. Subsequently, all participants received the same study material on the diagnosis of jaundice. Finally, they took a recall test on the study material. Outcome measurements were study time and test scores. Results There was a significant effect of experimental condition on students’ engagement in the learning activity and on learning outcomes. Students who deliberately reflected upon the cases invested more time in studying the material than those who made a differential diagnosis (respectively, mean = 254.97, standard deviation = 115.45 versus mean = 194.96, standard deviation = 111.68; p = 0.02; d = 0.53). Deliberate reflection was also related to higher scores in the test relative to differential diagnosis (respectively, mean = 22.08, standard deviation = 14.94 versus mean = 15.75, standard deviation = 9.24; p = 0.03; d = 0.51). Medium effect sizes (Cohen's d) were observed in both measurements. Conclusions Relative to making differential diagnosis, deliberate reflection while diagnosing cases fostered medical students’ engagement in learning and increased learning outcomes. Teachers can employ this relatively easy procedure, possibly both with simulated and real scenarios, to motivate their students and help them expand their knowledge, an important requirement for their professional development.

Exploring mechanisms underlying learning from deliberate reflection: An experimental study

“…The experiment showed deliberate reflection to foster students’ SI relative to giving differential diagnosis, but did not evaluate whether students actually engaged in more learning activities related to the cases. A follow‐up experiment showed that, relative to differential diagnosis, deliberate reflection fostered engagement with a subsequently studied relevant text (as measured by the amount of time spent processing that text) and higher cued recall from this text 5 . These findings suggest that deliberate reflection is an effective learning tool able to foster engagement in learning activities and, ultimately, learning.…”

“…Besides being helpful in professional practice, however, reflection is also considered important as a learning tool. It is expected to foster students’ engagement in learning activities, 2,3 and there is some empirical evidence that reflecting upon to‐be‐diagnosed clinical cases can foster medical students’ learning from subsequent study activities relevant to those cases 4,5 . However, this evidence is still preliminary and the mechanisms that underlie such potential positive effects of reflection are not yet understood.…”

“…The aforementioned studies on the effects of reflection on students’ learning 4,5 employed the ‘deliberate reflection procedure’, originally developed as a tool to improve physicians’ performance 6 . The procedure involves reasoning through clinical problems by generating a tentative diagnostic hypothesis, confronting this hypothesis with the patient's clinical findings, considering alternative explanations for the problem, and arguing for and against each emerging explanation before making a final decision.…”

“…Ribeiro et al 4,5 used the same deliberate reflection procedure in two experiments with medical students, exploring the effects of reflection on learning of new material (as opposed to refinement of previously learned knowledge). Specifically, they studied the potential of reflection to foster students’ engagement with, and learning from, a text that provided detailed explanations about the cases.…”

How to enhance and assess reflection in specialist training: a mixed method validation study of a new tool for global assessment of reflection ability

“…An ability to reflect is not only necessary for efficient use of feedback in medical education [ 10 ], it is also essential for clinical practice, and it has been argued that the ability to reflect on one’s own role and performance is a key factor in reliable self-assessment and expertise development [ 11 ]. It therefore seems logical to teach and assess reflection in specialist training [ 12 , 13 ].…”