Medical students' experiences and needs from written reflective journal feedback

Abstract

Introduction Reflective ability is an important skill for enhancing professionalism and developing communication skills. To improve reflective ability, medical educators encourage use of written reflective journals, for which feedback is important. It is difficult for educators to anticipate how their feedback will be perceived. Therefore, this study examined students' experiences with educators' written feedback on reflective journals. Methods A qualitative, immersion/crystallization analysis of 60 written feedback texts to 15 medical students (30 identified by students as meaningful and 30 as less meaningful) and in‐depth semi‐structured interviews with these students. We did not define ‘meaningful’, to leave room for students' own interpretations. We analysed the feedback to identify what it includes (its components) and analysed the interviews to learn about students' experiences of receiving the feedback and the specific components. Results Students experienced five components as meaningful: supportive and encouraging statements; legitimisation of their emotions; educators sharing personal‐professional experiences; asking questions to enhance reflection; and focusing on the students' main concern. These components enhanced students' willingness to read and learn from the feedback. Three components were experienced as less meaningful: detached, impersonal feedback; negative tone (criticism); and technical issues, for example brevity. These disappointing and hurtful components led students to pay less attention to the feedback or to invest less effort in future written assignments. Conclusions The present study identified components in written reflective journal feedback texts and the experience and needs of students who received them. It showed the complexity of writing reflective feedback because of the need to support students through it, help them deal with emotions, identify and focus on personal content that matters to them, and provide opportunities to develop and enhance their reflective ability, while being mindful of their emotional state. To help educators in this challenging task, a self‐assessment mnemonic (‘FEEDBACK’) for use before sending the initial feedback was developed.

A systematic scoping review of reflective writing in medical education

“…These will be termed the ‘physician's reactions’ . The design of the RW program ought to consider the following factors: Belief system Narratives Recognising that the physician’s notion of ‘ sensitivity’, ‘judgement’, ‘willingness’, ‘balance’, ‘ability’ and ‘responsiveness’ is influenced by their experience, skills, knowledge, attitude and motivations, physicians recruited to the RW program should be carefully evaluated To align expectations, the physician should be introduced to the benefits and role of RW in their personal and professional development The ethos, frequency, goals and format of the reflection and assessment methods should be clearly articulated to the physician [ 253 ] The physician should be provided with the knowledge, skills and mentoring support necessary to meet expectations [ 76 , 79 , 105 , 123 , 124 , 254 , 255 ] Training and support must also be personalised Contextual considerations Recognising that the physician’s academic, personal, research, administrative, clinical, professional, sociocultural and practice context will change, the structure, approach, assessment and support provided must be flexible and responsive The communications platform should be easily accessible and robust to attend to the individual needs of the physician in a timely and appropriate manner The program must support diversity [ 207 ] Environment The reflective relationship is shaped by the culture and structure of the environment in which the program is hosted in The RW programs must be hosted within a formal structured curriculum, supported and overseen by a host organisation which is able to integrate the program into regnant educational and assessment processes [ 9 , 115 , 219 , 220 , 230 , 233 , 242 , 246 ] Reflective relationship The faculty must be trained and provided access to counselling, mindfulness meditation and stress management programs [ 249 ] The faculty must support the development of the physician’s metacognitive skills [ 256 – 259 ], and should create a platform that facilitates community-centered learn...…”

“…Reflective relationship The faculty must be trained and provided access to counselling, mindfulness meditation and stress management programs [ 249 ] The faculty must support the development of the physician’s metacognitive skills [ 256 – 259 ], and should create a platform that facilitates community-centered learning [ 173 , 176 ], structured, timely, personalised open feedback [ 119 , 135 , 179 , 237 ] and support [ 128 , 131 , 138 , 196 , 199 , 231 , 249 ] The faculty must be responsive to changes and provide appropriate personal, educational and professional support and adaptations to the assessment process when required [ 207 ] To facilitate the development of effective reflective relationships, a consistent faculty member should work with the physician and build a longitudinal trusting, open and supportive reflective relationship …”

“…The faculty must support the development of the physician’s metacognitive skills [ 256 – 259 ], and should create a platform that facilitates community-centered learning [ 173 , 176 ], structured, timely, personalised open feedback [ 119 , 135 , 179 , 237 ] and support [ 128 , 131 , 138 , 196 , 199 , 231 , 249 ]…”

Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review

“…The exercise might involve traps to allow learners to detect their own errors. This exercise is performed individually, for example, in a reflective journal where professionals might write down reflections on their practice such as all the events (positive or negative) experienced, what these events meant for them, and what they learned from these experiences [ 29 ]. They may then reflect on how such experiences could help them in similar future circumstances.…”

Impact of combining human and analytics feedback on students’ engagement with, and performance in, reflective writing tasks

“…Yet, research on reflective writing has so far mainly focused on teachers' written feedback that emphasises cognitive development and content acquisition (Aronson et al, 2012;Thorpe, 2004), frequently overlooking other factors that also contribute to an improvement in learning, such as students' emotions, motivations and behaviours. The quality and meaningful feedback elements suggested for reflective writing tasks at the motivational and behavioural levels (Aronson et al, 2012;Dekker et al, 2013) as well as reactions to the tone of feedback (Dekker et al, 2013;Rozental et al, 2021) are understudied.…”