Using written text-based approach to promote reflection: does it work?

The article by Andrews (2014) enlightened me. The author’s vivid description of her attempts at using reflection with preclinical students was very real and illuminating. The students’ ability to follow Donald Schon’s three-step model of reflective practice was amazing. Yes, reflections need to be real – from real encounters with real people. The author identified ‘‘engagement’’ as the key element that provided the students with real experiences and they in return, responded with genuine reflections. I wish to share an example of using reflection where students had no direct access to real experience. Yet they felt connected and demonstrated engagement. In our new medical curriculum, Year 1 students were introduced to the concept of reflective writing. Literature on reflection in medical education revealed written text-based approaches do not appeal to the ‘‘net generation’’ of learners and suggested the creative use of multimedia for reflection. To strike a balance, three resources – HIV/AIDS, organ donation, dengue (in Malaysia) were uploaded and resource links were provided. As a formative assessment, students had to login to access the online resources, selected one of the resource and wrote a short reflective essay about it. General guidelines were provided. Several questions that could prompt reflection were given. All the 179 students submitted the essays online. Although not all the essays fit the description of a structured, thoughtful piece of academic writing that displayed reflective ability and cultural sensitivity, students’ engagement with the resources were evident. Students responded with much thought and insights, and reacted with strong emotions. Phrases like ‘‘I was totally amazed/deeply disappointed’’, ‘‘It worried me’’, appeared repeatedly throughout their essays. Some students had even gone through the three phases of reflection: noticing, processing and future action. Excerpts from an essay to illustrate: ‘‘. . . this is what I never think about before . . .’’ (noticing); ‘‘. . . do you ever think of donating your organs?’’ (processing); ‘‘. . . our decisions to become organ donors which my parents and I are now’’ (future action). Although real experience is desirable, online written textbased resources can promote reflection, perhaps particularly so if assessment-related. Through guided reflection and a structured approach, pre-clinical students can learn to reflect.