Added value of assessing medical students’ reflective writings in communication skills training: a longitudinal study in four academic centres

Abstract

ObjectivesThis study describes the development and implementation of a model to assess students’ communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students’ reflections in the assessment of communication skills.DesignThird-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods.Setting and participantsThe communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students.Outcome measuresThe students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach’s alpha, dimensionality and the person’s correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections’ depth, and the Thematic Score (TS) to map and grade reflections’ themes.ResultsThe Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE.ConclusionsAssessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods—possibly a metacognitive domain.

A systematic scoping review of reflective writing in medical education

“…The benefits of RW are rarely described in detail and may be divided into personal and professional benefits as summarised in Table 5 for ease of review. From a professional perspective, RW improves learning [ 96 , 112 , 119 , 147 , 157 , 170 , 179 , 185 – 192 ], facilitates continuing medical education [ 119 , 128 , 173 , 174 , 193 – 195 ], inculcates moral, ethical, professional and social standards and expectations [ 118 , 156 , 160 ], improves patient care [ 29 , 120 , 129 , 131 , 135 , 142 , 194 , 196 – 199 ] and nurtures PIF [ 150 , 157 , 172 , 191 , 200 ].…”

“…° To be more aware of patient autonomy and respecting each individual’s wishes [ 118 , 129 , 131 , 228 ]…”

“…From a personal perspective, RW increases self-awareness [ 114 , 127 , 137 , 161 , 166 , 179 , 185 , 202 , 216 ], self-advancement [ 9 , 131 , 134 , 150 , 168 , 174 , 195 , 205 , 217 , 229 ], facilitates understanding of individual strengths, weaknesses and learning needs [ 112 , 119 , 150 , 152 , 170 , 218 , 219 ], promotes a culture of self-monitoring, self-improvement [ 130 , 172 , 173 , 185 , 193 , 198 , 201 , 210 , 211 ], developing critical perspectives of self [ 193 , 223 ] and nurtures resilience and better coping [ 154 , 160 , 206 ]. RW also guides shifts in thinking and perspectives [ 148 , 149 , 156 , 203 , 207 , 208 ] and focuses on a more holistic appreciation of decision-making [ 37 , 118 , 126 , 174 , 177 , 194 , 196 , 199 , 200 , 224 – 226 ] and their ramifications [ 37 , 112 , 116 , 130 , 13...…”

“…° Query as to the extent that writing may be able to capture elements of the users’ reflective processes [ 118 ]…”

“…° Grading pressures users to write for approval [ 114 , 115 , 118 , 129 , 138 , 143 , 149 , 155 , 157 , 209 , 232 , 237 , 238 ]…”