CRITICAL REFLECTION IN PRE-CLERKSHIP MEDICAL EDUCATION: AN EXPERIMENTAL STUDY

Abstract

Abstract Aims: This study aims to (1) teach skills for critical reflection to first-year medical students at the University of Arizona College of Medicine-Tucson (UACOM-T), (2) measure pre-clerkship critical reflection, and (3) identify messaging encouraging medical students to engage in critical reflection as a strategy for advancing self-directed learning (SDL) skills. Background: SDL is a core expectation of medical education. Critical reflection, a pivotal skill within the science of SDL appears to be rarely taught explicitly, particularly in pre- clerkship curricula. Study Design: Experimental, modified true control posttest-only. Methods: In this experimental study, participants were randomized. The experimental group (A) received the UCSF Learning from your Experiences as a Professional (LEaP) guide followed by a reflection prompt and a single-question survey inquiring if they read the LEaP guide. Control group (B) received the definition of critical reflection followed by the reflection prompt, and then had access to review the LEaP Guide. The control group was also asked the single survey question. Medical knowledge scores (multiple choice quizzes and exams) were collected for current and previous curricular blocks. Results: Mean (+/- standard deviation (SD)) reflection scores for Groups A and B were 1.3 (+/- 1.2) and 1.2 (+/- 1.2), respectively. Mean (+/- SD) medical knowledge scores for ii Cardiology, Renal, and Pulmonology (CPR) block were 82.7 (+/- 11.4) for Group A and 80.1 (+/- 11.3) for Group B quizzes, and 86.0 (+/- 2.3) Group A and 86.2 (+/- 1.0) for Group B exams. The average Digestion, Metabolism, and Hormones (DMH) block quiz scores (+/- SD) were 81.4 (+/- 1.0) for Group A and 81.0 (+/- 4.6) for Group B, and average exam scores (+/- SD) were 80.1(+/- 9.6) Group A and 78.6 (+/- 9.7) for Group B. These differences between groups were not significant. Discussion: This study did not find significant differences in reflective ability between groups, or correlation with medical knowledge outcomes. The study did find fewer students in the experimental group read the LEaP guide than in the control group. There were limitations to the study including success of messaging to encourage engagement in developing SDL skills. Future directions may include qualitative approach to deepen understanding of students’ perspectives regarding participation in medical education research and advancing SDL.