Background
Little evidence exists to support the value of reflection in the clinical setting.
Objective
To determine whether reflecting and revisiting the “patient” during a standardized patient (SP) examination improves junior medical students’ performance and to analyze students’ perceptions of its value.
Design
Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists.
Participants
One hundred and forty-nine third year medical students.
Measurements
Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases.
Results
On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated “reflect–revisit” positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism.
Conclusions
Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect–revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence.
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Acknowledgments
The authors gratefully acknowledge Karen Richardson-Nassif, PhD, and Richard Riegelman, MD, PhD for reviewing this manuscript and making valuable suggestions. They also wish to thank Afifa Kouj, PhD for her biostatistical contribution and Laura Abate, MA for her library research. Finally, the authors wish to acknowledge the generous support of The George Washington University Clinical Learning and Simulation Skills (CLASS) Center.
Potential Financial Conflicts of Interest
None disclosed.
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Blatt, B., Plack, M., Maring, J. et al. Acting on Reflection: the Effect of Reflection on Students’ Clinical Performance on a Standardized Patient Examination. J GEN INTERN MED 22, 49–54 (2007). https://doi.org/10.1007/s11606-007-0110-y
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DOI: https://doi.org/10.1007/s11606-007-0110-y