2013; 35: 258–262

Letter to the editor

Fostering reflective capacity

with interactive reflective

writing in medical education:

Using formal analytic

frameworks to guide

formative feedback to

students’ reflective writing

Dear Sir

As learner (GWA) and educator (HSW) engaging in interactive

reflective writing (IRW) for fostering reflective capacity (RC),

we read Song & Stewart’s ‘‘Reflective writing (RW) in medical

education’’ (2012) with interest. We concur with teaching

reflection (with IRW) as a ‘‘clinically relevant skill’’ for ‘‘medical

and humanistic effectiveness’’. We however note negative

references to student perceptions of RW and to rubrics applied

to ‘‘reflectiveness of student writing’’ which ‘‘would likely

confer a significant burden of time and energy on faculty’’. In

this regard, we express concern with their omitting salient

developments within RW curricula potentially contributing to

‘‘buy-in’’ for such pedagogy (learners/faculty). These include

user-friendly formal analytic frameworks (Wald et al, 2010,

Reis et al, 2010, Wald et al, 2012) for feedback consistency/

effectiveness, i.e. guiding faculty in crafting quality individua-

lized written feedback to RW (hence ‘‘IRW’’) fostering RC,

‘‘priming’’ participants with student/faculty IRW manuals, and

training facilitators for effective small group collaborative

feedback to narratives – all geared toward promoting a more

in-depth reflective process. Feedback from interprofessional

faculty development workshops I (HSW) have conducted on

formative feedback to RW using a ‘‘cognitive schema’’ of such

frameworks as well as from learners on formative feedback to

RW has been positive. Quality formative feedback to learners’

RW can guide ‘‘thinking about thinking’’ rather than the

authors’ concern regarding ‘‘to try to manage and prescribe the

way students think’’.

From a personal perspective (GWA), reflecting upon

clinical experience with RW (about successful smoking

cessation patient counseling over multiple medical visits)

served as a nidus for a broader shift in my perspective on

personal/professional satisfaction as a medical professional.

Through RW, I realized I was beginning to draw satisfaction

from patient interactions instead of purely from successful

medical treatment/patient outcomes. The act of RW, its use as

springboard to collaborative peer reflection in small group

(facilitated with personalized feedback – HSW) and gaining

further insights through written feedback helped me explore

my response to this clinical encounter, challenge preconcep-

tions, and appreciate the value of adding peer perspectives to

my own reflective process, skills I plan on utilizing in the

future. IRW exercises reinforced my belief in the value of self-

reflection in medical practice.

Educators and learners are challenged to foster using a

reflective skills ‘‘toolkit’’ with technical skills for reflective

professionalism within clinical encounters (in clerkships and

beyond) for competent and compassionate patient-centered

health care. Effective implementation of IRW as a vehicle for

fostering RC through evaluation/interpretation of clinical

experience, we assert, can help meet this challenge.

Grayson W. Armstrong and Hedy S. Wald, PhD, Alpert Medical

School of Brown University, Providence, RI, USA. E-mail:

hedy_wald@brown.edu

References

Wald HS, Reis SP, Monroe AD, Borkan JM. 2010. ‘‘The Loss of My Elderly

Patient’’: Interactive reflective writing to support medical students’ rites

of passage. Med Teach 32(4):e178–e184.

Reis SP, Wald HS, Monroe AD, Borkan JM. Begin the BEGAN (The Brown

Educational Guide to the Analysis of Narrative): a framework for

enhancing educational impact of faculty feedback to students’ reflective

writing. Pt Educ Counsel. 2010; 80(2): 253–9.

Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP. 2012. Fostering and

evaluating reflective capacity in medical education: Developing the

REFLECT rubric for assessing reflective writing. Acad Med 87(1):41–50.

A broader basis for teaching

reflection

Dear Sir

Reflection is an important component of medical student

education that broadens students’ understanding of patient

experiences and facilitates cultural competency. As an exercise

in medical education, many students chafe at the confines of

258 ISSN 0142–159X print/ISSN 1466–187X online/13/30258–5 � 2013 Informa UK Ltd.

DOI: 10.3109/0142159X.2013.759646

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