An analysis of reflective writing early in the medical curriculum: The relationship between reflective capacity and academic achievement

Objective: To examine the relationship between reflection, gender, residency choice, word count, and academic achievement among medical students.Methods: A modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) was developed and used for this study (Cronbach's alpha of 0.86 with an intraclass correlation coefficient [ICC] of 0.68). This was applied to writing samples about professionalism in gross anatomy from first-year medical students between 2005 and 2011. Four analysts reviewed and scored written reflections independently. Composite reflection scores were compared with gender, residency choice, length of written reflection, NBME (R) Gross Anatomy and Embryology Subject Examination scores, and final gross anatomy course.Results: Total of 319 written reflections were evaluated. Female students who pursued medicine specialties had the highest composite reflection scores (87 [27.2%]). Word count frequently correlated with reflection score (p<0.0001). Students who performed well on the NBME (R) Gross Anatomy and Embryology Subject Examination tended to achieve high anatomy course grades (p<0.0001). There was no statistically significant relationship between composite reflection scores and NBME (R) Gross Anatomy and Embryology Subject Examination scores (p=0.16) or anatomy course grades (p=0.90).Conclusions: This study suggests there are likely no correlations between reflective capacity and academic performance on tests of medical knowledge administered early in the medical curriculum.