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Med Teach. 2019 Jan;41(1):3-16. doi: 10.1080/0142159X.2018.1505037. Epub 2019 Jan 11.

A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51.

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a Department of General Practice , RCSI , Dublin , Ireland.
b Health Professions Education Centre, RCSI , Dublin , Ireland.



Reflection is thought to be an essential skill for physicians. Although much has been written about it, there is little concurrence about how to best teach reflection in medical education. The aim of this review was to determine: (i) which educational interventions are being used to develop reflection, (ii) how is reflection being assessed, and (iii) what are the most effective interventions.


Inclusion criteria comprised: (i) undergraduate medical students, (ii) a teaching intervention to develop reflection, and (iii) assessment of the intervention. A review protocol was developed and nine databases were searched. Screening, data extraction, and analysis procedures were performed in duplicate. Due to the heterogeneity of studies, a narrative synthesis approach was performed for the study analysis.


Twenty-eight studies met the inclusion criteria. The interventions in these studies had at least of two of the following components related to reflection: (i) introduction, (ii) trigger, (iii) writing, (iv) guidelines, (v) small group discussion, (vi) tutor and (vii) feedback. Three validated rubrics were used to assess reflective writing in these studies.


The strongest evidence from studies in this review indicates that guidelines for, and feedback on, reflective writing improve student reflection.

[Indexed for MEDLINE]

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