Reflection Fatigue Among Medical Students

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Excerpt

Reflective practice in medical education can take several forms, including in-class discussions, written essays, and creative activities, such as painting or drawing.1 In my first two years at the Vanderbilt University School of Medicine (VUSM), I completed at least 36 reflective assignments. These included essays on leadership, learning, clinical sessions, ethical situations, personal and professional failures, and the social determinants of health. As an undergraduate English major and strong proponent of the role of the humanities in medicine, I recognize the importance of reflection to professional growth. Indeed, I would argue that the skills strengthened by reflection—self-awareness, empathy, and emotional intelligence—are among the most valuable traits for future physicians, and I applaud my school’s efforts to promote these values.
That said, I have noticed a growing sense of “reflection fatigue” in my classmates. Instead of viewing reflection as key to our development as humanistic physicians, many of us have come to consider reflective essays as another “box to check” or, worse, as “busywork.” The sheer number of assignments, along with the repetition of themes, has caused many to view reflections with cynicism.
Clearly, we should not return to an era in medical education in which students had neither the time nor the institutional support for reflection. But medical schools must also be aware of reflection fatigue. As a member of VUSM’s student curriculum committee, I know that our administration is trying to improve the quality of reflective practice in our curriculum. In light of ongoing changes to undergraduate medical education, I would like to offer three suggestions for improved reflection.
First, school administrators should review their longitudinal, clinical, and ethical courses to ensure that reflective assignments are neither duplicative nor excessive. Reducing the quantity of assignments, while increasing their quality, both enhances the student experience and decreases faculty workload. Second, faculty should respond to reflective assignments with feedback that engages and challenges students.1 Students are naturally more engaged when a mentor responds to their thoughts, particularly if the student’s essay concerns sensitive personal issues.2,3 Third, faculty and administrators should remember that reflection is personalized.2,3 Written assignments are only one form of processing knowledge about oneself and situations; discussion groups, one- on-one mentoring sessions, and artwork are other forms of reflection.
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