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Table 6 Shortcomings of RW programs

From: A systematic scoping review of reflective writing in medical education

Shortcomings of RW programs

Elaboration

Problems found in implementation of RW curriculum

Anxiety with having their private thoughts being shared with others

 ° Preference for one-on-one sharing with tutors instead [129, 149, 209, 231]

 ° Censorship of thoughts and reflections when sharing with others [37, 114, 136, 149, 160, 183]

 ° Process of sharing could feel impersonal if sharing is done virtually [165]

May fail to cater to the different learning styles of users [220, 232]

 ° Query as to the extent that writing may be able to capture elements of the users’ reflective processes [118]

 ° Other modalities for reflection (e.g. blogging) might have greater appeal to users [120]

 ° RW too restrictive for more experienced users due to rigidity of suggested frameworks [142, 196]

Barriers to user participation

 ° Lack of time and fatigue [29, 119, 136, 138, 157, 161, 167,168,169, 176, 181, 193, 196, 226, 232, 233]

 ° Lack of self-direction and motivation [29, 79, 119, 176, 188, 226, 231]

 ° Difficulty dealing with negative emotions arising from reflecting on difficult events [114, 168, 176, 193, 230]

 ° Felt that RW was unnecessary as they were already adept at introspection [227]

Objectives were not clearly defined to users and assessors

 ° Greater clarity of goals of RW needed throughout course for users to understand importance of what they were doing [114, 129, 135, 138, 142, 209, 227]

 ° Greater emphasis to be placed on role of assessors for them to provide adequate feedback and mentorship for users [50, 138]

Factors affecting quality of reflection

Lack of confidentiality and trust resulting in censorship of genuine thoughts and reflections [37, 114, 136, 149, 169, 183, 196]

Lack of support and feedback from mentors [37, 119, 133, 196]

Problems relating to writing

 ° Language competencies affecting expression [167, 229]

 ° Learning to write in a new voice unlike academic writing [114, 136]

Decreased authenticity of reflections to meet expectations of graded curriculum [9, 115, 157, 161, 166, 193, 209, 234]

Did not take module seriously due to it being formatively assessed [114, 172, 182, 226]

Enforcing of daily reflections caused users to reflect on experiences that were insignificant [119, 235, 236]

Problems found with assessment of RW curriculum

Assessment distracts users from the essence of reflection

 ° Grading pressures users to write for approval [114, 115, 118, 129, 138, 143, 149, 155, 157, 209, 232, 237, 238]

 ° Assessment causes censorship of tension of ethical dilemmas or censorship of unconventional opinions [119, 209]

Faculty’s confusion with assessment of reflection

 ° Uncomfortable with idea of reflection due to lack of experience [115, 226]

 ° Inconsistent definitions of reflections [114, 133, 188, 237]

 ° Subjective nature of judging the content [237]

 ° Influence of writing ability [132, 174, 180, 183]

 ° Lack of confidence in correlating assessment grade with depth of reflection [29, 105, 118, 126, 177, 207]

Problems with rubrics

 ° Unclear rubric categories with overlaps between different levels [145]

 ° Difficulty maintaining a consistent high inter-rater variability [143, 239]

Possible problems with reflection in itself

Triggering of negative emotions which users are unable to escape

 ° Questioning what has always been instinctual knowledge or status quo might bring instead a sense of uncertainty which complicates decision-making [207, 240]

 ° Users might become overly critical of themselves [207, 241]

 ° Self-doubt [225]

Becoming negatively self-isolated

 ° Personal forms of critical reflection might have the unintended effect of users becoming too focused on themselves instead [207]

Could distract learners from spending time on technical skills or knowledge acquisition [207, 225]