From task-oriented to meaning-making: beyond assessment drives learning to promote medical student engagement in narrative reflection

Abstract

Reflective writing has been widely employed to teach and assess medical students’ reflective ability. However, challenges in assessing narrative reflection reduce students’ engagement, which further risks them becoming reflective zombies. This study aimed to explore student engagement processes in constructing reflective writing and how instructional design and assessment shape those engagement processes. We employed a qualitative descriptive approach and conducted three Focus Group Discussions (FGDs) involving 20 undergraduate medical students from year 2 (preclinical), year 4 (early clinical), and year 6 (late clinical). Participants were recruited through maximum variation sampling, and data were analyzed thematically. Our findings revealed how students’ perceptions of reflective writing assignments evolved across academic levels. Preclinical and early clinical students tended to view reflective writing primarily as an assignment to be completed, while late clinical students, drawing on more frequent exposure towards authentic clinical experiences, perceived it as an opportunity for personal and professional growth and engaged more deeply in the meaning-making process. Students further emphasized how their engagement in reflective writing was shaped by instructional design and assessment strategies. To maximize the impact of reflective writing, instructional design must transition from a reliance on explicit prompts and rubrics toward the integration of authentic experiential opportunities. A multi-layered framework highlighting longitudinal reinforcement across the curriculum, individual and group reflective dialogue, and adoption of creative methodologies would collectively transform reflective writing into a robust driver of personal and professional growth.