Reflection and reflective writing have become familiar terms and practices with a goal of instilling, and perhaps increasing, empathetic interactions with patients and to also improve communication skills with both patients and colleagues (8). Generally, trainees are asked to reflect on an experience. This conceptual framework of using experience as a core learning tool began with John Dewey, who states “reconstruction or reorganization of experience” is the very heart of education (9). His theory on experience is expanded on by Carl Rogers (1), who states: “An experience is not an experience unless it involves interaction between self and another person and/or the larger environment.” For our learners’ place in the medical environment as their larger world, this experience can be a patient interaction, an ethical issue, a short story, or an interaction with a colleague. Wear (8) argues that the use of reflection in medical education requires more thoughtfulness and precision. She proposes that reflection not be approached as a singular event nor as a nebulous method but be part of a larger ongoing process in the education of physicians in the medical environment.

Wear (8) focuses on important questions to ask as we think about preparing reflective practice strategies in our education environment.

Moon (10) identifies four key elements of reflection to assure medical educators are asking learners to truly reflect:

Ultimately, this transformative action will result in a deepened commitment and renewed desire to continue investigating an experience. Transformative action, using reflective practice, recognizes the need for action, risk-taking, and doing things differently next time by re-forming decisions and actions. This type of action moves the act of reflective practice from a solitary act to one involving a community of others.

At the most basic level, writing of an experience enables the writer to perceive and undergo the experience. Reading and writing can be used to accelerate and deepen the clinical lessons learned in the shared work of providing health care. Early visionaries in the field of reflective writing, including Rita Charon, suggested that incorporating singular stories of patients and doctors into one’s medical education and practice might aid doctors in recognizing patients’ lived experiences and might support doctors’ awareness of the meaning of their own experiences (11). This greater understanding among health care providers could possibly improve the effectiveness of health care (12). The teaching and learning of reflection is to equip learners with the language skills to represent and recognize complex events. Learners learn to read while they practice writing. For example sessions may begin with a close reading of selected literature. This is accomplished in small groups, and there is opportunity to read and listen to others with the goal of multiple interpretations of the writing. A requirement is nonjudgmental listening. In this model of close reading and reflective writing, the teacher is not to judge but rather read and tell what is heard. This reflective process aligns with the mission of medical education in teamwork, peer learning, trust building, and caring for others.

It is common to use personal narratives as starting points for collective reflection. Space is created to tell and write about one’s experiences. Sharing of the stories among peers creates a common ground: shared core values of kindness, human connection, and commitment to social justice. In addition, fears, frustrations, and shame are shared. These stories have the power to show learners the future they are trying to create, name their core values, and identify threats to these core values (13).

A larger question addressed by Mann (15) goes beyond our understanding of reflection as a tool to deepen learning, to how and when the act of reflection might influence professional practice and benefit patients. Here is an education and research effort to theorize how the use of reflection can improve diagnostic accuracy and minimize error. Another area of research investigates how mindfulness impacts knowing when problems require a new approach to prevent errors (16). This certainly requires self-assessment and self-monitoring skills to identify the need for reflective analytical reasoning, which allows reframing of a challenging problem. Mamede et al. (17) report that reflection was associated with increased accuracy of diagnoses in challenging complex cases, but was not additive in common cases.

One way to understand the influence of house staff training is through narrative accounts of their experiences (18). The narratives generated by young learners and physicians in training provide an understanding of the interplay among resident interactions with patients, their own personal issues, and the struggles during the stages of professional development. The authors suggest that to gain self-awareness through writing narratives, reflective writing should be incorporated into curricula time in training programs. Equally as important, the faculty facilitators must have advanced facilitation skills and be self-aware through their own reflective process. The goal is an educational model that encourages being reflective so that a trainee can understand how one’s experiences influence learning and professional development. This can only naturally lead to graduating physicians who are more compassionate and fully developed to practice medicine.

There is growing evidence that reflection improves learning and performance in essential competencies. These competencies include professionalism, clinical reasoning, continuous practice improvement skills, and better management of complex health systems and patients. There are diverse pedagogical approaches and educational goals when planning curriculum to foster reflective learning and practice (7).

Aronson (7) describes 12 tips for teaching reflection. Elaboration of these tips can be found in her article and guide both learner and faculty development efforts, which will support successful experiences.