Tracking reflective practice-based learning by medical students during an ambulatory clerkship

OBJECTIVE: To explore the use of web and palm digital assistant (PDA)-based patient logs to facilitate reflective learning in an ambulatory medicine clerkship. DESIGN: Thematic analysis of convenience sample of three successive rotations of medical students' patient log entries. SETTING: Johns Hopkins University School of Medicine. PARTICIPANTS: MS3 and MS4 students rotating through a required block ambulatory medicine clerkship. INTERVENTIONS: Students are required to enter patient encounters into a web-based log system during the clerkship. Patient-linked entries included an open text field entitled, "Learning Need." Students were encouraged to use this field to enter goals for future study or teaching points related to the encounter. MEASUREMENT AND MAIN RESULTS: The logs of 59 students were examined. These students entered 3,051 patient encounters, and 51 students entered 1,347 learning need entries (44.1% of encounters). The use of the "Learning Need" field was not correlated with MS year, gender or end-of-clerkship knowledge test performance. There were strong correlations between the use of diagnostic thinking comments and observations of therapeutic relationships (Pearson's r=.42, p < 0.001), and between diagnostic thinking and primary interpretation skills (Pearson's r=.60, p < 0.001), but not between diagnostic thinking and factual knowledge (Pearson's r =.10, p=.46). CONCLUSIONS: We found that when clerkship students were cued to reflect on each patient encounter with the electronic log system, student entries grouped into categories that suggested different levels of reflective thinking. Future efforts should explore the use of such entries to encourage and track habits of reflective practice in the clinical curriculum.