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Reflective practice toolkit, introduction.

  • What is reflective practice?
  • Everyday reflection
  • Models of reflection
  • Barriers to reflection
  • Free writing
  • Reflective writing exercise
  • Bibliography

reflective writing in education

Many people worry that they will be unable to write reflectively but chances are that you do it more than you think!  It's a common task during both work and study from appraisal and planning documents to recording observations at the end of a module. The following pages will guide you through some simple techniques for reflective writing as well as how to avoid some of the most common pitfalls.

What is reflective writing?

Writing reflectively involves critically analysing an experience, recording how it has impacted you and what you plan to do with your new knowledge. It can help you to reflect on a deeper level as the act of getting something down on paper often helps people to think an experience through.

The key to reflective writing is to be analytical rather than descriptive. Always ask why rather than just describing what happened during an experience. 


Reflective writing is...

  • Written in the first person
  • Free flowing
  • A tool to challenge assumptions
  • A time investment

Reflective writing isn't...

  • Written in the third person
  • Descriptive
  • What you think you should write
  • A tool to ignore assumptions
  • A waste of time

Adapted from The Reflective Practice Guide: an Interdisciplinary Approach / Barbara Bassot.

You can learn more about reflective writing in this handy video from Hull University:

Created by SkillsTeamHullUni

  • Hull reflective writing video transcript (Word)
  • Hull reflective writing video transcript (PDF)

Where might you use reflective writing?

You can use reflective writing in many aspects of your work, study and even everyday life. The activities below all contain some aspect of reflective writing and are common to many people:

1. Job applications

Both preparing for and writing job applications contain elements of reflective writing. You need to think about the experience that makes you suitable for a role and this means reflection on the skills you have developed and how they might relate to the specification. When writing your application you need to expand on what you have done and explain what you have learnt and why this matters - key elements of reflective writing.

2. Appraisals

In a similar way, undertaking an appraisal is a good time to reflect back on a certain period of time in post. You might be asked to record what went well and why as well as identifying areas for improvement.

3. Written feedback

If you have made a purchase recently you are likely to have received a request for feedback. When you leave a review of a product or service online then you need to think about the pros and cons. You may also have gone into detail about why the product was so good or the service was so bad so other people know how to judge it in the future.

4. Blogging

Blogs are a place to offer your own opinion and can be a really good place to do some reflective writing. Blogger often take a view on something and use their site as a way to share it with the world. They will often talk about the reasons why they like/dislike something - classic reflective writing.

5. During the research process

When researchers are working on a project they will often think about they way they are working and how it could be improved as well as considering different approaches to achieve their research goal. They will often record this in some way such as in a lab book and this questioning approach is a form of reflective writing.

6. In academic writing

Many students will be asked to include some form of reflection in an academic assignment, for example when relating a topic to their real life circumstances. They are also often asked to think about their opinion on or reactions to texts and other research and write about this in their own work.

Think about ... When you reflect

Think about all of the activities you do on a daily basis. Do any of these contain elements of reflective writing? Make a list of all the times you have written something reflective over the last month - it will be longer than you think!

Reflective terminology

A common mistake people make when writing reflectively is to focus too much on describing their experience. Think about some of the phrases below and try to use them when writing reflectively to help you avoid this problem:

  • The most important thing was...
  • At the time I felt...
  • This was likely due to...
  • After thinking about it...
  • I learned that...
  • I need to know more about...
  • Later I realised...
  • This was because...
  • This was like...
  • I wonder what would happen if...
  • I'm still unsure about...
  • My next steps are...

Always try and write in the first person when writing reflectively. This will help you to focus on your thoughts/feelings/experiences rather than just a description of the experience.

Using reflective writing in your academic work

Man writing in a notebook at a desk with laptop

Many courses will also expect you to reflect on your own learning as you progress through a particular programme. You may be asked to keep some type of reflective journal or diary. Depending on the needs of your course this may or may not be assessed but if you are using one it's important to write reflectively. This can help you to look back and see how your thinking has evolved over time - something useful for job applications in the future. Students at all levels may also be asked to reflect on the work of others, either as part of a group project or through peer review of their work. This requires a slightly different approach to reflection as you are not focused on your own work but again this is a useful skill to develop for the workplace.

You can see some useful examples of reflective writing in academia from Monash University ,  UNSW (the University of New South Wales) and Sage . Several of these examples also include feedback from tutors which you can use to inform your own work.

Laptop/computer/broswer/research by StockSnap via Pixabay licenced under CC0.

Now that you have a better idea of what reflective writing is and how it can be used it's time to practice some techniques.

This page has given you an understanding of what reflective writing is and where it can be used in both work and study. Now that you have a better idea of how reflective writing works the next two pages will guide you through some activities you can use to get started.

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Reflective Writing Activities

In-class/at-home exercises.

All WR courses should offer students regular and varied opportunities for reflection, including personal, metacognitive, and social/systemic reflections that instructors assign as in-class activities and/or for homework throughout the term. Each semester, WR students will choose three of these reflections for inclusion in their cumulative portfolios . Below you will find ideas and examples that can be used or modified as you wish. Remember that reflections don’t always need to take written form. As long as students can capture them in some way (as a photo or video, for example), they can include them in their portfolios on Digication. Note that all sections of WR 111-WR 15x must also assign the Literacy Narrative , though only students who are new to the WR sequence will complete it.

Personal Reflections

In personal reflections, students reflect on their own experiences with communication, as well as their own identities vis-a-vis writing—their “personal views, knowledge, experiences, reactions, and positionality” (Goldsmith et al. “Expanding Reflective Writing Theory for Inclusive Practice.” Association for Writing Across the Curriculum workshop,, April 6, 2022. ).  They answer the question: “Who are you as a writer and communicator?

In relation to the Writing Program’s common portfolio literacy narrative :

  • Scaffold the literacy narrative with Qianqian Zhang-Wu’s “Draw your linguistic and cultural identity” activity (presented to the Writing Program in January 2023 here , with more information here ).
  • Have students create positionality maps (see resources here and here ) and have them reflect on the intersections between positionality and education/writing.
  • Follow up on the literacy narrative in a way that is relevant to your course level and/or course topic.

During the drafting and peer review process:

  • Assign the inner critic activity.
  • During peer review activities, have students reflect on how their identities/positionalities and/or past experiences with writing may shape their ways of engaging other students’ texts.

At the end of the semester:

  • Ask students to revisit and respond to their literacy narrative in light of their experiences in the class.
  • Have students reflect on how writing has helped them connect with communities at BU, both academic and nonacademic.

Metacognitive Reflections

In reflections for metacognition, students reflect on the writing and learning processes, on their “individual learning or choices made within disciplinary activity to move toward action” (Goldsmith et al.) They answer the question: “What have you learned about how to write and communicate?”  All of our Essential Lessons  contain metacognitive notes with specific applications in a sidebar. Instructors may also wish to consult our faculty guide to metacognition in the writing classroom.

In relation to texts: 

  • Have students reflect on/discuss how readings fit into the context of the course: Why did we do this reading/viewing/etc? What was the purpose of it? How would I have experienced it differently if it preceded this other author we read? How might I respond to this reading if I were writing a paper on it?
  • Before they begin writing, have students reflect on assignment goals: What am I imagining for the upcoming paper assignment? What feeling do I want my reader to take away from my paper, and why? Which of our class readings do I really want to include in my paper? Which do I definitely not want to include?
  • Before or after peer review, have students reflect on where they are in the process: What is the best thing about my draft at this point? What strategy or tip did I use in the process of working on this draft that has been helpful? Where am I stuck right now? What would I like feedback on at this point, and why?
  • Have students submit a cover memo with their final draft: If I had an extra two days, with no other commitments, to work on this paper, how would I change it and why? What is different about this paper than my other papers? What is one style or technique I borrowed from the writers we read?

At the end of the module:

  • Ask students to respond to the feedback they have received on a final draft: In what ways does the feedback align with how I was thinking about my essay? What, if anything, surprised me about the feedback I received, and why? How can I take this feedback and apply it to future assignments?
  • Once an assignment sequence is complete, have students consider what might transfer out: What skills did I develop during this assignment sequence? How could I apply them in other academic and/or non-academic contexts?

Social/Systemic Reflections

In social or systemic reflections, students “grapple with belief systems […] reflecting on concepts by examining broader social elements and understanding beyond personal experience” (Goldsmith et al.) They answer the question: “What do you believe about writing and communication?”

In relation to texts:

  • Have students tie course texts/content to larger questions about language and power.
  • Have students reflect on the syllabus as a genre that forms/is formed by social relationships and operates within a system of power.
  • Have students reflect on ________ as a genre that forms/is formed by social relationships and operates within a system of power
  • Have students reflect on the genre of and audience(s) for their draft: Where do you find this genre empowering? Where do you find yourself resisting constraints of this genre? Why?
  • Before and/or after peer review, have students reflect on beliefs (old and new) about language choice and “correctness” or “standard” language conventions.

At the end of semester:  

  • Have students reflect on their ideas about what writing is or how writing works (perhaps in relation to genre awareness, interactions with generative AI, critical language awareness, or another topic relevant to your topic)
  • Ask students to reflect on the relationship between writing, identity, and community–at BU, in their prospective field of study, or in other contexts.

reflective writing in education

What Is Reflective Writing?

Suraj and Simon are two high school students who had to team up for a class project. Within a few…

What Is Reflective Writing?

Suraj and Simon are two high school students who had to team up for a class project. Within a few weeks of working together, both of them realized that they have differing views about the project and can’t collaborate together. They communicate this with their teacher and the teacher asks them to reflect on the past few weeks—identify the challenges and write down the pain points that led them to their decision.

In this scenario, the teacher tries to help both Suraj and Simon out by encouraging them to practice self-reflection. An essential workplace skill, self-reflection is fundamental to our growth and development. Reflective writing is a great way to rewind your life and look at it from a different angle.

Meaning Of Reflective Writing

The process of reflective writing, importance of reflective writing at work.

Before we look at the various meanings and examples of reflective writing, let’s understand what the term ‘reflection’ stands for. At its simplest, reflection refers to a mental process that helps in processing and articulating events from the past. It’s a careful consideration of our thoughts and beliefs as we assess our assumptions and reactions to a certain event. Thanks to reflection, we’re able to process emotions and act and move forward in a thoughtful way.

Reflective writing requires you to analyze, describe and evaluate past situations. By evaluating experiences, you’re able to develop new insights that are instrumental to developing new outlooks. Recollecting instances from your past and writing them down is a fruitful way of examining your response to an event. Thinking about how it affected your life and how you could do things differently are the cornerstones of self-improvement.

Here are a few examples of reflective writing in everyday situations:

Self-review or peer reviews

Feedback about a program, reflective journal or log at work, the process of reflective writing.

As we’ve already established, reflective writing is a mental process involving contemplation and consideration. Before we look at the process involved in reflection, let’s look at the factors that influence your reflective writing style.

Why are you writing it?

Are others going to read it, how do you feel about writing, what are the emotions you’re experiencing, how capable are you of writing reflectively.

Now that you’ve considered multiple factors, let’s look at the important focus areas when it comes to reflective writing.


Provides information about what you’re reflecting on—it can be a personal experience or a topic.


You need to focus on the event, idea or analysis that you feel is most important. For example, identifying whether your previous job experience was good or bad.

Without takeaways, your reflective writing piece remains incomplete. Understand what you’ve learned and what you’re going to focus on, going forward.

Reflecting on work experiences is crucial as it helps us think about the realities of our work environment and where our strengths and weaknesses lie. In addition to identifying personal areas of growth, it helps us develop career ideas. For example, interviewers often ask job seekers questions such as ‘where would you like to see yourself in five years?’ Reflective writing helps in crafting answers and seeking out information that tells us where our interests, passions and values lie.

If you’re preparing for your next job interview, use this reflective writing format as a template.

<Introduction: Talk about why you were part of the event, the daily activities associated with it and the relevant experience you gained.>

<Main Body: Describe your past accomplishments and how your performance made a difference. Provide examples of any new skills or knowledge you acquired. Provide relevant details of how you applied your skills and gained new experiences.>

<Conclusion: End your reflection with an explanation about how the past experience was. Talk about how it helped you and how it contributed to your professional development.>

Everyone has their own style of writing and that’s the best part about it. Having your unique writing style adds flavor, especially when it comes to self-reflection. If you want to sharpen your writing skills and deliver your thoughts with clarity, turn to Harappa’s  Writing Proficiently course. This online writing course will help you structure your thoughts, polish your writing style and teach you to write clearly, concisely and compellingly. The Pyramid Principle in particular will help you present key points of messages upfront with supporting evidence. Discover how to tell a story with every communication you draft!

Explore topics such as What are  Written Communication  Skills, Different Types of  Writing Styles , Examples of  Descriptive Writing , What is  Narrative Writing , Common  Persuasive Writing  Techniques & The Importance Of  Expository Writing  and learn to draft well-crafted messages to convey your ideas and intentions.


Reflective writing and nursing education


  • 1 Breast Imaging of Oklahoma, Edmond, Oklahoma, USA. [email protected]
  • PMID: 15719711
  • DOI: 10.3928/01484834-20050201-03

Reflective writing is a valued tool for teaching nursing students and for documentation, support, and generation of nursing knowledge among experienced nurses. Expressive or reflective writing is becoming widely accepted in both professional and lay publications as a mechanism for coping with critical incidents. This article explores reflective writing as a tool for nursing education.

Publication types

  • Education, Nursing*
  • Open access
  • Published: 09 January 2023

A systematic scoping review of reflective writing in medical education

  • Jia Yin Lim 1 , 2 ,
  • Simon Yew Kuang Ong 3 , 4 , 5 ,
  • Chester Yan Hao Ng 1 , 2 ,
  • Karis Li En Chan 1 , 2 ,
  • Song Yi Elizabeth Anne Wu 1 , 2 ,
  • Wei Zheng So 1 , 2 ,
  • Glenn Jin Chong Tey 1 , 2 ,
  • Yun Xiu Lam 1 , 2 ,
  • Nicholas Lu Xin Gao 1 , 2 ,
  • Yun Xue Lim 1 , 2 ,
  • Ryan Yong Kiat Tay 1 , 2 ,
  • Ian Tze Yong Leong 1 , 2 ,
  • Nur Diana Abdul Rahman 4 ,
  • Min Chiam 4 ,
  • Crystal Lim 6 ,
  • Gillian Li Gek Phua 2 , 5 , 7 ,
  • Vengadasalam Murugam 2 , 5 ,
  • Eng Koon Ong 2 , 4 , 5 , 8 &
  • Lalit Kumar Radha Krishna 1 , 2 , 4 , 5 , 9 , 10  

BMC Medical Education volume  23 , Article number:  12 ( 2023 ) Cite this article

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Reflective writing (RW) allows physicians to step back, review their thoughts, goals and actions and recognise how their perspectives, motives and emotions impact their conduct. RW also helps physicians consolidate their learning and boosts their professional and personal development. In the absence of a consistent approach and amidst growing threats to RW’s place in medical training, a review of theories of RW in medical education and a review to map regnant practices, programs and assessment methods are proposed.

A Systematic Evidence-Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure the two concurrent reviews. Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2022 in PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus, Google Scholar, OpenGrey, GreyLit and ProQuest. The Split Approach saw the included articles analysed separately using thematic and content analysis. Like pieces of a jigsaw puzzle, the Jigsaw Perspective combined the themes and categories identified from both reviews. The Funnelling Process saw the themes/categories created compared with the tabulated summaries. The final domains which emerged structured the discussion that followed.

A total of 33,076 abstracts were reviewed, 1826 full-text articles were appraised and 199 articles were included and analysed. The domains identified were theories and models, current methods, benefits and shortcomings, and recommendations.


This SSR in SEBA suggests that a structured approach to RW shapes the physician’s belief system, guides their practice and nurtures their professional identity formation. In advancing a theoretical concept of RW, this SSR in SEBA proffers new insight into the process of RW, and the need for longitudinal, personalised feedback and support.

Peer Review reports


Reflective practice in medicine allows physicians to step back, review their actions and recognise how their thoughts, feelings and emotions affect their decision-making, clinical reasoning and professionalism [ 1 ]. This approach builds on Dewey [ 2 ], Schon [ 3 , 4 ], Kolb [ 5 ], Boud et al. [ 6 ] and Mezirow [ 7 ]’s concepts of critical self-examination. It sees new insights drawn from the physician’s experiences and considers how assumptions may integrate into their current values, beliefs and principles (henceforth belief system) [ 8 , 9 ].

Teo et al. [ 10 ] build on this concept of reflective practice. The authors suggest that the physician’s belief system informs and is informed by their self-concepts of identity which are in turn rooted in their self-concepts of personhood - how they conceive what makes them who they are [ 11 ]. This posit not only ties reflective practice to the shaping of the physician’s moral and ethical compass but also offers evidence of it's role in their professional identity formation (PIF) [ 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. With PIF [ 8 , 24 ] occupying a central role in medical education, these ties underscore the critical importance placed on integrating reflective practice in medical training.

Perhaps the most common form of reflective practice in medical education is reflective writing (RW) [ 25 ]. Identified as one of the distinct approaches used to achieve integrated learning, education, curriculum and teaching [ 26 ], RW already occupies a central role in guiding and supporting longitudinal professional development [ 27 , 28 , 29 ]. Its ability to enhance self-monitoring and self-regulation of decisional paradigms and conduct has earned RW a key role in competency-based medical practice and continuing professional development [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ].

However, the absence of consistent guiding principles, dissonant practices, variable structuring and inadequate assessments have raised concerns as to RW’s efficacy and place in medical training [ 25 , 37 , 38 , 39 ]. A Systematic Scoping Review is proposed to map current understanding of RW programs. It is hoped that this SSR will also identify gaps in knowledge and regnant practices, programs and assessment methods to guide the design of RW programs.


A Systematic Scoping Review (SSR) is employed to map the employ, structuring and assessment of RW in medical education. An SSR-based review is especially useful in attending to qualitative data that does not lend itself to statistical pooling [ 40 , 41 , 42 ] whilst its broad flexible approach allows the identification of patterns, relationships and disagreements [ 43 ] across a wide range of study formats and settings [ 44 , 45 ].

To synthesise a coherent narrative from the multiple accounts of reflective writing, we adopt Krishna’s Systematic Evidence-Based Approach (SEBA) [ 10 , 15 , 21 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. A SEBA-guided Systematic Scoping Review (SSR in SEBA) [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 50 , 53 , 54 , 55 ] facilitates reproducible, accountable and transparent analysis of patterns, relationships and disagreements from multiple angles [ 56 ].

The SEBA process (Fig.  1 ) comprises the following elements: 1) Systematic Approach, 2) Split Approach, 3) Jigsaw Perspective, 4) Funnelling Process, 5) Analysis of data and non-data driven literature, and 6) Synthesis of SSR in SEBA [ 10 , 15 , 21 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 57 , 58 , 59 , 60 ] . Every stage was overseen by a team of experts that included medical librarians from the Yong Loo Lin School of Medicine (YLLSoM) at the National University of Singapore, and local educational experts and clinicians at YLLSoM, Duke-NUS Medical School, Assisi Hospice, Singapore General Hospital, National Cancer Centre Singapore and Palliative Care Institute Liverpool.

figure 1

The SEBA Process

STAGE 1 of SEBA: Systematic Approach

Determining the title and background of the review.

Ensuring a systematic approach, the expert team and the research team agreed upon the overall goals of the review. Two separate searches were performed, one to look at the theories of reflection in medical education, and another to review regnant practices, programs, and assessment methods used in reflective writing in medical education. The PICOs is featured in Table  1 .

Identifying the research question

Guided by the Population Concept, Context (PCC) elements of the inclusion criteria and through discussions with the expert team, the research question was determined to be: “ How is reflective writing structured, assessed and supported in medical education? ” The secondary research question was “ How might a reflective writing program in medical education be structured? ”

Inclusion criteria

All study designs including grey literature published between 1st January 2000 to 30th June 2022 were included [ 61 , 62 ]. We also consider data on medical students and physicians from all levels of training (henceforth broadly termed as physicians).

Ten members of the research team carried out independent searches using seven bibliographic databases (PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus) and four grey literature databases (Google Scholar, OpenGrey, GreyLit, ProQuest). Variations of the terms “reflective writing”, “physicians and medical students”, and “medical education” were applied.

Extracting and charting

Titles and abstracts were independently reviewed by the research team to identify relevant articles that met the inclusion criteria set out in Table 1 . Full-text articles were then filtered and proposed. These lists were discussed at online reviewer meetings and Sandelowski and Barroso [ 63 ]’s approach to ‘negotiated consensual validation’ was used to achieve consensus on the final list of articles to be included.

Stage 2 of SEBA: Split Approach

The Split Approach was employed to enhance the trustworthiness of the SSR in SEBA [ 64 , 65 ]. Data from both searches were analysed by three independent groups of study team members.

The first group used Braun and Clarke [ 66 ]’s approach to thematic analysis. Phase 1 consisted of ‘actively’ reading the included articles to find meaning and patterns in the data. The analysis then moved to Phase 2 where codes were constructed. These codes were collated into a codebook and analysed using an iterative step-by-step process. As new codes emerge, previous codes and concepts were incorporated. In Phase 3, codes and subthemes were organised into themes that best represented the dataset. An inductive approach allowed themes to be “defined from the raw data without any predetermined classification” [ 67 ]. In Phase 4, these themes were then further refined to best depict the whole dataset. In Phase 5, the research team discussed the results and consensus was reached, giving rise to the final themes.

The second group employed Hsieh and Shannon [ 68 ]’s approach to directed content analysis. Categories were drawn from Mann et al. [ 9 ]’s article, “Reflection and Reflective Practice in Health Professions Education: A Systematic Review” and Wald and Reis [ 69 ]’s article “Beyond the Margins: Reflective Writing and Development of Reflective Capacity in Medical Education”.

The third group created tabulated summaries in keeping with recommendations drawn from Wong et al. [ 56 ]’s "RAMESES Publication Standards: Meta-narrative Reviews" and Popay et al. [ 70 ]’s “Guidance on the C onduct of N arrative Synthesis in Systematic Reviews”. The tabulated summaries served to ensure that key aspects of included articles were not lost.

Stage 3 of SEBA: Jigsaw Perspective

The Jigsaw Perspective [ 71 , 72 ] saw the findings of both searches combined. Here, overlaps and similarities between the themes and categories from the two searches were combined to create themes/categories. The themes and subthemes were compared with the categories and subcategories identified, and similarities were verified by comparing the codes contained within them. Individual subthemes and subcategories were combined if they were complementary in nature.

Stage 4 of SEBA: Funnelling Process

The Funnelling Process saw the themes/categories compared with the tabulated summaries to determine the consistency of the domains created, forming the basis of the discussion.

Stage 5: Analysis of data and non-data driven literature

Amidst concerns that data from grey literature which were neither peer-reviewed nor necessarily evidence-based may bias the synthesis of the discussion, the research team separately thematically analysed the included grey literature. These themes were compared with themes from data-driven or research-based peer-reviewed data and were found to be the same and thus unlikely to have influenced the analysis.

Stage 6: Synthesis of SSR in SEBA

The Best Evidence Medical Education (BEME) Collaboration Guide and the Structured approach to the Reporting In healthcare education of Evidence Synthesis (STORIES) were used to guide the discussion.

A total of 33,076 abstracts were reviewed from the two separate searches on theories of reflection in medical education, and on regnant practices, programs and assessments of RW programs in medical education. A total of 1826 full-text articles were appraised from the separate searches, and 199 articles were included and analysed. The PRISMA Flow Chart may be found in Fig.  2 a and b. The domains identified when combining the findings of the two separate searches were 1) Theories and Models, 2) Current Methods, 3) Benefits and Shortcomings and 4) Recommendations.

figure 2

a PRISMA Flow Chart (Search Strat #1: Theories of Reflection in Medical Education). b PRISMA Flow Chart (Search Strat #2: Reflective Writing in Medical Education)

Domain 1: Theories and Models

Many current theories and models surrounding RW in medical education are inspired by Kolb’s Learning Cycle [ 5 ] (Table  2 ). These theories focus on descriptions of areas of reflection; evaluations of experiences and emotions; how events may be related to previous experiences; knowledge critiques of their impact on thinking and practice; integration of learning points; and the physician’s willingness to apply lessons learnt [ 6 , 73 , 74 , 75 ]. In addition, some of these theories also consider the physician’s self-awareness, ability and willingness to reflect [ 76 ], contextual factors related to the area of reflection [ 4 , 77 ] and the opportunity to reflect effectively within a supportive environment [ 78 , 79 ]. Ash and Clayton's DEAL Model recommends inclusion of information from all five senses [ 80 , 81 , 82 , 83 ]. Johns's Model of Structured Reflection [ 84 ] advocates giving due consideration to internal and external influences upon the event being evaluated. Rodgers [ 39 ] underlines the need for appraisal of the suppositions and assumptions that precipitate and accompany the effects and responses that may have followed the studied event. Griffiths and Tann [ 75 ], Mezirow [ 77 ], Kim [ 85 ], Roskos et al. [ 86 ], Burnham et al. [ 87 ], Korthagen and Vasalos [ 78 ] and Koole et al. [ 74 ] build on Dewey [ 2 ] and Kolb [ 5 ]’s notion of creating and experimenting with a ‘working hypothesis’. These models also propose that the lessons learnt from experimentations should be critiqued as part of a reiterative process within the reflective cycle. Underlining the notion of the reflective cycle and the long-term effects of RW, Pearson and Smith [ 88 ] suggest that reflections should be carried out regularly to encourage longitudinal and holistic reflections on all aspects of the physician’s personal and professional life.

Regnant theories shape assessments of RW (Table  3 ). This extends beyond Thorpe [ 96 ]’s study which categorises reflective efforts into ‘non-reflectors’, ‘reflectors’, ‘critical reflectors’, and focuses on their process, structure, depth and content. van Manen [ 97 ], Plack et al. [ 98 ], Rogers et al. [ 99 ] and Makarem et al. [ 100 ] begin with evaluating the details of the events. Kim’s Critical Reflective Inquiry Model [ 85 ] and Bain’s 5Rs Reflective Framework [ 101 ] also consider characterisations of emotions involved. Other models appraise the intentions behind actions and thoughts [ 85 ], the factors precipitating the event [ 101 ] and meaning-making [ 85 ]. Other theories consider links with previous experiences [ 100 ], the integration of thoughts, justifications and perspectives [ 99 ], and the hypothesising of future strategies [ 98 ].

Domain 2: Current methods of structuring RW programs

Current programs focus on supporting the physician throughout the reflective process. Whilst due consideration is given to the physician’s motivations, insight, experiences, capacity and capabilities [ 25 , 96 , 112 , 113 , 114 , 115 , 116 ], programs also endeavour to ensure appropriate selection and training of physicians intending to participate in RW. Efforts are also made to align expectations, and guide and structure the RW process [ 37 , 116 , 117 , 118 , 119 , 120 , 121 , 122 ]. Physicians are provided with frameworks [ 76 , 79 , 105 , 123 , 124 ], rubrics [ 99 , 123 , 125 , 126 ], examples of the expected quality and form of reflection [ 96 , 115 , 116 ], and how to include emotional and contextual information in their responses [ 121 , 127 , 128 , 129 ].

Other considerations are enclosed in Table  4 including frequency, modality and the manner in which RW is assessed.

Domain 3: Benefits and Shortcomings

The benefits of RW are rarely described in detail and may be divided into personal and professional benefits as summarised in Table  5 for ease of review. From a professional perspective, RW improves learning [ 96 , 112 , 119 , 147 , 157 , 170 , 179 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 ], facilitates continuing medical education [ 119 , 128 , 173 , 174 , 193 , 194 , 195 ], inculcates moral, ethical, professional and social standards and expectations [ 118 , 156 , 160 ], improves patient care [ 29 , 120 , 129 , 131 , 135 , 142 , 194 , 196 , 197 , 198 , 199 ] and nurtures PIF [ 150 , 157 , 172 , 191 , 200 ].

From a personal perspective, RW increases self-awareness [ 114 , 127 , 137 , 161 , 166 , 179 , 185 , 202 , 216 ], self-advancement [ 9 , 131 , 134 , 150 , 168 , 174 , 195 , 205 , 217 , 229 ], facilitates understanding of individual strengths, weaknesses and learning needs [ 112 , 119 , 150 , 152 , 170 , 218 , 219 ], promotes a culture of self-monitoring, self-improvement [ 130 , 172 , 173 , 185 , 193 , 198 , 201 , 210 , 211 ], developing critical perspectives of self [ 193 , 223 ] and nurtures resilience and better coping [ 154 , 160 , 206 ]. RW also guides shifts in thinking and perspectives [ 148 , 149 , 156 , 203 , 207 , 208 ] and focuses on a more holistic appreciation of decision-making [ 37 , 118 , 126 , 174 , 177 , 194 , 196 , 199 , 200 , 224 , 225 , 226 ] and their ramifications [ 37 , 112 , 116 , 130 , 131 , 141 , 154 , 179 , 193 , 194 , 196 , 204 , 207 , 218 , 230 ].

Table  6 combines current lists of the shortcomings of RW. These limitations may be characterised by individual, structural and assessment styles.

It is suggested that RW does not cater to the different learning styles [ 220 , 232 ], cultures [ 190 ], roles, values, processes and expectations of RW [ 114 , 129 , 135 , 138 , 142 , 209 , 227 , 234 ], and physicians' differing levels of self-awareness [ 29 , 79 , 119 , 176 , 188 , 226 , 231 , 236 ], motivations [ 29 , 119 , 136 , 138 , 157 , 161 , 167 , 168 , 169 , 176 , 181 , 193 , 196 , 226 , 232 , 233 ] and willingness to engage in RW [ 37 , 114 , 136 , 149 , 160 , 183 ]. RW is also limited by poorly prepared physicians and misaligned expectations whilst a lack of privacy and a safe setting may precipitate physician anxiety at having their private thoughts shared [ 129 , 149 , 209 , 231 ]. RW is also compromised by a lack of faculty training [ 143 , 145 , 239 ], mentoring support [ 37 , 50 , 119 , 133 , 196 ] and personalised feedback [ 50 , 114 , 136 , 167 , 229 ] which may lead to self-censorship [ 37 , 114 , 136 , 149 , 160 , 183 ] and an unwillingness to address negative emotions arising from reflecting on difficult events [ 114 , 168 , 176 , 193 , 230 ], circumventing the reflective process [ 118 , 142 , 165 , 196 ] .

Variations in assessment styles [ 9 , 115 , 157 , 161 , 166 , 193 , 209 ], depth [ 29 , 105 , 118 , 126 , 177 , 207 ] and content [ 37 , 114 , 136 , 149 , 169 , 183 , 196 ], and pressures to comply with graded assessments [ 114 , 115 , 118 , 129 , 138 , 143 , 149 , 155 , 157 , 209 , 232 , 237 , 238 ] also undermine efforts of RW.

Domain 4. Recommendations

In the face of practice variations and challenges, there have been several recommendations on improving practice.

Boosting awareness of RW

Acknowledging the importance of a physician’s motivations, willingness and judgement [ 37 ], an RW program must acquaint physicians with information on RW’s role [ 128 ], program expectations, the form, frequency and assessments of RW and the support available to them [ 130 , 132 , 150 , 154 , 242 ] and its benefits to their professional and personal development [ 96 , 227 ] early in their training programs [ 115 , 220 , 242 , 243 ]. Physicians should also be trained on the knowledge and skills required to meet these expectations [ 1 , 37 , 135 , 151 , 160 , 215 , 244 , 245 ].

A structured program and environment

Recognising that effective RW requires a structured program. Recommendations focus on three aspects of the program design [ 132 ]. One is the need for trained faculty [ 9 , 115 , 219 , 220 , 230 , 233 , 242 , 246 ], accessible communications, protected time for RW and debriefs [ 125 ], consistent mentoring support [ 190 ] and assessment processes [ 247 ]. This will facilitate trusting relationships between physicians and faculty [ 30 , 114 , 168 , 196 , 231 , 233 ]. Two, the need to nurture an open and trusting environment where physicians will be comfortable with sharing their reflections [ 96 , 128 ], discussing their emotions, plans [ 127 , 248 ] and receiving feedback [ 9 , 37 , 79 , 114 , 119 , 128 , 135 , 173 , 176 , 179 , 190 , 237 ]. This may be possible in a decentralised classroom setting [ 163 , 190 ]. Three, RW should be part of the formal curriculum and afforded designated time. RW should be initiated early and longitudinally along the training trajectory [ 116 , 122 ].

Adjuncts to RW programs

Several approaches have been suggested to support RW programs. These include collaborative reflection, in-person discussion groups to share written reflections [ 128 , 131 , 138 , 196 , 199 , 231 , 249 ] and reflective dialogue to exchange feedback [ 119 ], use of social media [ 149 , 160 , 169 , 194 , 204 , 230 ], video-recorded observations and interactions for users to review and reflect on later [ 133 ]. Others include autobiographical reflective avenues in addition to practice-oriented reflection [ 137 ], support groups to help meditate stress or emotions triggered by reflections [ 249 ] and mixing of reflective approaches to meet different learning styles [ 169 , 250 ].

In answering the primary research question, “How is reflective writing structured, assessed and supported in medical education?” , this SSR in SEBA highlights several key insights. To begin, RW involves integrating the insights of an experience or point of reflection (henceforth ‘event’) into the physician’s currently held values, beliefs and principles (henceforth belief system). Recognising that an ‘event’ has occurred and that it needs deeper consideration highlights the physician’s sensitivity . Recognising the presence of an ‘event’ triggers an evaluation as to the urgency in which it needs to be addressed, where it stands amongst other ‘events’ to be addressed and whether the physician has the appropriate skills, support and time to address the ‘event’. This reflects the physician’s judgement . The physician must then determine whether they are willing to proceed and the ramifications involved. These include ethical, medical, clinical, administrative, organisational, sociocultural, legal and professional considerations. This is then followed by contextualising them to their own personal, psychosocial, clinical, professional, research, academic, and situational setting. Weighing these amidst competing ‘events’ underlines the import of the physician’s ability to ‘balance’ considerations. Creating and experimenting on their ‘working hypothesis’ highlights their  ‘ability’, whilst how they evaluate the effects of their experimentation and how they adapt their practice underscores their ‘ responsiveness ’ [ 2 , 5 , 74 , 75 , 77 , 78 , 85 , 86 , 87 , 90 ].

The concepts of ‘ sensitivity’, ‘judgement’, ‘willingness’, ‘balance’, ‘ability’ and ‘responsiveness’ spotlight environmental and physician-related factors. These include the physician’s motivations, knowledge, skills, attitudes, competencies, working style, needs, availabilities, timelines, and their various medical, clinical, administrative, organisational, sociocultural, legal, professional, personal, psychosocial, clinical, research, academic and situational experiences. It also underlines the role played by the physician’s beliefs, moral values, ethical principles, familial mores, cultural norms, attitudes, thoughts, decisional preferences, roles and responsibilities. The environmental-related factors include the influence of the curriculum, the culture, structure, format, assessment and feedback of the RW process and the program it is situated in. Together, the physician and their environmental factors not only frame RW as a sociocultural construct necessitating holistic review but also underscore the need for longitudinal examination of its effects. This need for holistic and longitudinal appraisal of RW is foregrounded by the experimentations surrounding the ‘working hypothesis’ [ 2 , 5 , 72 , 74 , 77 , 84 , 85 , 86 , 90 ]. In turn, experimentations and their effects affirm the notion of regular use of RW and reiterate the need for longitudinal reflective relationships that provide guidance, mentoring and feedback [ 87 , 90 ]. These considerations set the stage for the proffering of a new conceptual model of RW.

To begin, the Krishna Model of Reflective Writing (Fig.  3 ) builds on the Krishna-Pisupati Model [ 10 ] used to describe evaluations of professional identity formation (PIF) [ 8 , 10 , 24 , 251 ]. Evidenced in studies of how physicians cope with death and dying patients, moral distress and dignity-centered care [ 46 , 54 ], the Krishna-Pisupati Model suggests that the physician’s belief system is informed by their self-concepts of personhood and identity. This is effectively characterised by the Ring Theory of Personhood (RToP) [ 11 ].

figure 3

Krishna Model of Reflective Writing

The Krishna Model of RW posits that the RToP is able to encapsulate various aspects of the physician’s belief system. The Innate Ring which represents the innermost ring of the four concentric rings depicting the RToP is derived from currently held spiritual, religious, theist, moral and ethical values, beliefs and principles [ 13 , 51 , 53 , 252 ]. Encapsulating the Innate Ring is the Individual Ring. The Individual Ring’s belief system is derived from the physician’s thoughts, conduct, biases, narratives, personality, decision-making processes and other facets of conscious function which together inform the physician’s Individual Identity [ 13 , 51 , 53 , 252 ]. The Relational Ring is shaped by the values, beliefs and principles governing the physician’s personal and important relationships [ 13 , 51 , 53 , 252 ]. The Societal Ring, the outermost ring of the RToP is shaped by regnant societal, religious, professional and legal expectations, values, beliefs and principles which inform their interactions with colleagues and acquaintances [ 13 , 51 , 53 , 252 ]. Adoption of the RToP to depict this belief system not only acknowledges the varied aspects and influences that shape the physician’s identity but that the belief system evolves as the physician’s environment, narrative, context and relationships change.

The environmental factors influencing the belief system include the support structures used to facilitate reflections such as appropriate protected time, a consistent format for RW, a structured assessment program, a safe environment, longitudinal support, timely feedback and trained faculty. The Krishna Model of RW also recognises the importance of the relationships which advocate for the physician and proffer the physician with coaching, role modelling, supervision, networking opportunities, teaching, tutoring, career advice, sponsorship and feedback upon the RW process. Of particular importance is the relationship between physician and faculty (henceforth reflective relationship). The reflective relationship facilitates the provision of personalised, appropriate, holistic, and frank communications and support. This allows the reflective relationship to support the physician as they deploy and experiment with their ‘working hypothesis’. As a result, the Krishna Model of RW focuses on the dyadic reflective relationship and acknowledges that there are wider influences beyond this dyad that shape the RW process. This includes the wider curriculum, clinical, organisational, social, professional and legal considerations within specific practice settings and other faculty and program-related factors. Important to note, is that when an ‘event’ triggers ‘ sensitivity’, ‘judgement’, ‘willingness’, ‘balance’, ‘ability’ and ‘responsiveness’,  the process of creating and experimenting with a ‘working hypothesis' and adapting one's belief system is also shaped by the physician’s narratives, context, environment and relationships. 

In answering its secondary question, “ How might a reflective writing program in medical education be structured? ”, the data suggests that an RW program ought to be designed with due focus on the various factors influencing the physician's belief system, their  ‘sensitivity’, ‘judgement’, ‘willingness’, ‘balance’, ‘ability’ and ‘responsiveness’, and their creation and experimentation with their ‘working hypothesis’. These will be termed the ‘physician's reactions’ . The design of the RW program ought to consider the following factors:

Belief system

Recognising that the physician’s notion of ‘ sensitivity’, ‘judgement’, ‘willingness’, ‘balance’, ‘ability’ and ‘responsiveness’ is influenced by their experience, skills, knowledge, attitude and motivations, physicians recruited to the RW program should be carefully evaluated

To align expectations, the physician should be introduced to the benefits and role of RW in their personal and professional development

The ethos, frequency, goals and format of the reflection and assessment methods should be clearly articulated to the physician [ 253 ]

The physician should be provided with the knowledge, skills and mentoring support necessary to meet expectations [ 76 , 79 , 105 , 123 , 124 , 254 , 255 ]

Training and support must also be personalised

Contextual considerations

Recognising that the physician’s academic, personal, research, administrative, clinical, professional, sociocultural and practice context will change, the structure, approach, assessment and support provided must be flexible and responsive

The communications platform should be easily accessible and robust to attend to the individual needs of the physician in a timely and appropriate manner

The program must support diversity [ 207 ]


The reflective relationship is shaped by the culture and structure of the environment in which the program is hosted in

The RW programs must be hosted within a formal structured curriculum, supported and overseen by a host organisation which is able to integrate the program into regnant educational and assessment processes [ 9 , 115 , 219 , 220 , 230 , 233 , 242 , 246 ]

Reflective relationship

The faculty must be trained and provided access to counselling, mindfulness meditation and stress management programs [ 249 ]

The faculty must support the development of the physician’s metacognitive skills [ 256 , 257 , 258 , 259 ], and should create a platform that facilitates community-centered learning [ 173 , 176 ], structured, timely, personalised open feedback [ 119 , 135 , 179 , 237 ] and support [ 128 , 131 , 138 , 196 , 199 , 231 , 249 ]

The faculty must be responsive to changes and provide appropriate personal, educational and professional support and adaptations to the assessment process when required [ 207 ]

To facilitate the development of effective reflective relationships, a consistent faculty member should work with the physician and build a longitudinal trusting, open and supportive reflective relationship

Physician’s reactions

The evolving nature of the various structures and influences upon the RW process underscores the need for longitudinal assessment and support

The physician must be provided with timely, appropriate and personalised training and feedback

The program’s structure and oversight must also be flexible and responsive

There must be accessible longitudinal mentoring support

The format and assessment of RW must account for growing experience and competencies as well as changing motivations and priorities

Whilst social media may be employed to widen sharing [ 149 , 155 , 160 , 169 , 194 ], privacy must be maintained [ 120 , 189 ]

On assessment

Assessment rubrics should be used to guide the training of faculty, education of physicians and guidance of reflections [ 37 , 116 , 117 , 118 , 119 , 120 , 121 , 122 ]

Assessments ought to take a longitudinal perspective to track the physician's progress [ 116 , 122 ]

Based on the results from this SSR in SEBA, we forward a guide catering to novice reflective practitioners (Additional file  1 ).


This SSR in SEBA suggests that, amidst the dearth of rigorous quantitative and qualitative studies in RW and in the presence of diverse practices, approaches and settings, conclusions may not be easily drawn. Extrapolations of findings are also hindered by evidence that appraisals of RW remain largely reliant upon single time point self-reported outcomes and satisfaction surveys.

This SSR in SEBA highlights a new model for RW that requires clinical validation. However, whilst still not clinically proven, the model sketches a picture of RW’s role in PIF and the impact of reflective processes on PIF demands further study. As we look forward to engaging in this area of study, we believe further research into the longer-term effects of RW and its potential place in portfolios to guide and assess the development of physicians must be forthcoming.

Availability of data and materials

All data generated or analysed during this review are included in this published article and its supplementary files.


Reflective Writing

Professional Identity Formation

Ring Theory of Personhood

Best Evidence Medical Education

Structured approach to the Reporting In healthcare education of Evidence Synthesis

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Systematic Scoping Review

Systematic Evidence-Based Approach

Yong Loo Lin School of Medicine

Population, Intervention, Comparison, Outcome, Study Design

Realist And Meta-narrative Evidence Syntheses - Evolving Standards

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The authors would like to dedicate this paper to the late Dr. S Radha Krishna and A/Prof Cynthia Goh whose advice and ideas were integral to the success of this review and Thondy and Maia Olivia whose lives continue to inspire us.

The authors would also like to thank the anonymous reviewers, Dr. Ruaraidh Hill and Dr. Stephen Mason for their helpful comments which greatly enhanced this manuscript.

No funding was received for this review.

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Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore

Jia Yin Lim, Chester Yan Hao Ng, Karis Li En Chan, Song Yi Elizabeth Anne Wu, Wei Zheng So, Glenn Jin Chong Tey, Yun Xiu Lam, Nicholas Lu Xin Gao, Yun Xue Lim, Ryan Yong Kiat Tay, Ian Tze Yong Leong & Lalit Kumar Radha Krishna

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Jia Yin Lim, Chester Yan Hao Ng, Karis Li En Chan, Song Yi Elizabeth Anne Wu, Wei Zheng So, Glenn Jin Chong Tey, Yun Xiu Lam, Nicholas Lu Xin Gao, Yun Xue Lim, Ryan Yong Kiat Tay, Ian Tze Yong Leong, Gillian Li Gek Phua, Vengadasalam Murugam, Eng Koon Ong & Lalit Kumar Radha Krishna

Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore

Simon Yew Kuang Ong

Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore

Simon Yew Kuang Ong, Nur Diana Abdul Rahman, Min Chiam, Eng Koon Ong & Lalit Kumar Radha Krishna

Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore

Simon Yew Kuang Ong, Gillian Li Gek Phua, Vengadasalam Murugam, Eng Koon Ong & Lalit Kumar Radha Krishna

Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore

Crystal Lim

Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore

Gillian Li Gek Phua

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Eng Koon Ong

Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK

Lalit Kumar Radha Krishna

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Guide to Reflective Writing.

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Lim, J.Y., Ong, S.Y.K., Ng, C.Y.H. et al. A systematic scoping review of reflective writing in medical education. BMC Med Educ 23 , 12 (2023).

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Received : 10 August 2022

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Published : 09 January 2023


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  • Reflective writing
  • Medical education
  • Professional identity formation
  • Undergraduate medical education
  • Postgraduate medical education

BMC Medical Education

ISSN: 1472-6920

reflective writing in education


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