title: Acting on reflection: the effect of reflection on students' clinical performance on a standardized patient examination.
abstract: BACKGROUND
  Little evidence exists to support the value of reflection in the clinical setting.
  
  
  OBJECTIVE
  To determine whether reflecting and revisiting the "patient" during a standardized patient (SP) examination improves junior medical students' performance and to analyze students' perceptions of its value.
  
  
  METHODS
  Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists.
  
  
  METHODS
  One hundred and forty-nine third year medical students.
  
  
  METHODS
  Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases.
  
  
  RESULTS
  On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated "reflect-revisit" positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism.
  
  
  CONCLUSIONS
  Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect-revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence.
authors.affiliation: Clinical Learning and Simulation Skills Center, Department of Medicine, The George Washington University School of Medicine and Health Sciences, George Washington University Hospital, Washington, DC 20037, USA. msdbcb@gwumc.edu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Blatt
authors.forename: Margaret
authors.initials: M
authors.lastname: Plack
authors.forename: Joyce
authors.initials: J
authors.lastname: Maring
authors.forename: Matthew
authors.initials: M
authors.lastname: Mintz
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Simmens
mesh_terms: D003376:Counseling; D003657:Decision Making; D004219:District of Columbia; D004521:Educational Measurement; D006801:Humans; D011939:Mental Recall; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D013337:Students, Medical / Q000523:psychology*