title: Differences in Self-expression Reflect Formal Evaluation in a Fourth-year Emergency Medicine Clerkship.
abstract: BACKGROUND
  Medical schools have begun to incorporate self-reflection exercises into their curricula, with the belief that these exercises help students master the material more deeply and perform better. Reflection may be a potential learning tool for emergency medicine (EM), but there are few data supporting this hypothesis. The authors evaluated the relationship between a linguistic marker of the degree of reflection after a student's shift in an emergency department and that student's clerkship performance.
  
  
  METHODS
  The authors conducted a retrospective case series by analyzing the performance and reflective statements of 116 students from a single medical school who participated in a required EM clerkship at one or two of four clinical sites from 2013-14. After each shift, an attending emergency physician evaluated the student according to the RIME (Reporter-Interpreter-Manager-Educator) scheme. The authors developed software to extract the text from those comments, remove uninformative words and standardize the remaining words. The authors determined the most common words and two-word phrases that students used to describe their shift. The correlation between students' final clerkship grades and the fraction of student comments with at least one content word was analyzed.
  
  
  RESULTS
  Of the 145 possible students, 116 were included for analysis. The other 29 were excluded as they were visiting students who did not receive a final numeric grade. The correlation between final grade and the number of completed self-reflections was 0.32. The correlation between final grade and the average number of words in each self-reflection was 0.21. The first correlation is significantly greater than 0 (p=0.03, t-test), but the second correlation is not (p=0.16, t-test). The median final grade of those who wrote reflections on more than half of their shifts was significantly greater than those who wrote reflections half of the time, 83.675 versus 79.23 (p=0.05, 2-sample Kolmogorov-Smirnov test).
  
  
  CONCLUSIONS
  Students who reflected more frequently received a higher grade in an EM clerkship for fourth-year medical students. The number of words in each reflection was not significantly correlated with grade performance. The most common words and phrases students wrote were associated with learning and managing patients.
authors.affiliation: New York Presbyterian/Queens, Department of Emergency Medicine, Flushing, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Chary
authors.affiliation: University of Otago, Dunedin Hospital, Dunedin, New Zealand.
authors.forename: Amy
authors.initials: A
authors.lastname: Leuthauser
authors.affiliation: Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hu
authors.affiliation: Rush Medical College, Department of Emergency Medicine, Chicago, Illinois.
authors.forename: Braden
authors.initials: B
authors.lastname: Hexom
mesh_terms: D002982:Clinical Clerkship / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D012044:Regression Analysis; D012189:Retrospective Studies; D013337:Students, Medical; D014481:United States