Integrating students′ reflection-in-learning and examination performance as a method for providing educational feedback

Background: Feedback provided by integrating students′ examination performance and the reflection on learning process may assist medical students to identify the essential learning processes required for better understanding of learning material. Aims: To investigate the relationship between the student′s learning process and examination performance and to explore students′ perspectives on professional feedback given by integrating the self-reflection on learning process and individual examination performance. Settings and Design: At the end of every medical school block examination, faculty provided descriptive feedback to students regarding individual performance in each subject area. The study had a quasi-experimental design. Materials and Methods: Students′ (n=153) self-reflection on learning process was collected using a reflection-in-learning scale. The learning process of the students categorized in fail, pass and first-class categories were compared. Students′ self-reflection-in-learning and common mistakes found in answering essay questions were used to offer feedback. Students′ perspectives regarding feedback were collected using a validated questionnaire. Statistical Analysis: Kruskal-Wallis test and Mann-Whitney test were used to analyze the data. A P<0.017 was considered as statistically significant. Results: The median score of each item related to reflection was ≤4 (Scale 1-7) in all categories of students (n=153) reflecting a low level of reflection. There was a statistically significant difference in total reflection scores between fail (n=46) and first class category (n=42) students (P=0.002). The majority of students agreed feedback assisted in examination preparation, enhanced individual learning and allowed examinations to be viewed as more objective. Conclusions: This study shows the usefulness of the integration of medical students′ reflection-in-learning practices and examination performance in providing descriptive feedback. This modified feedback process may have improved students′ awareness leading to acceptance and a conscious practice of self-reflection and enhanced students′ examination performance.