Considerations in the use of reflective writing for student assessment: issues of reliability and validity
Bibliographic record
Abstract
CONTEXT: Reflective writing is a popular tool to support the growth of reflective capacity in undergraduate medical learners. Its popularity stems from research suggesting that reflective capacity may lead to improvements in skills such as empathy, communication, collaboration and professionalism. This has led to assumptions that reflective writing can also serve as a tool for student assessment. However, evidence to support the reliability and validity of reflective writing as a meaningful assessment strategy is lacking. METHODS: Using a published instrument for measuring 'reflective capacity' (the Reflection Evaluation for Learners' Enhanced Competencies Tool [REFLECT]), four trained raters independently scored four samples of writing from each of 107 undergraduate medical students to determine the reliability of reflective writing scores. REFLECT scores were then correlated with scores on a Year 4 objective structured clinical examination (OSCE) and Year 2 multiple-choice question (MCQ) examinations to examine, respectively, convergent and divergent validity. RESULTS: Across four writing samples, four-rater Cronbach's α-values ranged from 0.72 to 0.82, demonstrating reasonable inter-rater reliability with four raters using the REFLECT rubric. However, inter-sample reliability was fairly low (four-sample Cronbach's α = 0.54, single-sample intraclass correlation coefficient: 0.23), which suggests that performance on one reflective writing sample was not strongly indicative of performance on the next. Approximately 14 writing samples are required to achieve reasonable inter-sample reliability. The study found weak, non-significant correlations between reflective writing scores and both OSCE global scores (r = 0.13) and MCQ examination scores (r = 0.10), demonstrating a lack of relationship between reflective writing and these measures of performance. CONCLUSIONS: Our findings suggest that to draw meaningful conclusions about reflective capacity as a stable construct in individuals requires 14 writing samples per student, each assessed by four or five raters. This calls into question the feasibility and utility of using reflective writing rigorously as an assessment tool in undergraduate medical education.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.030 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".