Reflective Teaching Journals as an Effective Embedded Formative Assessment Process of Teaching Skill Development Confidence in a Longitudinal Medical Student-as-Teacher Elective

Abstract

Background

This study focuses on the use of reflective teaching journals by fourth year US allopathic medical school students (MS4) during a longitudinal medical student-as-teacher (SaT) elective, and how MS4s self-assess their perceptions around teacher skill development and individual transitions into resident educators who teach junior learners.

Method

Between September 2020 and December 2020, twelve MS4s in a longitudinal SaT elective completed 21 hours in a clinical bedside student teaching placement with embedded structured reflective teaching journals. Sixty-nine individual reflective teaching journal entries were collected in two distinct stages and analyzed using a phenomenographical lens.

Conclusion

From these data, the author established three thematic categories where reflective teaching journals reveal (a) a framework for pedagogical skill building, (b) provided a sense-making tool to navigate the psychosocial environment, and (c) a framework for educator identity formation. Structured reflective teaching journals with educator feedback support self-reflection and awareness of growth through the SaT elective. Health professions educators can leverage the reflective teaching journal as a formative assessment process to help learners identify transitions and grapple with educator identity confidence and the formation of new teacher skill development to further advance the field of future health professions education.

Introduction

The development of effective medical student teachers requires ongoing practice in self-assessment of learning needs, independent analysis and synthesis of information, and shared feedback on these skills [1–3]. Student-as-Teacher (SaT) training programs are uniquely designed to provide the students with the opportunity to put into practice pedagogical content and teacher skill development in real classroom environments [3–14]. Students in SaT programs need specific contextualized feedback and opportunity to self-reflect and be critical of things that change in their teaching practice to engage in a deeper learning process and improve their newly formed teacher skills [15, 16]. Embedded formative assessment methods support self-regulation of learning and encourage reflective thinking, which are essential to enhance student learning of foundational concepts in teacher skill pedagogy [2, 15–17].

Reflective teaching journals are widely recognized and advocated as a model for self-assessing teaching skills within preservice teacher education programs [16, 18–22] and health professions education programs [6–14]. Reflective teaching journals are designed for student teachers to further shape teacher skills through the act of written reflection and self-assessment, for the purpose of analysis and reassessment, which make explicit gains in knowledge about their growth and performance while in the teaching field [3, 22, 23]. When embedded into the day-to-day routines of student teaching as a formative assessment process, reflective teaching journals foster the construction of teacher skills and the development of logical problem-solving techniques. This practice plays a key role in cultivating self-efficacy and fostering growth as educators, thereby preparing student teachers for the next phase of their academic journey [24].

The use of reflective teaching journals has many benefits. The primary aim of reflective teaching journals is to improve teacher skill development and foster self-reflection and self-assessment skills in student teachers [16, 18, 21, 25]. Much of the educational literature on reflective teaching journals refers to the design and delivery as a self-assessment tool within curricular experiences such as clinical rotations and preservice student teaching classrooms. Several studies have investigated the benefits of incorporating reflective teaching journals through different phases of the educational journey—prior to, during, and after clinical rotations—aiming to foster a deeper understanding of self-awareness in patient care [2, 15, 17, 26]. Other studies describe different journal types, such as reflective and collaborative journals among peers and faculty, which may take the form of unstructured journals with open-ended questions or structured ones with predefined prompts and submission procedures [16, 18, 27]. For programs that embrace reflective journals in practice, key design characteristics with greatest potential to maximize their effectiveness include intentional guided practice process such as journal reflection training or guidelines [2], entries and prompts to elicit responses based on learning objectives [25], and active dialogue or high-information written feedback loops between faculty and student teachers [18, 23].

Incorporating reflective teaching journals into SaT program curricula as an embedded formative assessment method necessitates careful consideration of several key elements. These include the development of a structured framework or template for journal entries, the establishment of a defined number of required entries, the creation of content-specific journal prompts, and the integration of student teaching placements coupled with faculty feedback [3, 15, 17]. Research conducted by Pieper et al. (2012) and Alt and Raichel (2020) sheds light on the importance of in-depth faculty feedback, which has been found to enhance the quality of self-reflection and conceptual knowledge among learners [16, 25]. To optimize the effectiveness of this approach, it is essential to allocate dedicated time for the regular delivery of cyclical or repetitive reflective teaching journals, coupled with high-information faculty feedback. This integration into SaT learning experiences serves as a valuable tool for student teachers, fostering the development of critical thinking, self-awareness, and metacognitive skills to help [4, 23, 25]. Furthermore, student teaching placements in established1 courses allow for dedicated time to teach and reflect on their practice, while receiving tailored feedback from expert faculty, ultimately elevating the quality of their reflections [2, 16, 28].

There is evidence to suggest that the use of reflective teaching journals as formative assessment offers a variety of benefits for the medical student teacher including reflective thinking about and transition in their educator identity formation [17, 18, 25, 27, 29]. In this way, self-assessment and reflection “both evoke the personal process of deepening understanding to discover and learn for the purpose of improving an aspect of life” such as education [8, 35]. Therefore, this study focuses on how MS4s use embedded structured reflective teaching journals to assess their perceptions around teacher skill development, while in a fourth-year SaT elective, and how they anticipate their individual transition into resident educator (PGY) who teaches medical students. To guide this investigation, the researcher used the following research questions to guide the study: (a) What roles does the reflective teaching journal play in the transition of MS4s in a SaT elective? And (b) In what ways did MS4s self-assess and reflect on their confidence as new teachers?

Materials and Methods

This research is informed by the Transitional Theory paradigm—a model which asserts learner growth is supported through a structured sequence of instruction, practice, and feedback within a community of practice [24, 29–31]. It is within communities of practice such as (SaT) programs that learners will continuously develop and shape their teaching skills and recognize their individual learning edge as new teachers through engagement in student teaching placements and learning events that result in changed relationships, routines, and assumptions and roles about teaching [3, 24, 29]. The researcher used a phenomenographical approach to study and analyze the subjective experiences of twelve MS4s from one medical school SaT elective.

As part of a doctoral dissertation single-site study [32], the University of Pittsburgh Institutional Review Board approved the study, conducted at a different university, as exempt (STUDY20080031). The University of Pittsburgh served as the IRB of Record while the context of this study was at West Virginia University (WVU) School of Medicine (SoM) in Morgantown, WV. An Educational Site letter granting permission to implement the study was approved by the WVU SoM Vice Dean for Medical Education and Academic Affairs. Informed consent was obtained from all individual MS4s included in the study.

Participants and Setting

Medical Students as Educators (MSaE) is a longitudinal SaT elective. It is 9 months long and designed to introduce MS4s to basic teacher skill development in preparation for their role of resident who teaches (PGY). MS4s are required to complete student teaching placements in the clinical and non-clinical learning environments. The clinical student teaching placement includes teaching for 2 h every 3 weeks, during one semester, within an established course—Physical Diagnosis and Clinical Integration 3 (PDCI).2 Each MS4 had a preceptor (who was the expert teacher in the PDCI course), and two second year medical students (MS2) enrolled in the PDCI course. The MS4s teach lessons based on PDCI content covering in-patient clinical bedside skills (taking a detailed history and completing a physical exam) (6–8 sessions) they planned with the preceptor’s assistance. The clinical student teaching placement is undertaken after the MS4s have completed a 2-hour module on bedside teaching (overview of clinical bedside teaching pedagogical concepts, teaching to varied learner abilities, giving feedback). Additionally, MS4s attended monthly group workshops, taught by the MSaE elective director, which provided opportunity to discuss group reflection entry themes such as student teaching trends and provide high-information feedback and teaching skill development.

Data Sources

As part of the MSaE elective requirements, twelve MS4s were assigned to complete individual reflective teaching journal entries on their clinical teaching skill experience (see Table 1). A module on bedside teaching included the description, objective, instructions for journaling (the purpose of reflecting journaling, how often to journal, length of entry, what items to included), as well as a sample of questions. Monthly written feedback loops from MS2s, preceptor, and the MSaE elective director were provided to the MS4, in the form of a journal entry response through email. Responses included comments, group reflective questions, corrective plans for the next PDCI session, and suggested reading materials. Journal entries were not graded yet were required to pass the elective. All individual journal entry data captured was anonymous.

Table 1.

Reflective teaching journal template

Data Collection and Analysis

This study relied upon two stages of qualitative measures for data collection, from September 2020 through December 2020: (1) bi-weekly individual reflective teaching journals (2 submissions per month) 1–2 paragraphs in length, and (2) summative post-reflective teaching journal, 2 paragraphs in length, based on their overall clinical student teaching experience [33, 34] reflected in Fig. 1. In stage I, bi-weekly reflective teaching journals provided monthly formative feedback, from the MS4 to the MSaE director, and a specific format was used in the process. Students were provided with a prompt and several reflective questions to pick from addressing teacher skill development (Table 1). The MSaE director responded to the individual journal posts. The student teaching preceptor gave formative feedback about topics such as planning and teaching activities throughout the semester. At the end of the month, the MS4s received written summative feedback from their preceptor, MS2s, and the MSaE director on their individual teaching performance progress, in aggregate, which was incorporated into their bi-weekly journal posts on reflective teaching practice. Reflective journal entries were typed into West Virginia University’s Health Sciences Center portal for online education, SOLE (Study, Observe, Learn, Engage, Morgantown, WV). In stage II, all MS4s were provided summative feedback data, by the MSaE elective director, on their clinical bedside teaching performance to date and asked to submit one post-reflective teaching narrative (journal) prompt (Table 2). Post-reflective teaching journal entries were typed into Qualtrics (Qualtrics, Provo, UT).

Fig. 1.

Feedback process map

Table 2.

Summative post-reflective teaching journal template

Analysis Coding

Analysis of all individual journal entries relied upon a qualitative inductive content analysis [33, 34]. This analysis involved a multi-step process: First, monthly individual journal entries were reviewed as one set of data and were coded with individual meaning units (open codes) noted in single word descriptions or phrases of words written by the MS4s [33, 34]. Specifically, the researcher identified the ways in which the MS4s reflected on use of teacher skills in their practice and words that reflected transformation of self from student to teacher. Second, the researcher compared monthly individual bi-weekly reflective journals with previous ones to identify new meaning units until no new information was present and core meaning unit categories (themes) were solidified [34]. The same process was repeated with the individual post-reflective narrative. Internal validity evidence included investigator triangulation with peer doctoral committee review and memoing. In the final step, an additional layer of analysis involved comparing and contrasting relationships between 23 open codes which resulted in the generation of three categories (Table 3). Since the aim of the study focused on the anonymous experiences of MS4s within a SaT course, member check was not used.

Table 3.

Frequency and spread of individual meaning units related to individual journal entries and post-narrative reflection after data reduction process

Category	Individual meaning units which comprised the category	Frequency of journal entries where category presented
Pedagogical skill building
	Assessment of learning/learners (ability)	23
	Bedside (procedural) teaching skill development (e.g., DDx, Hx)	33
	Classroom teaching skill	26
	MSaE course tools to build and support growth	24
	Feedback and assessment as teaching tool	22
	Interpersonal and communication skill development	14
	Planning, pacing	14
	Time management	10
	Virtual teaching challenges	9
Sense-making tool to navigate the psychosocial environment
	Building rapport (trust) with learners	16
	Comfort in teaching	8
	Demonstrating empathy with learners	6
	Hierarchy of leadership in medicine	7
	Positive teaching environment	11
	Safety, psychological safety	11
Educator identity formation
	Adaptability, flexibility	11
	Educator identity formation and professionalism	9
	Imposter syndrome	4
	Feedback cycle and self-improvement	25
	Teaching field placement (co-preceptor/M2s) for self-improvement	16
	Professional independence (autonomy)	10
	Sense of teaching style (confidence in)	20
	Transitions from student to educator	21

Results

Twelve (100%) MS4s completed the bi-monthly individual journals. The frequency and percentage of items responses across the 3 months are detailed in Table 4. There were 69 (82%) individual journal entries submitted. One MS4 missed a deadline to submit the summative reflection. Other MS4s combined individual journal entries into one single entry, which altered the overall individual count. Entries were typically 1–2 paragraphs in length addressing 2–3 of the journal prompt questions (see Tables 1 and 2). The highest levels of confidence were reported in the “November” journal posts with (62.5%) “Very Confident,” and the lowest levels of confidence were reported in the “September” journal posts with (15%) “Very Confident.” While the bi-weekly journal entries contained seven questions, the most frequently employed ones were questions 1, 2, 3, and 6 (see Table 1). These questions pertained to the educational setting for teaching, the application of skills and knowledge in teaching practice, new ideas about teaching, and limitations or gaps in knowledge. Collectively, the MS4 journal entries in November primarily focused on addressing question no. 4 regarding teacher confidence and identity. The researcher found three overarching themes which support the initial research questions: Reflective teaching journals revealed (a) a framework for pedagogical skill building, (b) provided a sense-making tool to navigate the psychosocial environment, and (c) a framework for educator identity formation.

Table 4.

Frequencies and percentages of item responses across the four months of individual journal entries

Item Monthly journals	(1) Not confident n (%)	(2) Somewhat confident n (%)	(3) Confident n (%)	(4) Very confident n (%)	Mean	Total
September	0 (0%)	3 (15.0%)	11 (55.0%)	6 (30.0%)	3.15	20 (100%)
October	0 (0%)	0 (0.0%)	9 (40.9%)	13 (59.1%)	3.59	22 (100%)
November	0 (0%)	1 (6.2%)	5 (31.3%)	10 (62.5%)	3.56	16 (100%)
December	0 (0%)	0 (0%)	5 (45.5%)	6 (54.6%)	3.55	11 (100%)
Total	0 (0%)	4 (6.90%)	30 (43.1%)	35 (50.1%)	3.43	69 (100%)

Reflective Journaling as a Framework for Pedagogical Skill Building

Student teachers shared that reflective journaling provided a useful framework for thinking about pedagogical skills building and the role of the educator to apply the skills in the learning environment. One MS4 shared their experience with the importance of classroom management skills such as discussing clinical classroom norms and expectations for learning: “It was great to see how my [PDCI] co-preceptor made her expectations clear [to the MS2s]…being up front about expectations is very important especially in a learning setting that is clinical.”

For several student teachers, reflective journaling exercises drew attention to specific clinical classroom management skills to improve upon such as time management, lesson planning, and the pre-planning of breadth and depth of content to be covered. One MS4’s journal entry noted, “Time management is difficult. It is hard to limit time with M2’s [junior learners] because I think there is a lot that can be learned.” Another MS4’s journal entry stated, “It’s hard to be ok with not covering everything in one session…. truly listening and meeting students where they are at.” For many of these new student teachers, journaling provided an introspective space to write about how they grappled with the intersection of thinking like a teacher and a student. As explained by one MS4, after teaching MS2s at bedside during an unexpected patient encounter.

[...] we had a patient encounter where our patient became extremely emotional. This was my students’ first interaction where they had a patient crying in the room. I have previously been really focused on goals to accomplish for each meeting and clinical material that might be helpful. However, when this occurred, I realized that I need to also feel comfortable just giving students advice about an unexpected situation. I also wasn’t sure if I should intervene or if I should let the students try to work through such situations ... my [PDCI] co-preceptor intervened, and we tried to ensure that the patient felt comfortable and wanted to keep talking ... Seeing how my co-preceptor handled the situation was really helpful. (MS4, J24)

All MS4s monthly reflective journals drew attention to iterative teaching approaches in clinical bedside pedagogical skills such as taking a detailed history and completing a thorough physical examination. However, it was in the post-reflective journal that revealed their full self-assessment purpose of gained confidence in teaching.

[…] I could sense my confidence growing as I progressed through the course and got practice with methods like the 1-minute preceptor model as well as giving feedback. As I learned the theories behind various teaching styles and the idea of “learning your learner,” I could feel myself experimenting with different methods. ... we were given the tools to learn about the science behind why different teaching methods work, but we were also given so much flexibility to truly develop our own style and confidence. (MS4, J01)

These MS4 examples exemplify the investigation of the first and second research questions. They demonstrate the seamless incorporation of a reflective teaching journal into the learning process, facilitating a more deliberate self-assessment of how teaching events shape and build upon their confidence in teaching skill development as new teachers.

Reflective Journaling Provides a Sense-Making Tool to Navigate the Psychosocial Environment

Student reflective journals were used to make sense of the psychosocial environment with common behaviors encompassing sharing empathy, creating a safe learning environment, and sustaining rapport through effective interpersonal and communication skills. For example:

Even if I was addressing an area of improvement, I also tried to really normalize it. I would state that “I also used to have difficulty transitioning through different parts of the history, and sometimes it made me nervous because I wanted to make sure I was remembering all of the important questions.” Making this type of comment seemed to help my students feel more comfortable in knowing that this was simply a skill that everyone works towards, and we will work towards it together. (MS4, J19)

Throughout several of the MS4 individual journal entries, there were tones of how the hierarchical system was an underlying theme for which the MS4 internally grappled with while teaching MS2s. Journal statements such as “I tried to normalize [feedback] so [learners] don’t feel bad,” and “not as harsh as [feedback] would be from an attending [PDCI preceptor],” or “I try to be welcoming overall,” and even “down to earth” ascribe elements of the shared hierarchical struggle within their mindset that they intended to reduce in practice.

A different student positioned trust building as both the combination of demonstrated empathy and sharing similar life experiences. If their MS2s could see how close the MS4s are in their medical education curriculum to the learners, they too would understand the value of the content being taught. In other words, the MS4 became the bridge between the preceptor and the MS2. One student described it this way:

[...] I think one of the most important things an educator can learn (i.e., how do I convey what I know to someone else and make them understand why its (sic) important for them to learn it as well). For me this has been to share my prior experiences that they can relate to (ex, avoid these mistakes and pitfalls that I made when I was in your shoes, they love to test this on the OSCE, this is the way you are taught in class but in clinical medicine it’s done very differently, etc). This provides me with a unique angle that I can use to compliment what my [PDCI] preceptors are co-teaching. It furthermore makes me feel like the things I’m teaching matter and gives me a sense of agency in my students’ education. (MS4, J03)

As can be seen from their journal entries, the MS4s used the journals to transparently document how they process their transition from MS4 to PGY, which addressed research question 1. The journal, as a tool, encompassed their ability to self-assess their learning needs, their efforts in enhancing teaching and learning environments by drawing insights from their own successful outcomes, and their empathetic perspective gained from reflection on personal experience in the shoes of the MS2.

Reflective Journaling as a Framework for Educator Identity Formation

All participants wrote about their new self-awareness and about what it takes to become a good teacher, which involves the negotiation between self-as-student and self-as-teacher. “I am learning more and more to focus on teaching and observing rather than thinking of what I would do as a student. This is becoming much more natural and I find it easier to observe their [MS2] skills.” The reflective teaching journals became a framework for building MS4 educator identity, focusing their teaching goals on their MS2 progress and less on their own as a former MS2, but also clearly acknowledging the personal professional goals to work on. As explained,

[…] I found myself taking on more of a teacher role instead of thinking about what I would want to ask the patient at a MS4 level. This helped me focus more on what basics she was missing or asking correctly to the patient ... provide better feedback at her level as a MS2. (MS4, J4)

Other descriptions were external factors such as written and verbal feedback loops from the PDCI preceptor on how to implement direct change. One MS4 wrote, “I was not sure how I would transition from student to teacher but having a good attending [PDCI preceptor] to mentor me was important to help me along the way. My feedback was always positive and I always felt confident teaching […].” And another student teacher wrote, “I just need to continue to actively seek feedback. I feel like that is the true mark of an effective teacher – not only one who educates, but one who constantly looks for ways to improve themselves to better their teaching for their students.” The MS4s self-reflected on the positive impact of transition outcomes reliant not on the change itself but rather on the person’s perception of the change.

MS4s described their overall perception of this growth in their summative post-reflective summative teaching journal, and they specifically discussed how their student teaching learning experiences were linked to their transformative professional and personal development. For example,

Overall I see myself often thinking back to the feelings I had as a [MS2] student and how those impacted my learning experience. I remember what types of interactions gave me positive feelings and allowed me to ask questions freely and which interactions made me feel like I shouldn’t ask anything. I try to re-create the positive interactions with my students, and I think it has been working well so far ... I want to maintain my introspective teaching style and I want to be perceived as willing to make time to teach my students and patients as opposed to not having enough time/making them feel like I’m doing them a favor. (MS4, J35)

The results of the qualitative analysis indicated that regardless of MS4s individual teaching experience, a structured reflective teaching journal was instrumental in their discovery of self as a new educator transitioning to PGY and an overall upward trajectory of increasing confidence throughout the student teaching placement (see Table 4).

Discussion

This study examined the role of reflective journals as a self-assessment tool within an assessment process including structured prompts for student teachers in a medical SaT elective. This paper provides a unique perspective as it identifies how student teachers used the reflective teaching journal as a self-assessment tool for deliberate self-reflection assessment of new teacher skill development, gained confidence in the teaching field, and visible improvement in their transition from learner to teacher. This is important given the current emphasis on self-directed learning by the Liaison Committee on Medical Education [1]. The implications of this study suggest that medical SaT electives should provide opportunities for self-assessment coupled with written cyclical feedback loops through structured reflective teaching journals at the conclusion of each month.

The findings align with existing research in health professions education, underscoring the valuable and positive impact of reflective teaching journals as a self-assessment tool within an assessment process. Previous research in nursing and dental school [2, 17, 35] and preservice teacher programs [18–22] has consistently supported the value of reflective teaching journals paired with cyclical feedback. Recent studies further highlight that learners who use reflective teaching journals in concert with expert educator cyclical feedback loops demonstrate higher level self-reflection skill development [16] and critical thinking [5, 35]. Authors Yan and Careless (2021) posit that when designing assessment criteria, educators are tasked with “designing learning environments that provide students with plentiful opportunities to actively involved themselves in purposeful feedback activities which support the self-assessment process” (Carless 2020 as cited by Yan and Careless, 2021, p. 1121). The interplay of contextual feedback from others and self within the journaling process cannot be understated. Although there are many reasons for use of reflective journaling, the use of reflective teaching journals as an effective self-assessment tool for gauging learners’ progress towards meaningful change is key.

The major contribution of this study is that it expands upon previous qualitative research on the use of reflective journaling as a self-assessment tool to evaluate instructional approaches in health professions education. The rich reflections in this study, in which MS4s engage in deep introspection regarding their cognitive awareness of teaching skill development, suggest that incorporating reflective journals into the SaT curriculum need not be an overwhelming task. Some student teachers in preservice education programs have regarded reflective journaling as a perfunctory task in a packed curriculum [18]. However, when embedded into the assessment process, synchronized with student teaching placements, and accompanied by clear journaling guidance by the instructor, the practice of maintaining reflective teaching journals could serve as a source of motivation for uncovering latent teaching skills. The discovery of hidden skills, along with cyclical formative feedback, creates what Alt & Raichel (2020) describe as a routine process which enhances the engagement of learners in the process of journal writing and self-reflection for future planning [25]. A better understanding of how student teachers use reflective teaching journals for self-assessment to cultivate critical self-reflection skills early in their academic journey can offer valuable insights and confidence as they prepare for their future roles as educators and physicians.

As the literature has pointed out, participation in teaching communities of practice (CoP), such as SaT programs with likeminded individuals, plays a pivotal role in shaping educator identity, nurturing self-awareness and a sense of belonging [3, 35, 36]. The CoP in this study comprises PDCI preceptors, MS2s, the MSaE director, and fellow MS4s. When discussing how the MSaE course has afforded them the chance to explore their interest in education within this supportive community, one MS4 noted, “the MSaE course has connected me with opportunities to develop educational resources for children, in line with my goal of adolescent psychiatry…a large part of my career will be to connect with youth learners…” Thus, a significant benefit of the role of structured teaching journals in an SaT program is that it draws out educator identity.

Reflecting now on the initial research question as to whether the MS4s anticipated transitions into PGYs who teach, it is evident that reflective teaching journals play a crucial role in facilitating this development. Within these journals, most MS4s articulated their evolving teaching skills and their varying levels of confidence. However, upon closer examination, it becomes apparent that nearly all MS4s have reported increased confidence in their teaching abilities as future PGYs, as demonstrated in their summative post-reflective teaching journal. This increased confidence resulted from written feedback loops provided by the PDCI preceptor, MS2, and MSaE director, validating their thoughts and behaviors on what it looks and feels like to become an educator. On average, written summative feedback by the MSaE director required 20 min per MS4. Some MS4s appeared surprised in their own learning journey and how uncertain they were with their own change. For example, one MS4 checked both “confident” and “not confident” in their summative post-reflective teaching journal as they did not feel they were a “professional educator” yet although they felt they had gained plenty of experience to be “on par with where an MS4 should be” in their academic career. These findings align with the principles of Transitional Learning Theory, which suggests that during a transition, various elements such as relationships, routines, assumptions, and roles undergo transformation [29]. In the case of MS4s, this transition led to a positive impact, as they began to adopt a teacher’s perspective rather than that of a student.

Limitations

The study has two limitations. First, the study was conducted during the COVID-19 pandemic and resulted in the MS4 participants having to occasionally teach MS2s virtually before interacting in person with patients at bedside. The virtual environment was less conducive to teaching bedside skills, and this unfamiliar educational paradigm created some tension leaving MS4s and PDCI preceptors feeling constrained in what they teach and how they teach it. Moreover, not all PDCI preceptor teams could maintain a consistent learning schedule with planned meetings and educational objectives because of COVID-19 restrictions to patient care. As a result, some of the MS4 participants did not post a bi-weekly teaching journal reflection and, therefore, the journal entries were limited. A second limitation includes the role of the researcher in the study who served as both the lead researcher in the study and simultaneously directed and instructed within the MSaE elective. During her role as course director, all MS4s could contact her for support in their teaching and learning progress, which may have contributed to response bias in some journal posts about their overall impression of the MSaE elective. Additionally, the researcher maintained contact with peer observers and reviewer who provided insight and oversight into the methodology, design, and data collection process, effectively helping to identify any biases or potentially problematic research practices.

Conclusion

This study explores the utilization of structured reflective teaching journals as embedded formative assessment process designed to facilitate MS4s self-assessment of their perceptions regarding teacher skill development and confidence, in anticipation of their future roles as PGYs responsible for teaching. The findings underscore the effectiveness of reflective teaching journals within SaT programs, as they promote self-reflection, cognitive development, and valuable feedback. A beneficial extension of this research would involve implementing tracked structured reflective teaching journals as part of the MSaE elective, which follows the individual MS4 journey. This extension could provide further insights into the tangible benefits of a comprehensive teaching program, including a clinical teaching placement, and its implication on the transition of medical students to PGY roles. In summary, the results from this study indicate positive improvement in teacher skills acquisition and confidence as new teachers using structured reflective teaching journals.

Data Availability

The data that support the findings of this study are available from the corresponding author, AL, upon reasonable request.

Declarations

Conflict of Interest

The author declares no competing interests.