Table 6.

Shortcomings of RW programs

Shortcomings of RW programs	Elaboration
Problems found in implementation of RW curriculum	Anxiety with having their private thoughts being shared with others  ° Preference for one-on-one sharing with tutors instead [129, 149, 209, 231]  ° Censorship of thoughts and reflections when sharing with others [37, 114, 136, 149, 160, 183]  ° Process of sharing could feel impersonal if sharing is done virtually [165] May fail to cater to the different learning styles of users [220, 232]  ° Query as to the extent that writing may be able to capture elements of the users’ reflective processes [118]  ° Other modalities for reflection (e.g. blogging) might have greater appeal to users [120]  ° RW too restrictive for more experienced users due to rigidity of suggested frameworks [142, 196] Barriers to user participation  ° Lack of time and fatigue [29, 119, 136, 138, 157, 161, 167–169, 176, 181, 193, 196, 226, 232, 233]  ° Lack of self-direction and motivation [29, 79, 119, 176, 188, 226, 231]  ° Difficulty dealing with negative emotions arising from reflecting on difficult events [114, 168, 176, 193, 230]  ° Felt that RW was unnecessary as they were already adept at introspection [227] Objectives were not clearly defined to users and assessors  ° Greater clarity of goals of RW needed throughout course for users to understand importance of what they were doing [114, 129, 135, 138, 142, 209, 227]  ° Greater emphasis to be placed on role of assessors for them to provide adequate feedback and mentorship for users [50, 138]
Factors affecting quality of reflection	Lack of confidentiality and trust resulting in censorship of genuine thoughts and reflections [37, 114, 136, 149, 169, 183, 196] Lack of support and feedback from mentors [37, 119, 133, 196] Problems relating to writing  ° Language competencies affecting expression [167, 229]  ° Learning to write in a new voice unlike academic writing [114, 136] Decreased authenticity of reflections to meet expectations of graded curriculum [9, 115, 157, 161, 166, 193, 209, 234] Did not take module seriously due to it being formatively assessed [114, 172, 182, 226] Enforcing of daily reflections caused users to reflect on experiences that were insignificant [119, 235, 236]
Problems found with assessment of RW curriculum	Assessment distracts users from the essence of reflection  ° Grading pressures users to write for approval [114, 115, 118, 129, 138, 143, 149, 155, 157, 209, 232, 237, 238]  ° Assessment causes censorship of tension of ethical dilemmas or censorship of unconventional opinions [119, 209] Faculty’s confusion with assessment of reflection  ° Uncomfortable with idea of reflection due to lack of experience [115, 226]  ° Inconsistent definitions of reflections [114, 133, 188, 237]  ° Subjective nature of judging the content [237]  ° Influence of writing ability [132, 174, 180, 183]  ° Lack of confidence in correlating assessment grade with depth of reflection [29, 105, 118, 126, 177, 207] Problems with rubrics  ° Unclear rubric categories with overlaps between different levels [145]  ° Difficulty maintaining a consistent high inter-rater variability [143, 239]
Possible problems with reflection in itself	Triggering of negative emotions which users are unable to escape  ° Questioning what has always been instinctual knowledge or status quo might bring instead a sense of uncertainty which complicates decision-making [207, 240]  ° Users might become overly critical of themselves [207, 241]  ° Self-doubt [225] Becoming negatively self-isolated  ° Personal forms of critical reflection might have the unintended effect of users becoming too focused on themselves instead [207] Could distract learners from spending time on technical skills or knowledge acquisition [207, 225]