Can Reflective Writing Reconcile ACGME Core Competencies with Daily Encounters in Medical Education? A Prospective, Randomized, Cross-over Pilot Study

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Introduction Residency program directors are still exploring means to teach and evaluate ACGME core competencies. Finding simple means to reconcile ACGME core competencies with daily encounters offers a unique opportunity. Reflective writing through narratives may be the answer to simple and affordable means to achieve such goals. Methods To investigate the educational value of reflective writing, we conducted a prospective, randomized, cross-over pilot study among family practice residency program residents. The intervention group was introduced to the educational intervention. During the intervention, each narrative was analyzed by the authors, sentence by sentence, helping the learners spot ACGME core competencies. A week later, both groups were given five preselected narratives (test narratives) to analyze and identify what ACGME core competencies were reflected. A week later, the control group was subjected to the same intervention to comply with the cross-over design of the study. Data were then collected and a statistical analysis was completed. Results Nine learners were randomized into the control group and ten were randomized into the intervention group. Each learner analyzed ten sentences within the five test-narratives. The mean score for each learner across the ten sentences was calculated. The grand mean score for each group was calculated. The grand mean score for the control group was 58.75 (SD 13.4). The grand mean score for the intervention group was 69.90 (SD 15.8). Our one-tailed t test analysis showed no significant difference between the two groups (t = 1.647, df = 17, p = 0.057). Conclusion Our pilot study failed to show any statically significant improvement in the learners ability to reconcile the ACGME core competencies with their daily encounters using reflective writing. We identified several possibilities for the negative outcome. Sample size seems to be a major contributor. Further prospective randomized studies using larger sample sizes would be worthwhile to answer our research question.