“Tweet”-Format Writing Is an Effective Tool for Medical Student Reflection

Reflective writing during medical education allows for professional growth through retrospective analysis of experiential knowledge. However, these writing assignments can pose a challenge to millennial medical students who are more likely to assimilate knowledge through the use of innovative technology and who prefer their data in a concise format. Here, we present a novel, tweet-style reflective writing assignment to better engage the unique skill set of today’s medical students. We analyzed the written content partway through the year to determine whether or not the format retains the impact of longer, more structured reflective writing assignments. Surgical clerkship students were required to reflect on 3 distinct experiences through a 140-character written reflection, or tweet. Students were able to submit these assignments at any point during their rotation through a platform available on their smartphone or computer. There were no specifications with regard to content. These reflections were analyzed using modified grounded theory methods. Each tweet was analyzed by 2 individuals to ensure intercoder reliability. Codes were created a priori with respect to positive and negative domains, and type of experience. Department of Surgery, Warren Alpert School of Medicine, Brown University, Third Year Medical Student Surgical Clerkship. Third year medical students at the Warren Alpert School of Medicine, Brown University. Fifty-six medical students were included in this study. During the first 4 blocks of the 2016-2017 academic year, 56 students rotated through the third year surgical clerkship. One hundred and sixty-eight tweets were collected and coded. Sixty-nine tweets (42%) had a positive valence. Students reflected on the following experiences: patient interaction (54%), surgical education (34%), physician/resident interaction (27%), and career decisions (11%). Overall, 87 (52%) tweets were reflective. Many tweets included emotional reactions to specific experiences. Using tweet-style reflective writing, students identified and reacted to multiple salient experiences from their surgical clerkship. They reflected on both positive and negative emotions, mostly related to personal interactions with patients, but also associated with their education, their team, and their future career. Based on early analysis of the data, we believe that short format writing can be an effective format for reflection.