IOwing to great flexibility inherent to the concept of
reflection, the previous researchers employed diverse
criteria and assessment methods to study the degree
of reflection in their subjects only to add to the
multiple dimensions (5-9). In contrast, authors of
the present study, at more fundamental level,
wanted to understand the perceptions of the students
in terms of their attitudes and practices towards
learning and the importance of reflection in learning.
The students here in this part of the country are
exposed to a highly competitive environment
where the time constraints limit opportunity for
reflection right from their schooling. Hence,
conducting study soon after their entry in to the
medical school was proved reasonable to have an
insight in to their minds.
The questions were carefully designed to see that
all students comprehend them rightly. Knowing about
their prior stressful memory based educational
environment, we believed it would really be difficult
for the student to respond to questions with too much
comprehension. To avoid leaving questions as blank responses, closed ended questions with ‘yes’ or ‘no’
response were administered to sustain their interest.
From the actual responses of the students to Q I, it
was observed that majority of them gave a positive
response saying ‘yes’ (86.84%) to the attitude based
questions and a negative response saying ‘no’
(61.84%) to the need oriented practices projecting
an ideal behavior on their part (Table II). Whether
these kind of contrasting responses from the
proposed indicates that students are stereotypically
tuned to give answers as if to win the impression of
the teacher or is there a degree of comprehension
present in them, intrigued the authors. The possibility
for such unexpected responses may be due to the
fact that the students might have had an inherent
ability for reflection, unconsciously driving them to
differentiate between good and bad means of learning,
without even knowing that a concept called reflection
in learning exists. Realization that, practicing need
oriented habits like rote learning etc. just to pass
out the examinations is indeed not a good practice.
However, after a brief session of priming the students
on the importance of the concept of reflection in
learning and taking their responses from Q II it was
clear that there was a tendency to shift in the
existing perceptions. After priming, their responses
were sought again using a different scale for
responses which was intentionally employed to study
the level of comprehension the student was able to
make and to know if at all priming could bring in a
change. Priming had indeed played an important role in transforming their amateur ideas on reflection in
learning about attitudes and practices in to mature
or near concrete ideas. When asked about the attitudes towards reflection in learning, from most of
them (86.84%), who said ‘yes’ in QI, only 47.36%
continued to give positive response indicating the
degree of maturity they already possessed while a
significant proportion had now become ‘neutral’
(35.52%) in their attitudes towards reflective learning.
This neutral response indicated that they started
appreciating the concept of reflection in learning,
showing their maturity to introspect and respond as
‘sometimes’ rather than simply jumping to conclusion
by saying ‘yes’. Even on the five grade Likert scale,
if they really were to jump to conclusion they could
have answered ‘always’ or ‘more often’ but their
neutral response really amazed us. Similarly, those majority of the students who said ‘no’ (61.84%) to
need oriented practices like rote learning etc. now
opted for goal oriented practices (51.31% said ‘yes’).
They, after priming, must have learnt to know that
goal oriented practices are superior and long lasting
than the others. Surprisingly, majority of them who
opted for need oriented practices before priming (38.15
% of them) shifted to ‘neutral’ response (31.57%) of
goal oriented practices. Lastly, a small proportion of
them (17.10%) remained refractory to welcome any
change in their attitudes towards reflective learning
as well as goal oriented practices even after priming
(Table II).
The unusual and unexpected contrasting responses
as discussed above inspired the authors to
investigate further in to the factors possibly
responsible for the students’ varied responses. For
this purpose, the authors thought of making an
attempt to understand the young minds of students
operating using the defense mechanisms (18, 19).
When asked about the attitudes towards reflective
learning, though an entirely strange concept to them,
most of them saying ‘yes’ portrays their application
of defense mechanism of ‘Acting out’, wherein,
there is a direct expression of an unconscious wish
without being aware of the emotion that drives the
expressive behavior. This innate emotion present in
every one of us is the emotion for reflection. Called
by a few as the inner conscience, this reflection
acts like a comparator for wanted or unwanted
behavior.
When asked about the need oriented practices
majority of the students saying ‘no’ to what is an
expected practice is another point to discuss. They
were probably exercising the defense mechanism
of ‘Dissociation’ wherein the emotional distress
experienced by them during such un-targeted and
blind practices to get through their examinations have
driven them to modify their identity or character to a
perceived safe zone where they could boldly stand
and say ‘no’ to such need oriented practices in
learning.
The small group of students who were refractory to
any change even after priming probably was operating he defense mechanism of ‘Reaction formation’. This
defense explains that even though the inherent
tendency in the unconscious mind instructs them
towards a positive change, which, in this study, is,
‘to reflect’, they remained refractory. This may be
due to some distressing or uncomfortable emotions
preventing them to actively indulge in priming and
reform their ideas. This is the group probably with
loads of issues or concerns to be resolved. This
group poses the challenge to the medical teacher
wherein planned mentoring sessions are required to
bring them in the first instance to the level of
operation of the defense, ‘Suppression’ so as to at
least counsel them to suppress their distressing
emotions and prepare them to cope up with the
reality. Such serial mentoring sessions would finally
help this group distance themselves from such
emotions and enter the level of ‘Intellectualization’
Conclusion
This study on the perceptions of the medical students
about the concept of reflection has helped the authors
to analyze their varied behaviors probably operating
through defense mechanisms at different levels. This
study recommends that medical teachers may
attempt to understand the underlying psychological
principles that define a student’s perceptions towards
learning. Hence, the medical teachers should be encouraged to take up the role of a mentor and
promote reflective classrooms to introduce
approaches that channelize the behavior of the
medical student towards reflection in learning at the
beginning of the undergraduate course itself (20).
The medical education institutions may carefully plan
their curriculum so as to cater specific hours to teach
the art of reflection which will only free it from the
limits of hidden curriculum to a more explicit one.
Few of the methods that may be employed are
maintaining log books, faculty sharing their
experiences of reflection, videos stimulating reflection,
etc. Further studies are required to design strategies
to improve the performance levels of students through
such metacognitive skills so that learning becomes
a continuous process in the life of the student. The
authors finally emphasize the fact that it should be
the right of every medical student to be given the
opportunity to learn the art of reflection.
Limitations
The study however does not measure the behavior of
the student in an objective manner for which further
analysis of mind and body are necessary using
appropriate psychometric instruments. Nevertheless,
the study provides new insights for researchers to
further explore student behavior in a more objective
manner.
