Effect of reflection on medical students' situational interest

Context: Reflection has been considered crucial to learning. Engaging in reflection while solving problems is expected to foster identification of knowledge gaps and interest in learning more about them, the latter being a major motivational force in learning. Although theoretically sound, this assumption still lacks empirical evidence. This experiment investigated whether reflection while diagnosing clinical cases of different levels of difficulty influences medical students' awareness of knowledge gaps and situational interest.
Methods: Forty-two fourth-year students from a Brazilian medical school were randomly allocated to diagnose six clinical cases (three difficult; three easy), either by following a structured reflection procedure (reflection group) or by giving alternative diagnoses (control group). Subsequently, for each case, all students rated their situational interest and awareness of knowledge gaps.
Results: Situational interest was significantly higher in the reflection group than in the control group (mean = 4.10, standard deviation = 0.50 versus mean = 3.65, standard deviation = 0.48, respectively; p = 0.003; range, 1-5). The effect size was large (d = 0.92). Awareness of knowledge gaps was higher in the reflection group than in the control group, but the difference was not significant. Case difficulty influenced both situational interest, which was significantly higher on easy than on difficult cases (mean = 3.96, standard deviation = 0.56 versus mean = 3.80, standard deviation = 0.55, respectively; p = 0.004), and awareness of knowledge gaps, with higher scores observed on difficult compared with easy cases (mean = 3.99, standard deviation = 0.46 versus mean = 3.66, standard deviation = 0.53, respectively; p < .001). No interaction between experimental condition and case difficulty emerged.
Conclusion: Relative to providing alternative diagnoses while solving cases, structured reflection increased medical students' interest and may therefore be a useful tool for teachers concerned with enhancing students' motivation for learning. Surprisingly, easy cases promoted higher situational interest despite the higher awareness of knowledge gaps on difficult cases. This suggests the potential for case difficulty to inhibit students' interest in learning, a possibility that demands further investigation.