Is Reflective Learning Visible in Online Discussion Forums for Medical Students on General Practice Placements? A Qualitative Study.

Problem: Reflection is important for lifelong learning and professional development, and discussion forums have been highlighted as a potential platform for enhancing reflection further through peer interaction and teacher feedback. Forums provide students on general practice (GP) placement the opportunity to engage in collaborative reflective learning despite their geographical isolation and disparate schedules. This case report seeks to explore whether online discussion forums demonstrate community presence and reflective learning among medical students on GP placement. Intervention: Online discussion forums were introduced into the curriculum for University of Auckland Year 5 and 6 medical students on their respective 4- and 6-week GP placement. Via asynchronous posts and comments, groups of eight students on average presented cases and experiences for discussion with peers and an overseeing GP faculty member. Context: Students were dispersed across a large geographical area and were unlikely to have peer contact in their assigned practices. Online discussion forums were implemented for a number of reasons, including facilitating reflective learning. An adapted community of inquiry framework was used to investigate the cognitive, social, and teacher presence elements visible in the discussion forum transcripts of unanimously consenting groups. Content analysis of the transcripts was performed to evaluate the presence and quality of reflective learning. Impact: The forums were predominately student-led with relatively scarce comments by GP faculty facilitators. The majority of cases and experiences presented related to clinical management of patients and dissonance triggered by the on-site supervisor's actions. Ideas, knowledge, and understanding of presented encounters were shared and built on by positive and supportive interaction, broadening students' perspectives and, at times, leading to the formation of solutions. However, students' reflection was mostly superficial. Deep reflection was rarely present, and affective dimensions of reflection were disclosed relatively less than clinical cognitive aspects of reflection. Direct instruction, based on prior experience and pedagogical expertise, was the main form of comment made by faculty facilitators, who prompted with questions to a far lesser extent. Lessons Learned: Online discussion forums appeared to enable medical students on GP placement to interact positively with peers and faculty facilitators. However, deep reflection was not reached. Modifying the discussion forums to facilitate more peer interaction and addressing the barriers that limit faculty facilitation may encourage deeper and more affective reflections.