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Factors confounding the assessment of reflection: a critical review

Sebastiaan Koole1*, Tim Dornan2, Leen Aper1, Albert Scherpbier3, Martin Valcke4, Janke Cohen-Schotanus5 and Anselme Derese1

Author Affiliations

1 Centre for Educational Development, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

2 Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands

3 Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands

4 Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Belgium

5 Centre for Research and Innovation in Medical Education, Faculty of Medical Sciences, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands

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BMC Medical Education 2011, 11:104  doi:10.1186/1472-6920-11-104

Published: 28 December 2011



Reflection on experience is an increasingly critical part of professional development and lifelong learning. There is, however, continuing uncertainty about how best to put principle into practice, particularly as regards assessment. This article explores those uncertainties in order to find practical ways of assessing reflection.


We critically review four problems: 1. Inconsistent definitions of reflection; 2. Lack of standards to determine (in)adequate reflection; 3. Factors that complicate assessment; 4. Internal and external contextual factors affecting the assessment of reflection.


To address the problem of inconsistency, we identified processes that were common to a number of widely quoted theories and synthesised a model, which yielded six indicators that could be used in assessment instruments. We arrived at the conclusion that, until further progress has been made in defining standards, assessment must depend on developing and communicating local consensus between stakeholders (students, practitioners, teachers, supervisors, curriculum developers) about what is expected in exercises and formal tests. Major factors that complicate assessment are the subjective nature of reflection's content and the dependency on descriptions by persons being assessed about their reflection process, without any objective means of verification. To counter these validity threats, we suggest that assessment should focus on generic process skills rather than the subjective content of reflection and where possible to consider objective information about the triggering situation to verify described reflections. Finally, internal and external contextual factors such as motivation, instruction, character of assessment (formative or summative) and the ability of individual learning environments to stimulate reflection should be considered.