Open Access Open Badges Research article

Using video-cases to assess student reflection: Development and validation of an instrument

Sebastiaan Koole1*, Tim Dornan2, Leen Aper1, Bram De Wever3, Albert Scherpbier4, Martin Valcke3, 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 Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium

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

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 2012, 12:22  doi:10.1186/1472-6920-12-22

Published: 20 April 2012



Reflection is a meta-cognitive process, characterized by: 1. Awareness of self and the situation; 2. Critical analysis and understanding of both self and the situation; 3. Development of new perspectives to inform future actions. Assessors can only access reflections indirectly through learners’ verbal and/or written expressions. Being privy to the situation that triggered reflection could place reflective materials into context. Video-cases make that possible and, coupled with a scoring rubric, offer a reliable way of assessing reflection.


Fourth and fifth year undergraduate medical students were shown two interactive video-cases and asked to reflect on this experience, guided by six standard questions. The quality of students’ reflections were scored using a specially developed Student Assessment of Reflection Scoring rubric (StARS®). Reflection scores were analyzed concerning interrater reliability and ability to discriminate between students. Further, the intra-rater reliability and case specificity were estimated by means of a generalizability study with rating and case scenario as facets.


Reflection scores of 270 students ranged widely and interrater reliability was acceptable (Krippendorff’s alpha = 0.88). The generalizability study suggested 3 or 4 cases were needed to obtain reliable ratings from 4th year students and ≥ 6 cases from 5th year students.


Use of StARS® to assess student reflections triggered by standardized video-cases had acceptable discriminative ability and reliability. We offer this practical method for assessing reflection summatively, and providing formative feedback in training situations.