From Feedback to Performance: Structured Reflection Enhances Skill Development and Reflective Thinking in Medical Students

Background: While feedback-literate learners demonstrate the capacity to utilize feedback for behavioral modification, the specific role of structured reflection in procedural skill acquisition remains underexplored. This study examines how systematic reflection on feedback influences both practical skill development (suturing competency) and reflective ability in medical education, addressing a critical gap in skills-based training research. Methods: A quasi-experimental, normalized controlled trial was conducted from 2021-2023 with 75 medical trainees at Shahid Beheshti Hospital, Kashan University of Medical Sciences. The participants were nonrandomly assigned to the intervention (n=37) and control (n=38) group. The intervention group participated in a structured reflection workshop based on the Atkins model (comprising description, analysis, and action planning) prior to the suture workshop, whereas the control group proceeded directly to the suture workshop without reflective training. Both groups received identical instructional content and feedback from the instructor and assistants; however, only the intervention group engaged in a structured reflective exercise on the feedback received. The outcome measures included practical skill proficiency, assessed via a standardized 19-item checklist, and reflective ability, evaluated via the reflective ability rubric (RAR). To ensure reliability, two independent raters scored all the assessments. Data analysis was performed via independent t tests and Pearson correlation in SPSS. Results: Compared with the control group, the intervention group demonstrated significantly superior performance in practical skills, with mean scores of 18.43 ± 1.77 versus 15.03 ± 2.79, respectively (p < 0.001). Reflective ability assessment revealed a mean score of 3.73 ± 0.99 in the intervention group, with a strong positive correlation observed between reflective ability and practical skill performance (r = 0.936, p < 0.001). Subgroup analyses confirmed the robustness of these findings, showing consistent benefits of reflection training across all participants regardless of previous suture workshop experience (p = 0.34 for interaction) or gender (p = 0.57). Conclusions: This study demonstrates that structured reflection on feedback significantly enhances both procedural skill acquisition and reflective ability in medical trainees. The strong correlation between these competencies highlights the critical role of reflection in clinical learning. These findings support the systematic integration of guided reflection into skills training curricula to optimize educational outcomes. Future research should explore the impact of feedback-driven reflection on various procedural skills and assess its long-term effects on clinical performance.