Measuring the Level of Reflective Ability of Predoctoral Dental Students: Early Outcomes in an e-Portfolio Reflection

Learning to evaluate one's own skills through reflection and self-assessment prepares dental graduates for successfully navigating an ever-changing work environment throughout their careers, but the search continues for the most effective teaching and assessment strategies to develop students' skills in these areas. Beginning with the Class of 2017, the University of Missouri-Kansas City School of Dentistry adopted e-portfolios as a programmatic (four-year) global assessment measure in the predoctoral dental program, in large part to encourage the development of reflection. The aim of this study was twofold: to examine interrater reliability among raters when scoring reflective writing using a validated measure of reflection skill and to analyze students' level of reflective ability as fourth-year dental students. Reflections of all 102 students were independently evaluated by the three investigators using a grading rubric based on Bain's 5 Rs (reporting, responding, relating, reasoning/deconstructing, reconstructing). Intra-class correlation was used to assess interrater reliability among the three raters, resulting in a good range for agreement (ICC=0.67; 95% CI 0.54, 0.77). The results showed that the majority (70%) of the global reflections were rated at Level 2 (responding) and Level 3 (relating). Approximately 15% of the global reflections reached Level 4 (reasoning/deconstructing), and only one was rated at the highest level (Level 5, reconstructing). This study confirmed that reflection and reflective writing were difficult for students to accomplish. As a result, curricular enhancements at this school have been implemented that involve both faculty and student development. Ongoing evaluation is required to determine if those changes result in higher levels of reflective ability. The positive outcomes of reflection and writing warrant continued examination in how to improve this educational strategy across the curriculum.