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A Cohort Study on Reflective Practice Among Healthcare Interns at King Abdulaziz University

This cohort study of 126 healthcare interns at King Abdulaziz University reveals limited awareness and inconsistent use of reflective practices, highlighting significant disciplinary differences and a critical need for better curriculum integration to enhance reflection skills.

Original authors: Alwalaa A. Abulaban¹, Lana Adey AlShawwa¹, Abeer AlNowaiser², Maram Ahmed Banakhar³, Atef Moussa, Rani Ahmad⁶, Seham Bandar AlMouallad⁷, Mohammed K. Yousef, Aliaa Amr Alamoudi¹

Published 2026-06-24

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Alwalaa A. Abulaban¹, Lana Adey AlShawwa¹, Abeer AlNowaiser², Maram Ahmed Banakhar³, Atef Moussa, Rani Ahmad⁶, Seham Bandar AlMouallad⁷, Mohammed K. Yousef, Aliaa Amr Alamoudi¹

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you are a chef who just finished cooking a complex meal. Before you serve it to the next customer, you pause to ask yourself: "What went well? What tasted too salty? How could I make this dish even better next time?" In the world of medicine, this mental pause is called reflection. It's not just about thinking; it's about analyzing your experiences to learn and grow.

This study is like a "check-up" on how well healthcare interns (the newest doctors, nurses, and specialists) at King Abdulaziz University in Saudi Arabia are using this "mental pause" in their daily work.

Here is the story of what they found, broken down simply:

The Big Picture: A Mystery in the Kitchen

The researchers wanted to see if these interns were actually doing this "cooking review" (reflection) and if they understood what it was. They asked 126 interns (out of 740 who were invited) to fill out a survey. Think of this survey as a menu that asked them to rate how often they tasted their own food while cooking.

The Surprise:
Even though reflection is supposed to be a core part of their training, more than half of the interns (52%) didn't even know the word "reflection" existed. It's as if they were cooking amazing meals but had never heard the term "garnishing," even though they were doing it instinctively.

However, when asked if they thought reviewing their work was important for learning, 82% said "Yes!" They knew the value of the pause, even if they didn't know the name of the tool.

How They Tried to Learn (The Tools)

The study looked at how these interns were taught to reflect.

The Most Common Tool: The most popular method was asking questions like, "What happened? What could be done better?" (16.7%). It's like a teacher asking, "What did you learn from that mistake?"
The Rare Tools: Other methods, like keeping a portfolio (a diary of experiences) or watching a mentor model the behavior, were used very rarely. It's like having a fancy spice rack but only ever using salt.

The Hurdles: Why It's Hard to Pause

The interns were asked, "What stops you from reflecting?"

The #1 Blocker: Lack of awareness. They simply didn't know they should be doing it or how to start (23.8%).
The #2 Blocker: Lack of time. They are busy, and stopping to think feels like a luxury they can't afford (19.8%).
The #3 Blocker: Lack of experience in how to actually do it (19.0%).

The Results: Who Was Doing It Best?

The researchers gave everyone a score based on how well they reflected.

The Winners: Nursing interns scored the highest. They were the "chefs" who were most comfortable tasting and adjusting their dishes.
The Connection: The study found a strong link between self-appraisal (knowing your own strengths and weaknesses) and confidence in communication. If you know yourself well, you talk to patients better.
The Feeling: Interns who believed reflection was important and felt they were practicing it had much higher scores. It's like a runner who believes in their training plan running faster than one who doubts it.

The Takeaway

The paper concludes that while these future healthcare heroes have the instinct to reflect, they are missing the formal training and awareness to do it effectively.

The Problem: They are flying blind without a map. They don't know the term "reflection," and they aren't being taught the best ways to use it.
The Solution Suggested: The study suggests that universities need to introduce this concept earlier (during undergraduate years) and teach it more clearly. They also suggest training the teachers (educators) on how to model this behavior, because if the teachers don't show it, the students won't learn it.

In short, the study says: "We have great cooks (interns) who know they should taste their food, but we haven't taught them the name of the spoon or how to use it properly. We need to start teaching them that skill right from the start of their training."

Technical Summary: A Cohort Study on Reflective Practice Among Healthcare Interns at King Abdulaziz University

Problem Statement
Despite the established role of reflection as a core component of medical education—facilitating the transition from experience to deeper understanding and professional growth—there is a significant paucity of research regarding reflective practices among healthcare interns in Saudi Arabia. While global literature emphasizes reflection's utility in enhancing clinical skills, critical thinking, and self-monitoring, no prior study has specifically assessed the levels of reflective thinking and practice among healthcare interns in Saudi Arabia, nor has it addressed the unique challenges they face in their professional development. This gap limits the ability to design targeted educational interventions to support the next generation of healthcare professionals in the region.

Methodology
This study employed a cross-sectional cohort design involving 740 healthcare interns graduating from King Abdulaziz University (KAU) during the 2022–2023 academic year. The population included interns from Medicine (300), Nursing (130), Dentistry (180), Medical Technology, and Clinical Nutrition (47 and 32, respectively).

Instrumentation: Data collection utilized the validated Reflective Practice Questionnaire (RPQ), comprising 40 items across ten subcategories: Reflection-in-action, Reflection-on-action, Reflection with others, Self-appraisal, Desire for improvement, Confidence (General and Communication), Uncertainty, Stress interacting with patients, and Job satisfaction. The RPQ uses a 5-point Likert scale. Additional items assessed familiarity with the term "reflection," undergraduate exposure, perceived challenges, and beliefs regarding reflection's importance.
Data Collection: The survey was distributed via Google Forms to Intern Directors of each specialty, who disseminated the link to their respective cohorts. A pilot test ensured cultural and linguistic appropriateness.
Statistical Analysis: Data were analyzed using SPSS version 27 and GraphPad Prism version 8. Descriptive statistics were used for demographics. Reliability was assessed via Cronbach's alpha. Group comparisons utilized independent t-tests, one-way ANOVA with Least Significant Difference (LSD) post-hoc tests, and Games-Howell tests where normality assumptions were violated. General Linear Models (GLM) were employed to identify significant predictors of reflective practice scores.

Key Results
Out of 740 invited interns, 126 responded (17% response rate). The demographic breakdown was 67.5% female, with Dentistry (38.9%), Nursing (27.0%), Medicine (23.0%), and Applied Medical Sciences (7.0%) represented.

Awareness and Familiarity: A majority of interns (52.4%) were unfamiliar with the term "reflection" as an educational concept. Among those familiar (47.6%), 73.3% were first introduced to the concept during their undergraduate studies, primarily through self-learning (43.3%) or educators (46.7%).
Practice and Strategies: While 57.1% of interns reported practicing reflection, 31.0% were uncertain. The most common strategy employed was "reflection-evoking questions" (51.6%), followed by discussion with mentors/peers (42.1%). The least used strategies included role modeling (5.6%) and portfolios (5.6%).
Perceived Importance: Despite low familiarity with the terminology, 81.7% of interns believed reflection is important in the learning process.
Challenges: The most frequently cited barrier to practicing reflection was "lack of awareness about reflection" (23.8%), followed by "lack of time" (19.8%) and "lack of experience in doing reflection" (19.0%).
Correlations and Predictors:
- Significant positive correlations were found among all RPQ dimensions. The strongest correlation existed between Self-appraisal and Confidence in Communication ( $r = 0.738, p < 0.001$ ).
- Specialty Differences: Significant differences in overall reflective practice scores were observed across specialties ( $p = 0.043$ ). Nursing interns demonstrated significantly higher overall scores compared to other disciplines.
- Predictors: General Linear Model analysis identified two significant positive predictors of higher overall RPQ scores: being in the Nursing specialty ( $p = 0.043$ ) and the feeling of practicing reflection during the internship ( $p = 0.037$ ).
- Stress and Uncertainty: Nursing interns, while scoring highest in reflective practice, also reported higher levels of stress interacting with patients and uncertainty, suggesting that increased reflection capacity may initially correlate with heightened awareness of clinical complexities.

Key Contributions and Significance
This study represents the first assessment of reflective practice specifically among healthcare interns in Saudi Arabia. Its primary contributions include:

Baseline Data: It establishes a baseline indicating a disconnect between the intuitive value interns place on reflection and their formal familiarity with the concept, highlighting a need for explicit terminology and curriculum integration.
Disciplinary Variation: The findings reveal that reflective practice levels vary significantly by discipline, with nursing interns demonstrating superior performance in reflective metrics compared to medical and dental interns. This suggests that specific curricular elements in nursing education may be more effective in fostering reflection.
Identification of Barriers: The study identifies "lack of awareness" as the primary barrier, shifting the focus from resource constraints to the need for educational awareness campaigns and faculty training.
Educational Implications: The authors conclude that the current status of reflective practice at KAU suggests a need for better integration of reflection into the undergraduate curriculum. They propose leveraging high-performing disciplines (like nursing) as models for improvement and implementing structured faculty development programs to train educators in modeling and facilitating reflection.

The paper maintains a modest tone, acknowledging limitations such as the single-institution scope, the low response rate (17%), and the reliance on self-reported data. It refrains from making broad generalizations beyond the KAU context, instead positioning the study as a foundational step to inform future educational strategies and interventions for healthcare professionals in Saudi Arabia.