Presented By: Heather Christensen, University of Cincinnati
Co-Authors: Aaron Marshall, University of Cincinnati

Purpose 
Narrative reflection has a growing role in medical student education, as it has been shown to foster deeper understanding and encourage introspection. This can be particularly helpful during pre-clerkship years, when empathy and overall well-being decline. The purpose of this study was to pilot (optional) opportunities for second-year medical students to integrate reflective practice into their learning of renal and gastrointestinal systems. 

Methods
Narrative reflection opportunities (letter-writing, drawing, prompts) were offered to second-year medical students (M2, n=178) at University of Cincinnati College of Medicine (UCCoM) during their renal-gastrointestinal course. ChatGPT (AI) was utilized for sentiment analysis and generating themes from written responses; each (de-identified) student submission was coded for AI-generated themes. Responses were analyzed based on student demographics: gender, under-represented in medicine status (URiM), and quartile rank. Students were offered up to 1% extra credit for participating. 

Results 
129 students (72.5%) participated in the first round of reflection activities; participant demographics represented the M2 cohort for self-reported gender (53.5% female, 45.7% male) and URiM status (12.5%), and quartile rank. Of the initial participant group, 78% continued participation through all activities. Those most likely to stop participating were male (32% attrition vs. 13% females), non-URiM students (23% attrition vs. 12.5% URiM), and top quartile students (25% attrition in Q1/2 vs. 17.6% in Q3/4). AI-generated themes from open-ended responses included: complex integration of concepts, exploration of study modalities, concern for exam preparation, and focus on time-management/self-care. Sentiment analysis was positive and encouraging, revealing a sense of accomplishment and satisfaction with progress in the course. 

Conclusions 
Optional narrative reflection exercises provide medical students with an opportunity for meta-cognition and self-assessment. At the conclusion of this (currently ongoing) study, we will analyze student motivation for participation, and the impact on their learning and overall medical education experience.