Reflective writing is a useful tool in medical education to analyze student experiences and measure development of certain skills. This tool is particularly useful in identifying skill components of systems-based practice. These skills are necessary for any practicing physician, but are of particular importance as they are a required residency competency. There is now additional focus on systems-based practice with the passage of the Patient Protection and Affordable Care Act (ACA). In this qualitative, grounded theory study, the reflective writings of students at a United States medical school were analyzed using the constant comparative method to explore how the focus of a medical student progresses through the clinical curriculum. The interprofessional team of researchers specifically sought to determine if areas of medical student focus evolve vertically across the curriculum and if in the process students develop an understanding of systems-based practice. The data supported both of these objectives, and actively supports future research to identify ways, both inside and outside the curriculum, to leverage the students’ natural progression of focus in order to expand systems-based practice education.


Grounded Theory, Reflective Writing, Medical Education, Systems-Based Practice

Publication Date


Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.


Submission Location


To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.