Using a theory-based approach to explore medical students’ engagement with exemplar-based feedback and self-reflection for communication skills

Introduction Patient-Centered Communication (PCC) is essential to quality medical care and a crucial skill in medical education. While prior studies have focused on communication skills training in medical education, less is known about how learners engage in self-reflection when learning and practicing communication skills. The current study investigates levels of learner cognitive and reflective engagement with exemplar-based feedback and guided self-reflection to inform best practices for integrating self-regulated learning (SRL) supports in medical education.Methods Participants consisted of medical students in years one through three. Participants watched video vignettes depicting patients asking a question or making a statement, recorded verbal responses to the patients, reviewed their response alongside two exemplar responses, and completed a self-evaluation checklist aligned with defined communication learning objectives, and responded to three structured reflection prompts comparing their responses to the exemplars. Using an AI-assisted, human-in-the-loop coding process, participant engagement was evaluated using the ICAP taxonomy and Kember categorizations, each coded on a 1–4 scale reflecting framework-specific criteria. SRL strategies were coded as a separate unit of analysis that informed engagement.Results Participants demonstrated moderate to high engagement across the eight vignettes, characterized by predominantly Active (ICAP) and Understanding (Kember) level responses, with 91% of participants reaching peak Constructive (ICAP) engagement and 64% reaching peak Reflective (Kember) engagement at least once, along with widespread use of SRL strategies. Engagement varied between reflection prompts and across vignettes, with the third prompt and certain vignettes consistently eliciting deeper engagement.Discussion Results indicate that learners engaged meaningfully with exemplar-based feedback and self-reflection. Deeper engagement emerged with prompts that required comparison or improvement planning. While engagement varied by vignette and prompt, learners employed SRL strategies in nearly every reflection. These findings indicate that the use of exemplar responses and enhanced prompt design may support broader conceptual and deeper future learning.