Begin the BEGAN (The Brown Educational Guide to the Analysis of Narrative) - a framework for enhancing educational impact of faculty feedback to students' reflective writing

Objective: The study aim was the development of a method to further enhance the educational benefit of medical students' reflective writing. The setting is a Doctoring course at the Warren Alpert Medical School of Brown University, which includes reflective writing assignments, termed "field notes", combining students' reflective writing with ongoing individualized feedback from small group faculty.

Methods: Three-year (2005-2008) iterative process with three stages of immersion, analysis, and revision that resulted in the analysis framework. An interdisciplinary team composed of the four authors with backgrounds in narrative medicine, qualitative research, psychology, and medical education analyzed 12 first and second year students' selected field notes in iterative cycles. In each cycle, consultations with small group faculty and content experts were conducted to further validate the emergent framework.

Results: This process culminated in the creation of the Brown Educational Guide to Analysis of Narrative (BEGAN) framework, a guide for crafting feedback to students' reflective writing, and the integration of the BEGAN framework into the faculty and student manuals for the Doctoring Course in 2008-2009.

Conclusions: We propose the BEGAN framework as a useful innovative tool that can be incorporated in reflective writing curricula in the field of health professions education. It is tailored to support the educational impact of the course through additional scaffolding of student writing, and the robust process it delineates for crafting of faculty feedback. Providing systematic feedback to enhance reflective writing may represent the path forward in fostering professional development through reflection in health professions education.

Practice implications: The BEGAN can be incorporated in reflective writing curricula in the field of health professions education. It is a springboard for the necessary next steps of development and research into the acquisition of reflective and narrative competence in the emerging professional.