Implementing a Curricular Model for Structured Reflection in a Neurology Clinical Clerkship.

Background: Medical students frequently observe social, ethical, and systemic challenges during clinical rotations but often lack formal avenues for reflection. Structured reflective writing can promote critical thinking, empathy, and professional identity formation. Objective: To characterize the content and depth of student reflections on social elements of care during a neurology clerkship and assess the educational impact of a required reflective writing exercise. Methods: This retrospective qualitative study analyzed 46 reflective logs submitted by third-year medical students during their neurology rotation at the Cleveland Clinic (June 2023-May 2024). Logs focused on bias, social determinants of health, healthcare inequities, system challenges, or quality improvement. Logs and corresponding faculty responses were analyzed to identify themes, emotional tone, and professional development insights. Results: Most logs (77.3%) described bias, often related to gender or race. Students also noted communication barriers, access issues, and health inequities. Emotional tones included frustration (69.6%) and empathy (21.7%). Reflections often conveyed professional identity development (55%) and ethical reasoning (47.5%). Clerkship director responses were supportive, with frequent teaching points and validation. Conclusions: Students regularly encounter and meaningfully reflect on complex social issues during clinical training. Structured reflection offers critical insight into students' evolving perceptions of equitable care and often fosters professional growth. Integrating such exercises into clinical curricula may enhance students' ability to recognize and respond to bias and inequity in real-world practice.