Significant Event Illustration (SEI): innovative tool for enhancing student’s reflection skill.

Manabu Yoshimura

Keywords: Basic Medical Education, Reflection, Art, The WONCA tree, wrap up session.


It is important for medical students to reflect on their clinical practice. Writing a daily reflective journal is usually used, but some students are not good at writing. Documents creates a language barrier. Therefore, the author developed Significant Event Illustration(SEI), a modified version of Significant Event Analysis. An educational experiment was conducted to clarify its significance by using SEI in a debriefing session on the last day of clinical clerkship in family medicine.


This was a descriptive study.The subjects were 5/6th medical students who had completed four weeks of family medicine clerkship in the community. During a 3-hour debriefing session on the final day, each student was asked to write a 5-minute illustration on the SEI. The most memorable scene during the training period was to be illustrated in a simple way. The SEI was shared with peers and discussed. The meaning of all SEIs were analyzed qualitatively by the author. The categories used as reference were the six competencies of "the WONCA tree", as well as "procedures" and "others", for a total of eight categories. Emotional categories were also categorized into four categories: positive, negative, ambivalence, and tension. Triangulation was performed based on the students' journal.


A total of 66 patients completed the 5-course from November 2022 to May 2023, and all SEIs were collected from all of them. WONCA tree33(50%)[Person-centered care:7(10.6%), Community orientation:2(3%),Specific problems solving skills:0%, Comprehensive approach:8(12.1%), Primary care management:10(15.1%), Holistic meddling:6(9%) ], 24(36.3%) for procedures, 8(8%) for others. Positive: 40 (60.6%), Negative: 3 (4.5%), Ambivalent: 2 (3%), Tense: 20 (30.3%)."Making is fun and good to share others' experiences".


The SEI allowed for relatively easy reflection and sharing with teachers and classmates about the understanding of important competencies and emotional aspects of family medicine, suggesting its potential as an educational tool in the future.

Points for discussion:

how to organize a debriefing session

how to promote drawing illustrations for students

how to give effective feedback to each SEI


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