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Students perceive reflective writing as difficult. Concept mapping may be an alternative format for reflection, which provides support while allowing students to freely shape their thoughts. We examined (1) the quality of reflection in reflective concept maps created by first-year medical students and (2) students' perceptions about concept mapping as a tool for reflection. Mixed-method study conducted within the medical curriculum of Maastricht University, The Netherlands, consisting of (1) Analysis of the quality of reflection in 245 reflective co