CONTEXT Reflection on clinical experience is used by medical students to enhance the development of clinical practice skills and professional behaviours in the area of obstetrics and gynaecology. It is applied through small-group reflective tutorials, writing reflective summaries and one-to-one discussion of reflections with staff.OBJECTIVE To identify the levels of critical reflection achieved and explore the emergent themes in students' written reflections.METHODS Thematic analysis was undertaken to document the recurring emergent themes on which students chose to reflect and the depth of reflection students achieved.RESULTS Most students reflected on clinical, communication and reasoning skills, lack of medical knowledge, and the development of their own and others' professional practice. The 4 levels of reflection students demonstrated were: listing, where students only state the clinical experience; describing, where students describe the clinical experience, including what they did well and what they did not; applying, where students discuss what they need to change and how to develop, and integrating, where students apply reflection to future clinical practice. Few respondents demonstrated the ability to reflect to the level of integration except with facilitated discussion.DISCUSSION The range of experiences on which students reflected was appropriate. The information obtained from the emergent themes has been useful for programme development. At the end of the process students were still not reflecting at the level of integration. This affirms that reflectivity is a skill that develops throughout life. Evaluating the level of reflection achieved and discussing this explicitly with the student may be instrumental in helping the student develop his or her reflective capacity further.