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Fostering and Evaluating Reflective Capacity in Medical Education: Developing the REFLECT Rubric for Assessing Reflective Writing

Wald, Hedy S. PhD; Borkan, Jeffrey M. MD, PhD; Taylor, Julie Scott MD, MSc; Anthony, David MD, MSc; Reis, Shmuel P. MD, MHPE

Academic Medicine:
doi: 10.1097/ACM.0b013e31823b55fa
Evaluating Reflective Writing
Abstract

Purpose: Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students' reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion.

Method: Following a comprehensive search and analysis of the literature, the authors developed an analytic rubric through repeated iterative cycles of development, including empiric testing and determination of interrater reliability, reevaluation and refinement, and redesign. Rubric iterations were applied in successive development phases to Warren Alpert Medical School of Brown University students' 2009 and 2010 RW narratives with determination of intraclass correlations (ICCs).

Results: The final rubric, the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT), consisted of four reflective capacity levels ranging from habitual action to critical reflection, with focused criteria for each level. The rubric also evaluated RW for transformative reflection and learning and confirmatory learning. ICC ranged from 0.376 to 0.748 for datasets and rater combinations and was 0.632 for the final REFLECT iteration analysis.

Conclusions: The REFLECT is a rigorously developed, theory-informed analytic rubric, demonstrating adequate interrater reliability, face validity, feasibility, and acceptability. The REFLECT rubric is a reflective analysis innovation supporting development of a reflective clinician via formative assessment and enhanced crafting of faculty feedback to reflective narratives.

Author Information

Dr. Wald is clinical associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Dr. Borkan is professor and chair, Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Dr. Taylor is associate professor of family medicine and director of clinical curriculum, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Dr. Anthony is assistant professor of family medicine and director of medical student education, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Dr. Reis is professor and immediate past chair, Section of Family Medicine and Department of Medical Education, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, and adjunct clinical professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Wald, Warren Alpert Medical School of Brown University, Department of Family Medicine, 111 Brewster St., Pawtucket, RI 02860; telephone: (781) 424-2711; fax: (866) 372-7918; e-mail: hedy_wald@brown.edu.

First published online November 18, 2011

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A68.

Editor's Note: Commentaries on this article appear on pages 5 and 8.

© 2012 Association of American Medical Colleges