Background: Self-reflection facilitates the identification of performance gaps and is a critical step in the process of behavior change among physicians. However, little is known about reflection and its relation to behavior change in hospital medicine (HM) continuing medical education (CME). Our objectives were to identify associations between validated reflection scores and characteristics of CME presentations, and to measure associations between validated measures of reflection and behavior change among HM CME participants.
Methods: This was a cross-sectional study of 260 participants and 29 presenters delivering 31 presentations at a Mayo Clinic HM CME course in 2015. Participants provided CME reflection ratings, which were obtained from an instrument with known content, internal structure and criterion validity evidence (Wittich et al. Mayo Clinic Proc. 2013). The instrument contains 8 items on 5-point scales (range: strongly disagree to strongly agree) that address the following 4 levels of reflective thinking described by Kember et al: habitual action, understanding, reflection and critical reflection. Participants’ planned behavior change was assessed with a single item: “As a result of this presentation, I plan to make a change to my clinical practice”, which is rated on the same 5-point scale. Associations were measured between CME reflection scores and planned behavior change, and between CME reflection scores and characteristics of presentations and presenters. Scores were compared using linear regression models with generalized estimating equations to adjust standard errors for repeated data within each presentation. The threshold for statistical significance was set at p<0.05.
Results: A total of 223 out of 262 participants (85.1%) returned evaluations, yielding 6083 ratings for statistical analysis. There was a statistically significant correlation between CME reflection scores and behavior change scores across presentations (Pearson coefficient 0.69, p<.0001). Additionally, CME reflection scores (mean [SD]) were significantly associated with the number of audience response opportunities (0: 3.62 (0.57) vs. 1-3: 3.70 (0.54) v. ≥4: 3.75 (0.55), p=0.02) and the use of clinical cases ((3.55 [0.57]) vs. no clinical cases (3.37 [0.71]; p=0.004). There were no significant associations between CME reflection scores and presentation length (minutes), number of slides, presenter specialty or academic rank.
Conclusions: To our knowledge, this is the first study to measure the association between validated reflection scores and behavior change in HM CME. Reflection scores were strongly correlated with planned practice change among CME participants. Additionally, our findings indicate that CME presentations which incorporate audience response and clinical cases may lead to greater reflection and planned changes in clinical practice.