Essential steps in developing best practices to assess reflective skill: A comparison of two rubrics.

PURPOSE: Medical education lacks best practices for evaluating reflective writing skill. Reflection assessment rubrics include the holistic, reflection theory-based Reflection-on-Action and the analytic REFLECT developed from both reflection and narrative-medicine literatures. To help educators move toward best practices, we evaluated these rubrics to determine (1) rater requirements; (2) score comparability; and (3) response to an intervention. METHODS: One-hundred and forty-nine third-year medical students wrote reflections in response to identical prompts. Trained raters used each rubric to score 56 reflections, half written with structured guidelines and half without. We used Pearson's correlation coefficients to associate overall rubric levels and independent t-tests to compare structured and unstructured reflections. RESULTS: Reflection-on-Action training required for two hours; two raters attained an interrater-reliability = 0.91. REFLECT training required six hours; three raters achieved an interrater-reliability = 0.84. Overall rubric correlation was 0.53. Students given structured guidelines scored significantly higher (p < 0.05) on both rubrics. CONCLUSIONS: Reflection-on-Action and REFLECT offer unique educational benefits and training challenges. Reflection-on-Action may be preferred for measuring overall quality of reflection given its ease of use. Training on REFLECT takes longer but it yields detailed data on multiple dimensions of reflection that faculty can reference when providing feedback.

A comparison of two methods of teaching reflective ability in Year 3 medical students.

CONTEXT: Little is known about best practices for teaching and learning reflection. We hypothesised that reflective ability scores on written reflections would be higher in students using critical reflection guidelines, or receiving feedback on reflective skill in addition to reflection content, or both, compared with those in students who received only a definition of reflection or feedback on reflection content alone. METHODS: Using a 2 (guidelines) × 2 (feedback) × 2 (time) design, we randomly assigned half of our sample of 149 Year 3 medical students to receive critical reflection guidelines and the other half to receive only a definition of critical reflection. We then randomly divided both groups in half again so that one half of each group received feedback on both the content and reflective ability in their reflections, and the other received content feedback alone. The learners' performance was measured on the first and third written reflections of the academic year using a previously validated scoring rubric. We calculated descriptive statistics for the reflection scores and conducted a repeated-measures analysis of variance with two between-groups factors, guidelines and feedback, and one within-group factor, occasion, using the measure of reflective ability as the dependent variable. RESULTS: We failed to find a significant interaction between guidelines and feedback (F = 0.51, d.f. = 1, 145, p = 0.48). However, the provision of critical reflection guidelines improved reflective ability compared with the provision of a definition of critical reflection only (F = 147.1, d.f. = 1, 145, p < 0.001). Feedback also improved reflective ability, but only when it covered reflective skill in addition to content (F = 6.5, d.f. = 1, 145, p = 0.012). CONCLUSIONS: We found that the provision of critical reflection guidelines improved performance and that feedback on both content and reflective ability also improved performance. Our study demonstrates that teaching learners the characteristics of deeper, more effective reflection and helping them to acquire the skills they need to reflect well improves their reflective ability as measured by performance on reflective exercises.

Understanding Pandemic Experiences Among America's Elders.

Older Americans' experiences of the COVID-19 pandemic, including social isolation and loneliness, generosity, and resilience, must be studied and addressed.

Twelve tips for teaching reflection at all levels of medical education.

BACKGROUND: Review of studies published in medical education journals over the last decade reveals a diversity of pedagogical approaches and educational goals related to teaching reflection. AIM: The following tips outline an approach to the design, implementation, and evaluation of reflection in medical education. METHOD: The method is based on the available literature and the author's experience. They are organized in the sequence that an educator might use in developing a reflective activity. RESULTS: The 12 tips provide guidance from conceptualization and structure of the reflective exercise to implementation and feedback and assessment. The final tip relates to the development of the faculty member's own reflective ability. CONCLUSION: With a better understanding of the conceptual frameworks underlying critical reflection and greater advance planning, medical educators will be able to create exercises and longitudinal curricula that not only enable greater learning from the experience being reflected upon but also develop reflective skills for life-long learning.

Development and pilot testing of a reflective learning guide for medical education.

BACKGROUND: Reflection is increasingly incorporated into all levels of medical education but little is known about best practices for teaching and learning reflection. AIMS: To develop a literature-based reflective learning guide for medical education and conduct a pilot study to determine whether (1) guide use enhances medical students' reflective writing skills and (2) reflective scores correlate with participant demographics and satisfaction. METHODS: Guide development consisted of literature review, needs assessment, single institution survey, and educational leader consensus. The pilot cohort study compared professionalism reflections written with and without the guide by third-year medical students on their core obstetrics and gynecology rotation. Reflections were scored using a previously validated rubric. A demographics and satisfaction survey examined effects of gender and satisfaction, as well as qualitative analysis of optional written comments. Analyses used independent t-tests and Pearson's correlations. RESULTS: We developed a two-page, literature-based guide in clinical Subjective-Objective-Assessment-Plan (SOAP) note format. There was a statistically significant difference, p < 0.001, in the reflection scores between groups, but no effects of gender or satisfaction. Student satisfaction with the guide varied widely. CONCLUSIONS: A single exposure to a literature-based guide to reflective learning improved written reflections by third-year medical students.

Healthy Aging Across the Stages of Old Age.

Healthy aging is among the key frontiers for twenty-first century geriatrics and gerontology. Gerontology is positioned to address not only disease, debility, frailty, and death but also patients' hopes to remain healthy and high functioning and optimize their wellness. Definitions, models, and metrics of healthy aging are increasingly dynamic and multidimensional, drawing from biomedicine, social sciences, older adults' perspectives, and geroscience. Given current and projected demographics, focus on healthy aging at population, health system, research, clinical, and individual levels will lower costs and burdens while improving lives. Multiple models and strategies exist to guide progress in this critical emerging area.

Recommendations for Welcoming Back Nursing Home Visitors During the COVID-19 Pandemic: Results of a Delphi Panel.

OBJECTIVES: Nursing homes became epicenters of COVID-19 in the spring of 2020. Due to the substantial case fatality rates within congregate settings, federal agencies recommended restrictions to family visits. Six months into the COVID-19 pandemic, these largely remain in place. The objective of this study was to generate consensus guidance statements focusing on essential family caregivers and visitors. DESIGN: A modified 2-step Delphi process was used to generate consensus statements. SETTING AND PARTICIPANTS: The Delphi panel consisted of 21 US and Canadian post-acute and long-term care experts in clinical medicine, administration, and patient care advocacy. METHODS: State and federal reopening statements were collected in June 2020 and the panel voted on these using a 3-point Likert scale with consensus defined as ≥80% of panel members voting "Agree." The consensus statements then informed development of the visitor guidance statements. RESULTS: The Delphi process yielded 77 consensus statements. Regarding visitor guidance, the panel made 5 strong recommendations: (1) maintain strong infection prevention and control precautions, (2) facilitate indoor and outdoor visits, (3) allow limited physical contact with appropriate precautions, (4) assess individual residents' care preferences and level of risk tolerance, and (5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial well-being of residents. CONCLUSIONS AND IMPLICATIONS: The COVID-19 pandemic has seen substantial regulatory changes without strong consideration of the impact on residents. In the absence of timely and rigorous research, the involvement of clinicians and patient care advocates is important to help create the balance between individual resident preferences and the health of the collective. The results of this evidence-based Delphi process will help guide policy decisions as well as inform future research.