Boenink A D, Oderwald A K, De Jonge P, Van Tilburg W, Smal J A
Department of Psychiatry, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
Med Educ. 2004 Apr;38(4):368-77. doi: 10.1046/j.1365-2923.2004.01787.x.
This study describes the development of an instrument to measure the ability of medical students to reflect on their performance in medical practice.
A total of 195 Year 4 medical students attending a 9-hour clinical ethics course filled in a semi-structured questionnaire consisting of reflection-evoking case vignettes. Two independent raters scored their answers. Respondents were scored on a 10-point scale for overall reflection score and on a scale of 0-2 for the extent to which they mentioned a series of perspectives in their reflections. We analysed the distribution of scores, the internal validity and the effect of being pre-tested with an alternate form of the test on the scores. The relationships between overall reflection score and perspective score, and between overall reflection score and gender, career preference and work experience were also calculated.
The interrater reliability was sufficient. The range of scores on overall reflection was large (1-10), with a mean reflection score of 4.5-4.7 for each case vignette. This means that only 1 or 2 perspectives were mentioned, and hardly any weighing of perspectives took place. The values over the 2 measurements were comparable and were strongly related. Women had slightly higher scores than men, as had students with work experience in health care, and students considering general practice as a career.
Reflection in medical practice can be measured using this semistructured questionnaire built on case vignettes. The mean score allows for the measurement of improvement by future educational efforts. The wide range of individual differences allows for comparisons between groups. The differences found between groups of students were as expected and support the validity of the instrument.
本研究描述了一种用于测量医学生反思其医疗实践表现能力的工具的开发。
共有195名四年级医学生参加了一个为期9小时的临床伦理课程，他们填写了一份由引发反思的病例 vignettes 组成的半结构化问卷。两名独立评分者对他们的答案进行评分。受访者的整体反思得分以10分制计分，他们在反思中提及一系列观点的程度以0 - 2分制计分。我们分析了分数分布、内部效度以及用测试的替代形式进行预测试对分数的影响。还计算了整体反思得分与观点得分之间以及整体反思得分与性别、职业偏好和工作经验之间的关系。
评分者间信度足够。整体反思得分范围较大（1 - 10），每个病例 vignette 的平均反思得分为4.5 - 4.7。这意味着只提及了1或2个观点，并且几乎没有对观点进行权衡。两次测量的值具有可比性且密切相关。女性得分略高于男性，有医疗保健工作经验的学生以及考虑将全科医学作为职业的学生得分也较高。
可以使用基于病例 vignettes 的这种半结构化问卷来测量医疗实践中的反思。平均分可用于衡量未来教育努力带来的进步。个体差异的广泛范围允许进行组间比较。学生组之间发现的差异符合预期，支持了该工具的有效性。
