Leung Kit H, Pluye Pierre, Grad Roland, Weston Cynthia
Information Technology Primary Care Research Group, Department of Family Medicine, Faculty of Medicine, McGill University, 517 Pine Avenue West, Montreal, Quebec, Canada.
J Contin Educ Health Prof. 2010 Spring;30(2):78-88. doi: 10.1002/chp.20063.
The importance of reflective practice is recognized by the adoption of a reflective learning model in continuing medical education (CME), but little is known about how to evaluate reflective learning in CME. Reflective learning seldom is defined in terms of specific cognitive processes or observable performances. Competency-based evaluation rarely is used for evaluating CME effects. To bridge this gap, reflective learning was defined operationally in a reflective learning framework (RLF). The operationalization supports observations, documentation, and evaluation of reflective learning performances in CME, and in clinical practice. In this study, the RLF was refined and validated as physician performance was evaluated in a CME e-learning activity.
Qualitative multiple-case study wherein 473 practicing family physicians commented on research-based synopses after reading and rating them as an on-line CME learning activity. These comments formed 2029 cases from which cognitive tasks were extracted as defined by the RLF with the use of a thematic analysis. Frequencies of cognitive tasks were compared in a cross-case analysis.
Four RLF cognitive processes and 12 tasks were supported. Reflective learning was defined as 4 interrelated cognitive processes: Interpretation, Validation, Generalization, and Change, which were specified by 3 observable cognitive tasks, respectively. These 12 tasks and related characteristics were described in an RLF codebook for future use.
Reflective learning performances of family physicians were evaluated. The RLF and its codebook can be used for integrating reflective learning into CME curricula and for developing competency-based assessment. Future research on potential uses of the RLF should involve participation of CME stakeholders.
继续医学教育（CME）中采用反思性学习模式，体现了反思性实践的重要性，但对于如何评估继续医学教育中的反思性学习却知之甚少。反思性学习很少根据特定的认知过程或可观察到的表现来定义。基于能力的评估很少用于评估继续医学教育的效果。为了弥补这一差距，在反思性学习框架（RLF）中对反思性学习进行了操作性定义。这种操作性定义有助于观察、记录和评估继续医学教育以及临床实践中的反思性学习表现。在本研究中，随着在一项继续医学教育电子学习活动中对医生表现的评估，反思性学习框架得到了完善和验证。
定性多案例研究，473名执业家庭医生在阅读并对基于研究的概要进行评分后，将其作为在线继续医学教育学习活动发表评论。这些评论形成了2029个案例，通过主题分析从中提取反思性学习框架所定义的认知任务。在跨案例分析中比较认知任务的频率。
支持反思性学习框架的四个认知过程和12项任务。反思性学习被定义为四个相互关联的认知过程：解释、验证、概括和改变，分别由3项可观察到的认知任务来具体说明。这12项任务及相关特征在反思性学习框架代码手册中进行了描述，以备将来使用。
对家庭医生的反思性学习表现进行了评估。反思性学习框架及其代码手册可用于将反思性学习融入继续医学教育课程，并用于开展基于能力的评估。关于反思性学习框架潜在用途的未来研究应让继续医学教育利益相关者参与进来。
