Ratelle John T, Wittich Christopher M, Yu Roger C, Newman James S, Jenkins Sarah M, Beckman Thomas J
Dr. Ratelle: Assistant Professor of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Wittich: Associate Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Yu: Assistant Professors of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Newman: Assistant Professors of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN. Ms. Jenkins: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Dr. Beckman: Professor of Medicine and Medical Education, Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
J Contin Educ Health Prof. 2017 Summer;37(3):161-167. doi: 10.1097/CEH.0000000000000162.
Reflection exposes performance gaps and is a step in the process of behavior change among adult learners. However, little is known about the relationships between reflection and behavior change in CME. Our objectives were to measure associations between validated reflection scores and behavior change among CME participants and to identify associations between reflection and characteristics of CME presentations.
This was a cohort study of attendees at a national hospital medicine CME course. Participants provided reflection scores for each presentation and planned commitment-to-change (CTC) statements at the conclusion of the course. Reflection scores from 1 (strongly disagree) to 5 (strongly agree) were averaged for each presentation. CTC statements were linked to their accompanying presentations. A 3-month postcourse survey was conducted to assess if planned CTCs were successfully implemented.
In all, 223 of 281 participants (79.4%) returned evaluations. Of the 195 planned CTC statements available for postcourse analysis, 128 (65.6%) were implemented. Reflection scores correlated with the number of planned CTC statements across all presentations (Pearson correlation, 0.65; P < .001). In addition, higher reflection scores (mean [SD]) were associated with the presence of audience response opportunities (Yes: 4.13 [0.18] versus No: 3.96 [0.16]; P = .01) and the use of clinical cases (Yes: 4.09 [0.18] versus No: 3.86 [0.12]; P < .01).
To our knowledge, this is the first study to show a relationship between participant reflection and CTC in conference-based CME. Presentations that incorporate clinical cases and audience response systems seem to stimulate participant reflection and behavior change.
反思能暴露表现差距，是成人学习者行为改变过程中的一个步骤。然而，对于继续医学教育（CME）中反思与行为改变之间的关系，我们知之甚少。我们的目标是衡量CME参与者中经过验证的反思分数与行为改变之间的关联，并确定反思与CME课程演示特征之间的关联。
这是一项针对全国医院医学CME课程参与者的队列研究。参与者在课程结束时为每个演示提供反思分数，并规划了改变承诺（CTC）声明。每个演示的反思分数从1（强烈不同意）到5（强烈同意）进行平均。CTC声明与相应的演示相关联。在课程结束3个月后进行了一项调查，以评估规划的CTC是否得到成功实施。
在281名参与者中，共有223人（79.4%）返回了评估。在可用于课程后分析的195条规划的CTC声明中，128条（65.6%）得到了实施。反思分数与所有演示中规划的CTC声明数量相关（Pearson相关性，0.65；P <.001）。此外，更高的反思分数（均值[标准差]）与存在观众反馈机会相关（是：4.13[0.18]，否：3.9⑥[0.16]；P = 0.01）以及临床病例的使用相关（是：4.09[0.18]，否：3.8⑥[0.12]；P < 0.01）。
据我们所知，这是第一项显示基于会议的CME中参与者反思与CTC之间关系的研究。纳入临床病例和观众反馈系统的演示似乎能激发参与者的反思和行为改变。
