Skip to main content
main-content
Top

Tip

Swipe om te navigeren naar een ander artikel

Gepubliceerd in: Perspectives on Medical Education 5/2020

Open Access 17-08-2020 | Replication Studies

The reliability characteristics of the REFLECT rubric for assessing reflective capacity through expressive writing assignments: A replication study

Auteurs: Lawrence Grierson, Samantha Winemaker, Alan Taniguchi, Michelle Howard, Denise Marshall, Joyce Zazulak

Gepubliceerd in: Perspectives on Medical Education | Uitgave 5/2020

share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail
insite
ZOEKEN

Abstract

Introduction

The medical education community has implemented writing exercises that foster critical analysis and nurture reflective capacity. The REFLECT rubric (Wald et al. 2012) was developed to address the challenge of assessing these written reflections. The objective of this replication work is to explore the reproducibility of the reliability characteristics presented by the REFLECT developers.

Methods

Five raters evaluated narratives written by medical students and experienced clinicians using the REFLECT rubric. Reliability across rubric domains was determined via intraclass correlation coefficient and internal consistency was determined via Cronbach’s alpha.

Results

Intraclass coefficients demonstrated poor reliability for ratings across all tool criteria (0.350–0.452) including overall ratings of narratives (0.448). Moreover, the internal consistency between scale items was also poor across all criteria (0.529–0.621).

Discussion

We did not replicate the reliability characteristics presented in the original REFLECT article. We consider these findings with respect to the contextual differences that existed between our study and the Wald and colleagues study, pointing particularly at the possible influence that repetitive testing and refinement of the tool may have had on their reviewers’ shared understanding of its use. We conclude with a discussion about the challenges inherent to reductionist approaches to assessing reflection.

Introduction

Reflection is a metacognitive activity that involves thinking intentionally about performance before, during, or after situations with the aim of detecting and characterizing the mental models that underpin the decisions and actions relevant to the performance outcome [1, 2]. These models refer to the representations that one has of the relationships that exist between various aspects of the world in which they perform. When healthcare practitioners reflect, it allows them to perceive information from clinical encounters in a way that has the potential to inform their practice in future encounters. As such, it is seen as an essential habit to nurture in new physicians. Accordingly, many medical training programs have adopted writing exercises as a way to develop the capabilities of reflection. In these and other similar assignments, learners write personal stories, or ‘narratives’, of professional encounters as a way to explore their own experiences within those stories. In doing so, learners are encouraged to attend to the emotions, memories, biases, sensory experiences, and social interactions that may have been meaningful within that encounter and to consider the way in which they influenced their ability to communicate the perspectives of patients [310], perform critical analyses [1113], construct clinical meaning [14], understand practitioner roles [15], and appreciate personal values and beliefs [16]. However, the integration of these exercises within the curriculum has presented a difficult question: what role do written narratives play in helping us determine our residents’ competence as reflective practitioners?
The literature regarding the use of written narratives in medical education reveals a prominent line of research concerned with the development of tools to facilitate the assessment of reflective writing [5, 6, 12, 13]. Among the most widely published of these is the Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT), which presents a matrix wherein five criterion characteristics of the written narrative are assessed on a 4-level scale that spans from ‘non-reflective’ to ‘critically reflective’ and that offers a provision for specifying whether any critical level reflection was indicative of confirmatory or transformative learning [5, 12]. The tool also prompts users to justify their rankings for each criterion, which involves generating written commentary pertaining to the aspects of the text that are particularly representative of the chosen ratings. These justifications are intended to serve as the foundation for the delivery of feedback to learners. In this way, the tool apparently serves two purposes. The first is to standardize the assessment of medical trainees’ capability to reflect through examination of their written narratives. The second is to guide faculty reviewers as they structure meaningful feedback. The tool’s exhibited characteristics of good reliability (ICC single measures = 0.632)—albeit with considerable variation in reliability coefficients across developmental iterations (0.376–0.748)—support its suitability for assessing written reflections. However, reliability characteristics are often directly relevant to the contexts in which a measurement tool is developed and tested, and it is therefore important to replicate psychometric examination of such tools before applying them in new educational contexts [17, 18].
In this Replication study, an investigation of the reliability characteristics of the REFLECT rubric in our own context is presented. This involved recruiting five medical educators to read and assess the reflective writing of a group of medical students and a group of experienced family physicians by way of the final version of the REFLECT tool described by Wald and colleagues [12]. These ratings provided the data foundations for appraisal of whether the rubric’s reliability characteristics were reproducible in our context.

Methods

Participants

Five (5) faculty educators from the medical education community at McMaster University (Hamilton, Canada) were recruited as raters for this study. Care was taken to recruit individuals with more than 5 years of experience at delivering writing curricula for the purposes of promoting reflection. All raters provided informed consent according to the guidelines set out by the Hamilton Integrated Research Ethics Board (HIREB) and the Declaration of Helsinki (2013) before participating in this study.

Data collection

Two sets of writing assignments were acquired. One set was written by 15 first-year medical students during their first term at McMaster University. The second set of submissions were written by 15 clinician faculty from the Department of Family Medicine at McMaster University. Both groups had written pieces in response to a prompt that was selected from McMaster’s undergraduate professional competency curriculum on the basis of its relevance to both groups:
During this time in your life, self-care is particularly important. How are you caring for your whole being—body, mind and spirit—during this time of your life? Are there particular strategies/ideas for achieving balance that you might share with your colleagues?
All writers also provided informed consent according to the guidelines set out by the HIREB before their narratives were included in this study.

The tool

The REFLECT rubric comprises five essential criteria that are rated on one of four levels. The five essential criteria are the spectrum of written exploration, the writer’s presence in the written work, the quality of description of the concerning issue, the writer’s attention to their own and others’ emotions, and the overall meaning the writer derives from the explored experience. For each written narrative, each of the five criteria as well as the overall written work is rated as either non-reflective, introspective, reflective, or critically reflective [12]. An assessment of the reflection associated with the overall written work was included because Wald and colleagues indicated including such a rating in their development process for research purposes. We recognize that students do not typically receive this information as part of assessments involving this tool. Raters are required to provide written justifications for each reflective level assigned to each criterion.

Protocol

All five raters attended a 2-hour introductory workshop during which they were introduced to the assessment tool. As a training exercise during this session, each rater used the rubric independently to assess a set of two additional written submissions provided by consenting family medicine residents. The raters then participated in a facilitated discussion wherein they reviewed their ratings and arrived at a common understanding and approach to using the tool.
Following this orientation, each rater was assigned written submissions from the study sample pseudo-randomly. The pseudo-randomization process ensured that each submission was reviewed by two different raters, and that no two raters assessed the exact same submissions. All rubric assessments were completed by hand with pen-and-paper and returned within three weeks to the research team.

Analysis

The four levels of reflection ability were numbered one (non-reflective) through four (critically reflective). In order to assess inter-rater reliability, we applied the statistical methods of Wald and colleagues (2012), and determined the single measures intraclass correlations associated with the ratings of each of the four criteria as well as the overall written work [19]. We also used Cronbach’s alpha to report the internal consistency of the ratings. Intraclass correlation values less than 0.5 are indicative of poor reliability, values between 0.5 and 0.75 indicate moderate reliability, values between 0.75 and 0.9 indicate good reliability, and values greater than 0.90 indicate excellent reliability [20].

Results

The full spectrum of the REFLECT scale was used by raters. Tab. 1 shows the scoring of the submissions for each rater.
Table 1
Distribution of participant ratings across scale levels and subdomains
 
First rater (%)
Second rater (%)
Writing spectrum
– Habitual action (non-reflective)
25.4
22.0
– Thoughtful action or introspection
15.3
11.9
– Reflection
33.9
42.4
– Critical reflection
25.4
23.7
Presence
– Habitual action (non-reflective)
18.6
13.6
– Thoughtful action or introspection
27.1
35.6
– Reflection
27.1
20.3
– Critical reflection
27.1
30.5
Description of disorienting dilemma
– Habitual action (non-reflective)
20.7
10.7
– Thoughtful action or introspection
22.4
35.7
– Reflection
34.5
35.7
– Critical reflection
22.4
17.9
Attending to emotions
– Habitual action (non-reflective)
24.1
24.1
– Thoughtful action or introspection
29.3
27.6
– Reflection
13.8
27.6
– Critical reflection
32.8
20.7
Analysis and meaning making
– Habitual action (non-reflective)
20.3
15.3
– Thoughtful action or introspection
22.0
27.1
– Reflection
30.5
32.2
– Critical reflection
27.1
25.4
Overall rating
– Habitual action (non-reflective)
28.3
24.1
– Thoughtful action or introspection
17.0
17.2
– Reflection
26.4
34.5
– Critical reflection
28.3
24.1
Tab. 2 shows the single measures intraclass coefficient and Cronbach alpha statistics for each criterion and overall rating. Intraclass coefficients demonstrated poor reliability for ratings of all criteria. Moreover, the internal consistency between scale items was poor across all criteria.
Table 2
Reliability characteristics of participant ratings
 
ICC single measures
(95% CI)
Cronbach alpha
Writing spectrum
0.368 (0.125–0.570)
0.532
Presence
0.367 (0.125–0.567)
0.529
Description of disorienting dilemma
0.452 (0.220–0.635)
0.621
Attending to emotions
0.350 (0.107–0.555)
0.514
Analysis and meaning making
0.384 (0.145–0.581)
0.549
Overall rating
0.448 (0.222–0.628)
0.613

Discussion

We sought to determine whether ratings of the reflective quality of written narratives generated through application of the REFLECT rubric in our own context would yield reliability characteristics similar to those described by Wald and colleagues in their published presentation of the tool and its development [12]. Of note, our analysis revealed reliability characteristics that were poor and considerably lower. Where Wald and colleagues (2012) achieved intraclass coefficients as high as 0.748 for overall reliability [12], we realized a coefficient for similar ratings of only 0.448, with coefficients associated with the tool’s various components registering mostly at lower levels than that.
It is important to keep in mind that characteristics of good reliability are often directly relevant to the contexts in which a tool is tested [17, 18], and, in this regard, we can acknowledge a number of differences between the context of our application and that of Wald and colleagues. For instance, Wald and colleagues tested the REFLECT tool exclusively on narratives written by undergraduate medical students, whereas our narratives were authored by a mix of medical students and clinical faculty. Moreover, each bit of reflective writing in our study was rated by two reviewers, while the tool developers typically employed three raters in their tests; a potential limitation of our replication. However, from our view, perhaps the most salient contextual difference is that the rubric presented by Wald and colleagues was developed over a series of three iterations and five pilot tests, all conducted within a year (2009–2010), and largely at their own institution (Brown University, Providence, RI, USA), while our use of the tool involved a single, later application at a different institution than the one at which it was developed (McMaster University, Hamilton, Canada). In this regard, we speculate that Wald and colleagues’ iterative process of development may not only have improved the technical components of the tool, but also their collective ability to apply it towards the reflection construct. That is, their raters, through the repetitive use, discussion, and refinement described in the 2012 paper, may have constructed, amongst themselves, a shared understanding of the rubric’s criteria and, in turn, an approach to using the tool that improved its overall reliability. The notion here is that the good reliability statistics do not emerge solely as a function of the tool, but through an intersection between the assessors’ application of the tool and their understanding of what it is designed to measure. This sort of consensus understanding building may have occurred because the same raters were included across testing iterations or by way of a progressively-refined set of directions provided to raters by the research team; although, we recognize neither is discernible from the Wald report. While we attempted to prepare our assessors through a pre-study rater training process, this may not have been sufficient to reconcile any fundamental differences in the way our raters and their raters understood the tool’s constructs. Indeed, our training may have amplified differences.
Importantly, this exercise has strengthened our belief that measuring reflection through written narrative is potentially flawed, running counter to the philosophical underpinnings of reflection [2123]. Where most theories of reflection endorse imaginative exploration of cognitive, affective, physical, and verbal experiences when making meaning of vague and uncertain circumstances [24, 25], the creation of a tool that simplifies reflection into discrete components limits learners ability to be expansive and promotes their tendency to cater their writing to the goal of ‘scoring well’ [26, 27]. From our perspective, a written reflection serves as a catalyst for formative dialogue between learners and instructors [28], much like that which occurs during simulation debriefing [2, 14, 29, 30]. The idea is that the writing exercise prompts learners to think upon a recent experience and to construct an account of how aspects of that experience influenced their decisions and actions. In doing so, learners are challenged to identify influences and interactions that were not previously noticed, and to use these revelations to formulate strategies that can be brought forward into future experiences. However, learners (at any stage of expertise) are typically not capable of identifying all the relevant aspects that impart influence on a clinical encounter on their own [30, 31]. Through writing, however, they can share their accounts with an instructor; and by reading, these instructors can come to a deeper appreciation of the representations and assumptions that underpin learner behaviour. In doing so, bespoke feedback that targets learners’ needs can be generated. In this way, the writing supports formative assessment, but does not, in and of itself, constitute the object of assessment.
The REFLECT developers hold that the tool supports this formative process; yet its reduction of the reflection to a set of pre-defined criteria highlights a fundamental challenge in incorporating reflection activities into medical education curricula. Recent shifts in medical training have given way to an education paradigm that increasingly distills medical practice into defined professional activities, each of which that can be directly observed. In this regard, we can understand the application of a reductionist perspective onto the construct. Simply put, by presenting reflection as a set of discrete components, the educator is provided a means of assessment for this important physician activity that fits into the competency-based model. However, through reductionist assessment, the educator also runs the risk of assuming that the degree of competence that a learner has for reflection can be determined through the critical reading of his or her written account. Accordingly, the narrative may be characterized as something of a final report of the whole reflection process, and the assessment may not account for any reflection that occurs as a consequence of the writing.

Conclusion

Through this replication exercise, we were afforded the opportunity to consider more fulsomely our understanding of the factors that come to bear when assessing reflection in medical education. In doing so, we have highlighted that it is vitally important for the medical education community to come to a shared understanding of how reflection is conceptualized and utilized within the curriculum. In particular, we echo the recommendations of De la Croix and Veen (2018), and advocate for approaches to reflection that abandon the checklist and encourage learners to reflect freely, employing styles that nurture and protect the deeply personal nature of self-exploration [24].

Acknowledgements

The authors acknowledge Dr. Anthony Levinson and the McMaster MedPortal Group for all their valuable assistance as well as Meera Mahmud for assistance with data analysis.

Conflict of interest

L. Grierson, S. Winemaker, A. Taniguchi, M. Howard, D. Marshall and J. Zazulak declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail
Literatuur
1.
go back to reference Schön DA. The reflective practitioner. New York, NY: Basic Books; 1983. Schön DA. The reflective practitioner. New York, NY: Basic Books; 1983.
2.
go back to reference Sandars J. The use of reflection in medical education: AMEE Guide no. 44. Med Teach. 2009;31:685–95. CrossRef Sandars J. The use of reflection in medical education: AMEE Guide no. 44. Med Teach. 2009;31:685–95. CrossRef
3.
go back to reference Wear D, Zarconi J, Garden R, et al. Reflection in/and writing: pedogogy and practice in medical education. Acad Med. 2012;87:1–7. CrossRef Wear D, Zarconi J, Garden R, et al. Reflection in/and writing: pedogogy and practice in medical education. Acad Med. 2012;87:1–7. CrossRef
4.
go back to reference Shapiro J, Kasman D, Shafer A. Words and wards: a model of reflective writing and its uses in medical education. Med Humanit. 2006;27:231–44. CrossRef Shapiro J, Kasman D, Shafer A. Words and wards: a model of reflective writing and its uses in medical education. Med Humanit. 2006;27:231–44. CrossRef
5.
go back to reference Reis SP, Wald HS, Monroe AD, et al. Begin the BEGAN (The Brown Educational Guide to the Analysis of Narrative)—a framework for enhancing educational impact of faculty feedback to students’ reflective writing. Patient Educ Couns. 2010;80:253–9. CrossRef Reis SP, Wald HS, Monroe AD, et al. Begin the BEGAN (The Brown Educational Guide to the Analysis of Narrative)—a framework for enhancing educational impact of faculty feedback to students’ reflective writing. Patient Educ Couns. 2010;80:253–9. CrossRef
6.
go back to reference Plack MM, Driscoll M, Marquez J, et al. Assessing reflective writing on a pediatric clerkship by using a modified Bloom’s taxonomy. Ambul Pediatr. 2007;7:285–91. CrossRef Plack MM, Driscoll M, Marquez J, et al. Assessing reflective writing on a pediatric clerkship by using a modified Bloom’s taxonomy. Ambul Pediatr. 2007;7:285–91. CrossRef
7.
go back to reference Cohn FG, Shapiro J, Lie DA, et al. Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. Acad Med. 2009;84:587–96. CrossRef Cohn FG, Shapiro J, Lie DA, et al. Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. Acad Med. 2009;84:587–96. CrossRef
8.
go back to reference White J. The use of reflective writing in exploring student experiences in surgery. J Surl Educ. 2008;65:518–20. CrossRef White J. The use of reflective writing in exploring student experiences in surgery. J Surl Educ. 2008;65:518–20. CrossRef
9.
go back to reference Winkel AF, Hermann N, Graham MJ, et al. No time to think: making room for reflection in obstetrics and gynecology residency. J Grad Med Educ. 2010;2:610–5. CrossRef Winkel AF, Hermann N, Graham MJ, et al. No time to think: making room for reflection in obstetrics and gynecology residency. J Grad Med Educ. 2010;2:610–5. CrossRef
10.
go back to reference Mamede S, Schmidt HG, Penaforte JC. Effects of reflective practice on the accuracy of medical diagnoses. Med Educ. 2008;42:468–75. CrossRef Mamede S, Schmidt HG, Penaforte JC. Effects of reflective practice on the accuracy of medical diagnoses. Med Educ. 2008;42:468–75. CrossRef
11.
go back to reference Driessen E, van Tartwijk J, Dornan T. Teaching Rounds: the self critical doctor: helping students become more reflective. Br Med J. 2008;336:827. CrossRef Driessen E, van Tartwijk J, Dornan T. Teaching Rounds: the self critical doctor: helping students become more reflective. Br Med J. 2008;336:827. CrossRef
12.
go back to reference Wald HS, Borkan JM, Taylor JS, et al. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med. 2012;87:41–50. CrossRef Wald HS, Borkan JM, Taylor JS, et al. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med. 2012;87:41–50. CrossRef
13.
go back to reference Carter AG, Creedy DK, Sidebotham M. Critical thinking evaluation in reflective writing: development and testing of carter assessment of critical thinking in midwifery (reflection). Midwifery. 2017;54:73–80. CrossRef Carter AG, Creedy DK, Sidebotham M. Critical thinking evaluation in reflective writing: development and testing of carter assessment of critical thinking in midwifery (reflection). Midwifery. 2017;54:73–80. CrossRef
14.
go back to reference Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ. 2009;14:595–621. CrossRef Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ. 2009;14:595–621. CrossRef
15.
go back to reference Peterkin A, Roberts M, Kavanagh L, et al. Narrative means to professional ends New strategies for teaching CanMEDS roles in Canadian medical schools. Can Fam Physician. 2012;58:e563–e9. Peterkin A, Roberts M, Kavanagh L, et al. Narrative means to professional ends New strategies for teaching CanMEDS roles in Canadian medical schools. Can Fam Physician. 2012;58:e563–e9.
16.
go back to reference Ashbury JE, Fletcher BM, Birtwhistle RV. Personal journal writing in a communication skills course for first-year medical students. Med Educ. 1993;27:196–204. CrossRef Ashbury JE, Fletcher BM, Birtwhistle RV. Personal journal writing in a communication skills course for first-year medical students. Med Educ. 1993;27:196–204. CrossRef
17.
go back to reference Kane MT. Current concerns in validity theory. J Educ Meas. 2001;38:319–42. CrossRef Kane MT. Current concerns in validity theory. J Educ Meas. 2001;38:319–42. CrossRef
18.
go back to reference Messick S. Test validity and the ethics of assessment. Am Psychol. 1980;35:1012. CrossRef Messick S. Test validity and the ethics of assessment. Am Psychol. 1980;35:1012. CrossRef
19.
go back to reference Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8. CrossRef Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8. CrossRef
20.
go back to reference Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–63. CrossRef Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–63. CrossRef
21.
go back to reference Sumsion J, Fleet A. Reflection: can we assess it? Should we assess it? Assess Eval High Educ. 1996;21:121–31. CrossRef Sumsion J, Fleet A. Reflection: can we assess it? Should we assess it? Assess Eval High Educ. 1996;21:121–31. CrossRef
22.
go back to reference Stewart S, Richardson B. Reflection and its place in the curriculum on an undergraduate course: should it be assessed? Assess Eval High Educ. 2000;25:369–80. CrossRef Stewart S, Richardson B. Reflection and its place in the curriculum on an undergraduate course: should it be assessed? Assess Eval High Educ. 2000;25:369–80. CrossRef
23.
go back to reference Rolfe G. Rethinking reflective education: what would Dewey have done? Nurse Educ Today. 2014;34:1179–83. CrossRef Rolfe G. Rethinking reflective education: what would Dewey have done? Nurse Educ Today. 2014;34:1179–83. CrossRef
24.
go back to reference de la Croix A, Veen M. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspect Med Educ. 2018;7:394–400. CrossRef de la Croix A, Veen M. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspect Med Educ. 2018;7:394–400. CrossRef
25.
go back to reference Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Med Educ. 2015;49:461–75. CrossRef Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Med Educ. 2015;49:461–75. CrossRef
26.
go back to reference Hays R, Gay S. Reflection or ‘pre-reflection’: What are we actually measuring in reflective practice? Med Educ. 2011;45:116–8. CrossRef Hays R, Gay S. Reflection or ‘pre-reflection’: What are we actually measuring in reflective practice? Med Educ. 2011;45:116–8. CrossRef
27.
go back to reference Birden HH, Usherwood T. ‘They liked it if you said you cried’: How medical students perceive the teaching of professionalism. Med J Aust. 2013;199:406–9. CrossRef Birden HH, Usherwood T. ‘They liked it if you said you cried’: How medical students perceive the teaching of professionalism. Med J Aust. 2013;199:406–9. CrossRef
28.
go back to reference Yorke M. Formative assessment in higher education: moves towards theory and the enhancement of pedagogic practice. J Higher Educ. 2003;45(4):477–501. CrossRef Yorke M. Formative assessment in higher education: moves towards theory and the enhancement of pedagogic practice. J Higher Educ. 2003;45(4):477–501. CrossRef
29.
go back to reference Levitt-Jones T, Gersbach J, Arthur C, et al. Implementing a clinical competency assessment model that promotes reflection and ensures nursing graduates’ readiness for professional practice. Nurse Educ Pract. 2011;11:64–9. CrossRef Levitt-Jones T, Gersbach J, Arthur C, et al. Implementing a clinical competency assessment model that promotes reflection and ensures nursing graduates’ readiness for professional practice. Nurse Educ Pract. 2011;11:64–9. CrossRef
30.
go back to reference Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25. CrossRef Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25. CrossRef
31.
go back to reference Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005;80(10):S46–S54. CrossRef Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005;80(10):S46–S54. CrossRef
Metagegevens
Titel
The reliability characteristics of the REFLECT rubric for assessing reflective capacity through expressive writing assignments: A replication study
Auteurs
Lawrence Grierson
Samantha Winemaker
Alan Taniguchi
Michelle Howard
Denise Marshall
Joyce Zazulak
Publicatiedatum
17-08-2020
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Perspectives on Medical Education / Uitgave 5/2020
Print ISSN: 2212-2761
Elektronisch ISSN: 2212-277X
DOI
https://doi.org/10.1007/s40037-020-00611-2