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Relationship between critical reflection and quality improvement proposal scores in resident doctors

Authors

  • Christopher M Wittich,

    1. Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Darcy A Reed,

    1. Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Monica M Drefahl,

    1. Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Colin P West,

    1. Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Furman S McDonald,

    1. Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    2. Internal Medicine Residency Office of Educational Innovations, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Kris G Thomas,

    1. Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Andrew J Halvorsen,

    1. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Thomas J Beckman

    1. Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Christopher M Wittich, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel: 00 1 507 284 8161; Fax: 00 1 507 284 5370; E-mail: wittich.christopher@mayo.edu

Abstract

Medical Education 2011: 45: 149–154

Objectives  Transformative learning theory supports the idea that reflection on quality improvement (QI) opportunities and the ability to develop successful QI projects may be fundamentally linked. We used validated methods to explore associations between resident doctors’ reflections on QI opportunities and the quality of their QI project proposals.

Methods  Eighty-six residents completed written reflections on practice improvement opportunities and developed QI proposals. Two faculty members assessed residents’ reflections using the 18-item Mayo Evaluation of Reflection on Improvement Tool (MERIT), and assessed residents’ QI proposals using the seven-item Quality Improvement Project Assessment Tool (QIPAT-7). Both instruments have been validated in previous work. Associations between MERIT and QIPAT-7 scores were determined. Internal consistency reliabilities of QIPAT-7 and MERIT scores were calculated.

Results  There were no significant associations between MERIT overall and domain scores, and QIPAT-7 overall and item scores. The internal consistency of MERIT and QIPAT-7 item groups were acceptable (Cronbach’s α 0.76–0.94).

Conclusions  The lack of association between MERIT and QIPAT-7 scores indicates a distinction between resident doctors’ skills at reflection on QI opportunities and their abilities to develop QI projects. These findings suggest that practice-based reflection and QI project development are separate constructs, and that skilful reflection may not predict the ability to design meaningful QI initiatives. Future QI curricula should consider teaching and assessing QI reflection and project development as distinct components.

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