title: A reflective learning framework to evaluate CME effects on practice reflection.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Information Technology Primary Care Research Group, Department of Family Medicine, Faculty of Medicine, McGill University, 517 Pine Avenue West, Montreal, Quebec, Canada. kit.leung@mail.mcgill.ca
authors.forename: Kit H
authors.initials: KH
authors.lastname: Leung
authors.forename: Pierre
authors.initials: P
authors.lastname: Pluye
authors.forename: Roland
authors.initials: R
authors.lastname: Grad
authors.forename: Cynthia
authors.initials: C
authors.lastname: Weston
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D003194:Computer-Assisted Instruction; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education*; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research