title: Relationship between critical reflection and quality improvement proposal scores in resident doctors.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. wittich.christopher@mayo.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Wittich
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Reed
authors.forename: Monica M
authors.initials: MM
authors.lastname: Drefahl
authors.forename: Colin P
authors.initials: CP
authors.lastname: West
authors.forename: Furman S
authors.initials: FS
authors.lastname: McDonald
authors.forename: Kris G
authors.initials: KG
authors.lastname: Thomas
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Halvorsen
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008910:Minnesota; D009936:Organizational Innovation; D058996:Quality Improvement; D013850:Thinking