title: Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing.
abstract: OBJECTIVE
  Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students' reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion.
  
  
  METHODS
  Following a comprehensive search and analysis of the literature, the authors developed an analytic rubric through repeated iterative cycles of development, including empiric testing and determination of interrater reliability, reevaluation and refinement, and redesign. Rubric iterations were applied in successive development phases to Warren Alpert Medical School of Brown University students' 2009 and 2010 RW narratives with determination of intraclass correlations (ICCs).
  
  
  RESULTS
  The final rubric, the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT), consisted of four reflective capacity levels ranging from habitual action to critical reflection, with focused criteria for each level. The rubric also evaluated RW for transformative reflection and learning and confirmatory learning. ICC ranged from 0.376 to 0.748 for datasets and rater combinations and was 0.632 for the final REFLECT iteration analysis.
  
  
  CONCLUSIONS
  The REFLECT is a rigorously developed, theory-informed analytic rubric, demonstrating adequate interrater reliability, face validity, feasibility, and acceptability. The REFLECT rubric is a reflective analysis innovation supporting development of a reflective clinician via formative assessment and enhanced crafting of faculty feedback to reflective narratives.
authors: Warren Alpert Medical School of Brown University, Providence, Rhode Island 02860, USA. hedy_wald@brown.edu
authors: Hedy S
authors: HS
authors: Wald
authors: Jeffrey M
authors: JM
authors: Borkan
authors: Julie Scott
authors: JS
authors: Taylor
authors: David
authors: D
authors: Anthony
authors: Shmuel P
authors: SP
authors: Reis
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005246:Feedback; D006801:Humans; D012237:Rhode Island; D013850:Thinking; D014956:Writing