title: Measuring faculty reflection on medical grand rounds at Mayo Clinic: associations with teaching experience, clinical exposure, and presenter effectiveness.
abstract: OBJECTIVE
  To develop and validate a new instrument for measuring participant reflection on continuing medical education (CME) and determine associations between the reflection instrument scores and CME presenter, participant, and presentation characteristics.
  
  
  METHODS
  This was a prospective validation study of presenters and faculty at the weekly medical grand rounds at Mayo Clinic in Rochester, Minnesota, from January 1, 2011, through June 30, 2011. Eight items (5-point Likert scales) were developed on the basis of 4 reflection levels: habitual action, understanding, reflection, and critical reflection. Factor analysis was performed to account for clustered data. Interrater and internal consistency reliabilities were calculated. Associations between reflection scores and characteristics of presenters, participants, and presentations were determined.
  
  
  RESULTS
  Participants completed a total of 1134 reflection forms. Factor analysis revealed a 2-dimensional model (eigenvalue; Cronbach α): minimal reflection (1.19; 0.77) and high reflection (2.51; 0.81). Item mean (SD) scores ranged from 2.97 (1.17) to 4.01 (0.83) on a 5-point scale. Interrater reliability (intraclass correlation coefficient) for individual items ranged from 0.58 (95% CI, 0.31-0.78) to 0.88 (95% CI, 0.80-0.94). Reflection scores were associated with presenters' speaking effectiveness (P<.001) and prior CME teaching experience (P=.02), participants' prior clinical experiences (P<.001), and presentations that were case based (P<.001) and used the audience response system (P<.001).
  
  
  CONCLUSIONS
  We report the first validated measure of reflection on CME at medical grand rounds. Reflection scores were associated with presenters' effectiveness and prior teaching experience, participants' clinical exposures, and presentations that were interactive and clinically relevant. Future research should determine whether reflection on CME leads to better patient outcomes.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. Wittich.Christopher@mayo.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Wittich
authors.forename: Jason H
authors.initials: JH
authors.lastname: Szostek
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Reed
authors.forename: Jeanine L
authors.initials: JL
authors.lastname: Kiefer
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
authors.forename: Jayawant N
authors.initials: JN
authors.lastname: Mandrekar
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032882:Comprehension; D004502:Education, Medical, Continuing; D005163:Factor Analysis, Statistical; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D008875:Middle Aged; D008910:Minnesota; D015233:Models, Statistical; D015588:Observer Variation; D010820:Physicians / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013663:Teaching; D013850:Thinking