Measuring faculty reflection on adverse patient events: development and initial validation of a case-based learning...

Area of Science:

• Medical Education
• Quality Improvement
• Physician Professional Development

Background:

• Physician reflection on adverse events is crucial for behavior change and quality improvement (QI).
• Limited research exists on physician reflection specifically within QI contexts.
• A validated tool is needed to measure physician reflection on patient safety events.

Purpose of the Study:

• To develop and validate a computerized case-based learning system (CBLS).
• To measure faculty physicians' levels of reflection on adverse patient events.
• To assess the reliability and validity of the CBLS for QI research.

Main Methods:

• Prospective validation study involving staff physicians in Internal Medicine.
• Development of a CBLS with three case scenarios (systems, medication, diagnostic errors).
• Faculty completed reflection questionnaires and case assessments; factor analysis and reliability testing were performed.

Main Results:

• The CBLS demonstrated good usability, with 91.3% satisfaction ratings.
• Factor analysis identified two reflection levels: Minimal and High, with strong internal consistency (Cronbach's α=0.77).
• Reflection scores positively correlated with case generalizability (p=0.001) and relevance (p=0.02).

Conclusions:

• The CBLS is a valid instrument for stratifying physician reflection on adverse events.
• Physician reflection is enhanced by the generalizability and relevance of patient case scenarios.
• The CBLS can facilitate future research comparing QI outcomes between low and high-reflecting physicians.