A modified tool for "reflective practice" in medical education: Adaptation of the REFLECT rubric in Persian

Abstract

CONTEXT: Reflection is a learnable process that enhances long-life learning, clinical decision-making, and can foster empathy and professionalism. One of the methods for teaching reflection is "reflective writing" that is conducted in "reflective practice." Some tools have been developed to assess "reflective capacity," and The Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) is one of them. AIMS: This study aimed to adapt the REFLECT rubric in Persian. SETTINGS AND DESIGN: This quantitative study was conducted in a medical school with the participation of medical interns through census sampling, and in three stages, including translation, pilot study, and main study. SUBJECTS AND METHODS: Persian translation was obtained by the "forward/backward translation" method. We made some changes in the tool and used it in the pilot and main study to confirm validity and reliability. STATISTICAL ANALYSIS USED: Cronbach's alpha coefficient, Pearson correlation, and Cohen's kappa were applied for statistical analysis. Data analysis was performed using SPSS23. RESULTS: We inserted a numerical value of 1-4 at the reflection levels, and also removed Axis 2 and an optional writing component. In the pilot study, face and content validity was confirmed involving 10 interns and five medical education specialists. Then, 67 interns participated in the main study, and we measured the reliability of the tool by internal consistency through Cronbach's alpha (0.83) and test-retest through correlation coefficient (0.89). The size of the agreement was measured to determine the inter-rater reliability by Cohen's kappa (0.84). CONCLUSIONS: The modified REFLECT version is a valid and reliable tool that can help us to assess reflective capacity. The use of this tool is recommended for reflective practice in medicine.