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Volume 30 (2)
Volume 30, Issue 2, Spring 2010 
J Contin Educ Health Prof 2010; 30(2)
ORIGINAL RESEARCH
Kit H. Leung, Pierre Pluye, Roland Grad, Cynthia Weston A b s t r a c t Introduction: The adoption of a reflective learning model in continuing medical education (CME) acknowledges the importance of reflective practice. Nevertheless, little is known about how to evaluate reflective learning in CME. The term reflective learning is seldom defined in terms of specific cognitive processes or observable performances. Competency-based evaluation is rarely used for evaluating CME effects. To bridge this gap, reflective learning was operationally defined in a reflective learning framework (RLF). The operationalization supports observations, documentation, and evaluation of reflective learning performances in CME, and in clinical practice. In this study, the RLF was refined and validated as physician performance was evaluated in a CME e-learning activity. Methods: Qualitative multiple-case study wherein 473 practicing family physicians commented on research-based synopses after reading and rating them as an on-line CME learning activity. These comments formed 2029 cases from which cognitive tasks were extracted as defined by the RLF with the use of a thematic analysis. Frequencies of cognitive tasks were compared in a cross-case analysis. Results: Four RLF cognitive processes and 12 tasks were supported. Reflective learning was defined as 4 interrelated cognitive processes: Interpretation, Validation, Generalization, and Change, which were specified by 3 observable cognitive tasks, respectively. These 12 tasks and related characteristics were described in an RLF codebook for future use. Discussion: Reflective learning performances of family physicians were evaluated. The RLF and its codebook can be used for integrating reflective learning into CME curricula and for developing competency-based assessment. Future research on potential uses of the RLF should involve participation of CME stakeholders. Lessons for Practice
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