Characterization of Reflective Capacity of Anesthesiology Trainees in an Irish Tertiary Referral Teaching Hospital

Hassan M Ahmed; Audrey Dunn Galvin; Aoife O'Loughlin; Aisling O'Meachair; Jeffrey B Cooper; Richard H Blum; George Shorten

doi:10.46374/volxxiv_issue1_ahmed

Characterization of Reflective Capacity of Anesthesiology Trainees in an Irish Tertiary Referral Teaching Hospital

J Educ Perioper Med. 2022 Jan 1;24(1):E678. doi: 10.46374/volxxiv_issue1_ahmed. eCollection 2022 Jan-Mar.

Authors

Hassan M Ahmed¹, Audrey Dunn Galvin², Aoife O'Loughlin³, Aisling O'Meachair³, Jeffrey B Cooper^{4

5

6}, Richard H Blum^{5

6

7}, George Shorten^{3

8}

Affiliations

¹ is Lecturer in the Department of Anesthesia and Intensive Care, Faculty of Medicine, Cairo University, Cairo, Egypt, and Consultant in the Department of Anesthesia and Intensive Care, Leeds Teaching Hospitals, Leeds, United Kingdom.
² is Programme Director Early Years and Childhood Studies in the School of Applied Psychology, Cork University Hospital, University College, Cork, Ireland; and Visiting Professor in the Department of Paediatrics and Child Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
³ is Specialist Registrar, is Senior House Officer, and is Consultant, Department of Anesthesia and Intensive Care, Cork University Hospital, Cork, Ireland.
⁴ is Professor in the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
⁵ is Professor of Anesthesia and is Associate Professor of Anesthesia, Harvard Medical School, Boston, MA.
⁶ is Executive Director Emeritus and Senior Fellow and is Senior Faculty, Center for Medical Simulation, Boston, MA.
⁷ is Senior Associate in Perioperative Anesthesia in the Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
⁸ is Professor of Anesthesia and Intensive Care Medicine at the School of Medicine, University College of Cork, Cork, Ireland; and Funded Investigator, at the Insight II SFI Research Centre, Cork, Ireland.

Abstract

Background: Reflective practice is associated with improved accuracy of medical diagnosis and superior performance in complex situations. Systematic observation of trainees' reflective capacities constitutes a basis for an effective support of reflective practice within the training paradigm. We set out to examine the reflective capacity among anesthesiology trainees in a tertiary referral hospital.

Methods: We invited 61 anesthesiology trainees in Cork University Hospitals, Ireland, to participate. Each trainee was invited to respond to 2 investigator-written vignettes prepared by the investigators and suitable for evaluation using the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) and to produce and then respond to a written vignette based on their own experience. All responses were assessed by 2 independent assessors who had undergone training in the application of the REFLECT rubric, which gives quantifiable scores. Interrater reliability was assessed by weighted kappa coefficient. Association between years of training in medicine and level of reflective capacity was examined using correlation and multiple regression analyses, controlling for age.

Results: Twenty-nine trainees agreed to participate, the overall REFLECT Level was 2.16 (SD 0.7), corresponding to "thoughtful action," indicating low to moderate reflective ability. Cronbach's alpha for the 5 items of the REFLECT scale was excellent (r = 0.92). Weighted kappa was very satisfactory (k = 0.81). A strong association was demonstrated between years in medicine and scores on REFLECT, controlling for age of participant (F = -2.57, Beta coefficient = -0.30). Respondents with less experience had greater mean REFLECT scores than respondents with more experience (F = 5.5, P = .02; post hoc mean difference = 0.7, P = .03 for ≤32 months vs ≥99 months). There was a significant effect for gender (t = -4.3, P = .001), with women's responses receiving greater REFLECT scores than men's responses (mean difference = 0.67, P = .001).

Conclusions: Overall, participants demonstrated low to moderate reflective capacity, as assessed by the REFLECT rubric. Reflective capacity of the anesthesiology trainees appears to decrease as years of medical training progress. However, our respondents were not sampled over time to fully support this conclusion. Further research is needed on the psychometric properties of the REFLECT rubric and the generalizability of our findings.

Keywords: Anesthesia trainees; REFLECT; medical experience; reflective capacity; tertiary Irish hospital.