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Lookup NU author(s): Dr James Field, Professor Chris VernazzaORCiD
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Developing a grading matrix for reflection What problem was addressed? Reflective practise sits at the heart of professional knowledge and competence. Clinical teachers at all levels (both undergraduate and postgraduate) are faced with the challenge of developing and assessing this important skill. Structured, objective rubrics do exist for assessing reflection; however no one main rubric has been widely adopted, perhaps due to their complexity. What was tried? Newcastle Dental School uses a ‘BUMS’ grading system; merit, satisfactory, borderline fail and unsatisfactory. A focussed literature review facilitated the development of three important domains of reflective practise and reflective writing; these were entered into a BUMS assessment matrix (see online supplement). From 2010-2012, Stage 2 Dentistry and Hygiene and Therapy students were asked to write a clinical reflective report. The grading matrix was published in advance and students were asked to grade their work prior to submission. The reports were team-marked by six members of staff. The domains were: i) Level of reflection – a poor report would be descriptive, with no attempt at reasoning. For example, “I asked the receptionist to reschedule the patient”. A failing report would contain only descriptive reflection, where reasons are provided but only in a reportive way. For example, “I asked the receptionist to reschedule the patient because I was running late”. A satisfactory report would also contain dialogic reflection, where the report mulls over the reasons and explores alternatives (Perhaps….. I wonder…. Maybe….). Finally a meritorious report would contain mostly critical reflection, taking into account the social context in which events took place and decisions were made. For example roles, relationships, gender, ethnicity etc. ii) Level of exploration – a poor report would be purely descriptive, with no consideration of other factors. A failing report would be too descriptive or lengthy, at the expense of influencing and alternative factors. A satisfactory report would contain a brief description and consider influencing and alternative factors. A meritorious report would do the same, but also consider clear and explicit learning points. iii) Frames of reference (FoR) - a poor report would take no account of other FoR/standing back from the situation. It would only be written from the observer’s point of view. A failing report would only pay minor consideration to FoR. A satisfactory report would consider FoR for most reported events, and a meritorious report would clearly demonstrate that FoR had been considered for all events reported during the clinical encounter. Kappa scores between staff and student grades improved each year, reaching 0.677 for the 2012 cohort (n=110, SE 0.093, P<0.000). What lessons were learned? Students and staff reported that the matrix helped them to understand the process of reflection. When publishing the matrix in advance, failure rates dropped from circa 15% to 2%. All individuals who failed to write a satisfactory report graded themselves as satisfactory; these students must be identified for further tutoring. Clinical teachers and postgraduate clinical trainers found the matrix useful for developing reflective skill and quickly assessing the level of reflection within a report. The grading matrix was shown to be a valid and reliable tool.
Author(s): Field J, Vernazza C
Publication type: Article
Publication status: Published
Journal: Medical Education
Year: 2013
Volume: 47
Issue: 5
Pages: 531
Print publication date: 10/04/2013
ISSN (print): 0308-0110
ISSN (electronic): 1365-2923
Publisher: Wiley-Blackwell Publishing Ltd.
URL: http://dx.doi.org/10.1111/medu.12179
DOI: 10.1111/medu.12179
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