Plack MM¹, Driscoll M², Blissett S², McKenna R¹, Plack TP¹; 1. Stony Brook University, Stony Brook, New York, USA. 2. Touro College, Bay Shore, New York, USA. margaret.plack@stonybrook.edu

PURPOSE: Reflection is a widely accepted learning tool in professional education. In physical therapy, reflection is considered critical to practice. Journal writing is advocated in facilitating reflection, yet little is written about how to assess reflection in journals. The purpose of this study was to develop and test a method of assessing reflection in journals; and to determine whether, and to what level, reflection occurs in journals. SUBJECTS: Physical therapy students maintained written reflective journals throughout their eight-week clinical affiliations. METHOD: Students were introduced to concepts of reflective practice with definitions of terms and reflective questions prior to their first affiliation. A coding schema was developed to assess the journals. Two instructors and one physical therapist assessed forty-three journals. ANALYSIS: Nine elements of reflection were defined and utilized. The text of each journal was analyzed for evidence of these nine elements. Each journal was also categorized as non-reflective, reflective, or critically reflective. Descriptive statistics were used to demonstrate evidence of reflection. Gamma statistics and intra-class correlation coefficients (ICC) were utilized to determine inter-rater reliability. RESULTS: Raters assessed 95.3-100% of the journals as showing at least 1 element of reflection. Averaging the three raters, the number of journals showing evidence of each of the nine elements ranged from 18.3 ± 1.15 to 39.3 ± 3.51. The average percent agreement between rater pairs for the nine elements of reflection was 80.5 ± 6.74 (range 65.1-93.0); the average gamma statistic for between rater pairs was 0.85 ± 0.19 (range 0.29-1.00); and the ICC(2,1) between all raters ranged from 0.03-0.72. Homogeneity of certain data sets resulted in the lower gamma and ICC values. The average of three raters assessed 6.3 ± 0.58 of the journals as non-reflective; 18.7 ± 0.58 as reflective; and 18.0 ± 1.00 as critically reflective. The average percent agreement between rater pairs for the overall assessment of the journals was 74.3 ± 8.12 (range 67.4-85.7); the average gamma statistic for between rater pairs was 0.92 ± 0.06 (range 0.88-0.98); and the ICC(2,1) between all raters was 0.74. These results represent an acceptable level of agreement for use of this coding schema for educational purposes. CONCLUSION: Reflective journals allow students to revisit, and learn from their experiences while actively and independently linking theory to practice. Additionally, journals enable faculty to understand the clinical experience from the student’s perspective. This instrument provides a mechanism of assessing evidence of reflection in written journals, which may assist instructors in evaluating their efficacy in facilitating reflective practice among students.

Copyright 2004 by the American Physical Therapy Association

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