Reflection and reflective practice in health professions education: a systematic review

This article by Karen Mann and colleagues was just published online …

Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Advances in Health Sciences Education 2007 Nov 23; [Epub ahead of print; subscription required]
Abstract: The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research. PubMed Record    Related Articles 

Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers

This study, just published online in the Journal of General Internal Medicine, examined the quality of five guidelines covering various musculoskeletal disorders. The panel concluded that despite rigorous development, the quality of the published guidelines did not always meet their high standards.

Nuckols TK, Lim YW, Wynn BO, Mattke S, Maclean CH, Harber P et al. Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers. J Gen Intern Med 2007 Nov 21; [Epub ahead of print]

BACKGROUND: Rigorous guideline development methods are designed to produce recommendations that are relevant to common clinical situations and consistent with evidence and expert understanding, thereby promoting guidelines’ acceptability to providers. No studies have examined whether this technical quality consistently leads to acceptability.
OBJECTIVE: To examine the clinical acceptability of guidelines having excellent technical quality.
DESIGN AND MEASUREMENTS: We selected guidelines covering several musculoskeletal disorders and meeting 5 basic technical quality criteria, then used the widely accepted AGREE Instrument to evaluate technical quality. Adapting an established modified Delphi method, we assembled a multidisciplinary panel of providers recommended by their specialty societies as leaders in the field. Panelists rated acceptability, including “perceived comprehensiveness” (perceived relevance to common clinical situations) and “perceived validity” (consistency with their understanding of existing evidence and opinions), for ten common condition/therapy pairs pertaining to Surgery, physical therapy, and chiropractic manipulation for lumbar spine, shoulder, and carpal tunnel disorders.
RESULTS: Five guidelines met selection criteria. Their AGREE scores were generally high indicating excellent technical quality. However, panelists found 4 guidelines to be only moderately comprehensive and valid, and a fifth guideline to be invalid overall. Of the topics covered by each guideline, panelists rated 50% to 69% as “comprehensive” and 6% to 50% as “valid”.
CONCLUSION: Despite very rigorous development methods compared with guidelines assessed in prior studies, experts felt that these guidelines omitted common clinical situations and contained much content of uncertain validity. Guideline acceptability should be independently and formally evaluated before dissemination.

Guidelines examined:

Languages, living, dying and constructed …

Are you fascinated by the diversity of languages in the world, and saddened by how many of them are dying? According to the National Geographic, a language dies every two weeks. Why does this matter?
Language defines a culture, through both the people who speak it and what it allows speakers to say. Words that describe a particular cultural practice or idea rarely translate precisely into another language. Many endangered languages have rich oral cultures with stories, songs, and histories passed on to younger generations, but no written forms. With the extinction of a language, an entire culture is lost.

Enduring Voices: Saving Disappearing Languages

Every 14 days a language dies. By 2100, more than half of the more than 7,000 languages spoken on Earth—many of them never yet recorded—will likely disappear, taking with them a wealth of knowledge about history, culture, the natural environment, and how the human brain works.

National Geographic’s Enduring Voices Project strives to preserve endangered languages by identifying language hotspots—the places on our planet with the most unique, poorly understood, or threatened indigenous languages—and documenting the languages and cultures within them.

Among the world’s disappearing tongues is northern Australia’s Magati Ke—still spoken by 70-something “Old Man” Patrick Nanudjul.

Glossary of Terms Related to Language and Language Endangerment

Here is a site from the National Virtual Translation CenterLanguages of the World

The main purpose of this website is to provide information about the language families of the world and their most important and populous members, including their history, status, their linguistic characteristics, and their writing in as simple and concise a way as possible. We base this website on the belief that all languages have evolved from the need of human beings to express their thoughts, beliefs, and desires, that all languages meet the social, psychological, and survival needs of people who use them. In this sense, all languages, no matter how small and remote, are equal. All equally deserve study because all of them provide valuable insights into human nature.
Some features …
Language Listing (introduction / structure / writing / resources); Interactive Language MapTest your knowledge about the languages of the world

Then there are constructed or artificial languages, also known as conlang. See these Wikipedia entries:  Constructed language; List of constructed languages (Read about such languages as Volapük; Esperanto; Idiom Neutral; Latino sine flexione; Ido; Occidental; Novial; Glosa and Interlingua)

Plagiarism and punishment

lobachevsky.jpg  The following editorial and commentary were published in the November 10 issue of BMJ. [Full text is available free online.] (I can never hear the word plagiarize without thinking of Nicolai Ivanovich Lobachevsky.)
See also Writing & Publishing: all posts

Godlee F. Plagiarism and punishment [editorial]. BMJ  2007;335
Extract: Plagiarism is one of the three high crimes of research fraud. The US Office for Research Integrity (ORI) puts it up there with the big boys, fabrication and falsification, in its definition of research misconduct ( Some have argued that the definition should extend to lesser crimes such as undeclared conflict of interest and duplicate publication, but to my knowledge no one has questioned that theft of another person’s work is fraud.

How big a problem is plagiarism? The Committee on Publication Ethics (COPE) lists 18 cases of alleged plagiarism reviewed from 1998 to 2005 (, but as with research fraud generally this is likely to be a substantial underestimate of the true extent. Detection has been difficult in the past, but the internet, which has made plagiarism much easier to commit, is also making it easier to detect, as Michael Cross explains …

Cross M. Policing plagiarism. BMJ  2007;335:963-964 

In the internet age, copying someone else’s work can be as simple as clicking and dragging a computer mouse over a few plausible paragraphs. By the same token, the world wide web makes fraud easy to detect. Over the past decade, a range of software products has become available for detecting plagiarism, especially by students. However, experts are questioning whether Britain’s strategy for detecting academic fraud is the right one for catching the most damaging types of misconduct.

There is no evidence that plagiarism is becoming more prevalent in research. But there is no doubt that plagiarism happens, perhaps because of mindsets acquired in education.1 The Committee on Publication Ethics, an international forum for editors of peer reviewed journals, has discussed “30 or 40” alleged cases of research plagiarism over the past 10 years, says its chairman, Harvey Marcovitch.
Sections: Defining plagiarism; Relying on a single tool; Alternative tools; Bespoke work

A Google Scholar Primer

 Almost a year ago I wrote A Google Primer, which some of you have told me you have found useful. This week I took a careful look at Google Scholar, and I’ll pass on some of the things I discovered. Scholar’s advantages and disadvantages have been well documented and I won’t go into them in detail here. See also A little Google history from the Internet Archive

See Shultz M. Comparing test searches in PubMed and Google Scholar. J Med Libr Assoc 2007; 95(4):442-445. [Open Access]

Google Scholar is terrific for serendipitous searching, especially if you use the Cited By feature. This is what I tell my students:

  • Use Google Scholar as a starting point, keeping in mind limitations such as lack of subject indexing and undeterminable coverage
  • Use the Advanced Scholar Search to take advantage of several advanced search features at the same time, and use the Scholar Preferences
  • Enrich your searches by using other (free) databases such as PubMed or TRIP  (Turning Research Into Practice) or the Index to Chiropractic Literature because Scholar’s coverage of MEDLINE, for example, is incomplete (although Scholar does cover a lot of “grey literature” absent from PubMed)

If you compare the search features on the Google Advanced Search and Google Scholar Advanced Search pages, some puzzling differences appear. Some features may be used in both. Here are some highlights of Scholar and Google search features:

Downloading into bibliographic software

I have been frustrated by what I thought was the inability to download references from Scholar. Well, this week I discovered that you can download from Google Scholar, and into 5 different software managers. Outstanding! Simply go to Scholar Preferences , scroll down to Bibliography Manager and choose one.  See the link Import into RefMan on the bottom line in this screen shot (click on the image to enlarge it):

 kroenke1.png    Link to search (Turn on the bibliography manager in Google Scholar to see all the links.)

Boolean searchingWords and phrases in both Googles are automatically ANDed. OR can be used (uppercase). You can NOT words or phrases by using  – .Truncation or wildcard searching

In Google, use * to capture all forms of a word, e.g. chiropract*. Oddly, this does not work in Google Scholar.

Phrase searching

“Exact phrase” is an option in both advanced search screens; enter phrases in quotation marks in basic searches.

Author searching

This is a search feature in Google Scholar advanced search; au:  in basic search also works, although results may be incomplete (e.g. au: taylor-vaisey)

Publication searching

This is a search feature in Google Scholar advanced search. Caution: Titles are entered in the form in which they appear in publications, and the search screen only gives one chance to enter titles. Publication:  seems to work in some cases, but is unreliable. There is no way to capture all forms of a title in one search, as far as I can see.

Date searching

You can specify date ranges in Scholar; broad ranges only are available in Google.

Language searching

Google has a long drop box for countries on its advanced search screen. You can also choose from many languages in Google preferences. Scholar has no language feature on its search page, but you can choose 8 language limiters in Scholar Preferences. (A puzzling difference that may have to do with bias …)

File type

This is a choice on the Google advanced search page, not on Scholar. But you can limit by file type in Scholar basic search (e.g. filetype:pdf).

Domain limiting

This is a feature on the Google advanced search page, not on Scholar. But you can limit by domain in Scholar basic search (e.g. site:edu).

Citation searching

The “Cited by” feature is only in Google Scholar (see above screen shot). Also use the Related Articles feature. I don’t know how they create the latter but they seem to pick title words and authors. I tried to figure out how to find all the “cited by” records for a particular author, but this seems to be pretty random, unlike PubMed, which uses a formula.

Refining results

Google Scholar includes broad subject categories in its advanced search. In Google,  however, I just discovered that you can refine a search on a topic like “chronic fatigue syndrome” by the categories below. (These appear only after you do a search.)

Treatment; Tests/diagnosis; For patients; From medical authorities; Symptoms; Causes/risk factors; For health professionals; Alternative medicine; Patient handouts; Clinical trials; Continuing education; Practice guidelines 

A guide to the Canadian Medical Association Handbook on Clinical Practice Guidelines

cmaj.gif  A guide to the CMA Handbook on Clinical Practice Guidelines (published in July 2007) has just been published in the November 6, 2007 issue of CMAJ:

A guide to the Canadian Medical Association Handbook on Clinical Practice Guidelines

From the Canadian Medical Association CMA  Infobase Web site:

The Canadian Medical Association (CMA) published its new Handbook on Clinical Practice Guidelines to promote systematic development and effective implementation of clinical practice guidelines. This document provides updated guidance on how to use clinical practice guidelines to achieve optimal outcomes of patient care. Among its key audience are health care practitioners, administrators, policy-maker, groups, organizations and societies involved in guideline development, adaptation and/or implementation.

From the Guide:
At the fourth meeting of the Guideline International Network, held in Toronto in August 2007, world experts from 31 countries met to discuss the challenges and innovations afforded by clinical practice guidelines.  Although each country faces unique local challenges to the implementation of effective health care, members of the guideline community have repeatedly and generously shared their solutions to these challenges, many of which are applicable in other countries. Nevertheless, it can be difficult for the local implementer with limited resources to harness this knowledge.

See also IMPLEMENTING CLINICAL PRACTICE GUIDELINES: A Handbook for Practitioners. Developed at the 1996 CMA workshop Guideline implementation: making it happen

Journal of Athletic Training: Open Access journal

jat.jpg  The Journal of Athletic Training is an Open Access, peer-reviewed journal, and the official publication of the National Athletic Trainers’ Association, Inc.

Mission: to enhance communication among professionals interested in the quality of health care for the physically active through education and research in prevention, evaluation, management and rehabilitation of injuries.

Free full text is available from the journal’s Web site from 2000 to the present, and from PubMed Central from 1992.

Author Instructions   PubMed Records