Study Shows Relationships Between Reflection and Behavior Change in CME*

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23 September 2017

In an original research article published in the Journal of Continuing Education in the Health Professions (JCEHP) Summer 2017 issue, Volume 37, Number 3 titled “Relationships Between Reflection and Behavior Change in CME”, results demonstrate a relationship between participant reflection and commitment-to-change (CTC) in conference-based CME. The study found that presentations that incorporate clinical cases and audience response systems seem to stimulate participant reflection and behavior change.


The value of CME defined by the Accreditation Council for Continuing Medical Education (ACCME) as a “learner-centered, continuous improvement model” with the aim to “serve physicians’ learning and practice needs and to promote public health” has already been demonstrated. Research is now seeking to identify which types of CME are most effective. Although CME can be delivered in a variety of formats (conferences, lectures, workshops, online materials) and it is generally accepted that it should be interactive and use multiple educational methods, research continues on understanding which methods are most effective, and in which settings.


This study aimed to measure associations between validated reflection scores and behavior change among CME participants and to identify associations between reflection and characteristics of CME presentations.

It was a cohort study of attendees at a national hospital medicine CME course. Participants provided reflection scores for each presentation and planned commitment-to-change (CTC) statements at the conclusion of the course. Reflection scores from 1 (strongly disagree) to 5 (strongly agree) were averaged for each presentation. CTC statements were linked to their accompanying presentations. A 3-month post-course survey was conducted to assess if planned CTCs were successfully implemented.


In all, 223 of 281 participants (79.4%) returned evaluations. Of the 195 planned CTC statements available for post-course analysis, 128 (65.6%) were implemented. Reflection scores correlated with the number of planned CTC statements across all presentations (Pearson correlation, 0.65; P < .001). In addition, higher reflection scores (mean [SD]) were associated with the presence of audience response opportunities (Yes: 4.13 [0.18] versus No: 3.96 [0.16]; P = .01) and the use of clinical cases (Yes: 4.09 [0.18] versus No: 3.86 [0.12]; P < .01).


Reflective learning, as it applies to CME, was defined as “[involving] a critical comparison of new information with existing knowledge (in the context of an educational experience), which clarifies meaning, creates new understanding, and/or results in a changed perspective”.


Based on the results, CME presenters have data to support the incorporation of active learning techniques, such as the use of clinical cases and audience response systems, to stimulate reflection and CTC amongst their audience members.



liV Agency has developed and created multiple learning programs that specifically leverage a reflective learning component in order to lead to improved learning outcomes. A reflective learning program automated platform is available in a turn-key format and liV has demonstrated success in integrating reflective learning accredited formats into live symposia as well.


*Please note the original article is referenced below and has been directly quoted in most of this article.


If you’d like to learn more about incorporating reflective learning as an educational instructional design method into your current educational initiatives or would like to see some of our work in this area, please contact Namita Vashi by email at [email protected].



(1) Ratelle JT, Wittich CM, Yu RC, Newman JS, Jenkins SM, Beckman TJ.

Relationships Between Reflection and Behavior Change in CME; J Contin Educ Health Prof. 2017 Summer; 37(3):161-167. doi: 10.1097/CEH.0000000000000162.


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