• Christopher M Wittich, Darcy A Reed, Henry H Ting, Richard A Berger, Kelly M Nowicki, Morris J Blachman, Jayawant N Mandrekar, and Thomas J Beckman.
• Dr. Wittich is associate professor of medicine, Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Reed is associate professor of medicine, Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Ting is professor of medicine and associate dean of continuous professional development, Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Berger is professor of orthopedics and dean of continuous professional development, Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Ms. Nowicki is administrator, Mayo Clinic School of Continuous Professional Development, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Blachman is clinical professor and associate dean of continuous professional development and strategic affairs, University of South Carolina School of Medicine, Columbia, South Carolina. Dr. Mandrekar is professor of biostatistics, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Beckman is professor of medicine and medical education, Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.
• Acad Med. 2014 Oct 1; 89 (10): 1392-7.

PurposeTo validate a measure of reflection on participation in quality improvement (QI) activities and to identify associations with characteristics of QI projects, participants, and teams.MethodThis was a prospective validation study of all Mayo Clinic team participants who submitted QI projects for maintenance of certification (MOC) credit from 2010 to 2012. The authors developed a measure of reflection on participation in QI activities and explored associations between participants' overall reflection scores and characteristics of projects, participants, and teams.ResultsA total of 922 participants (567 physicians) on 118 teams completed QI projects and reflections. Factor analysis revealed a two-dimensional model with good internal consistency reliabilities (Cronbach alpha) for high (0.85) and low (0.81) reflection. Reflection scores (mean [standard deviation]) were associated with projects that changed practice (yes: 4.30 [0.51]; no: 3.71 [0.57]; P < .0001), changed the health care system (yes: 4.25 [0.54]; no: 4.03 [0.62]; P < .0001), and impacted patient safety (P < .0001). Physicians' reflection scores (4.27 [0.57]) were higher than support staff scores (4.07 [0.55]; P = .0005). A positive association existed between reflection scores and the number of QI roles per participant (P < .0001). There were no associations with participant gender, team size, or team diversity.ConclusionsThe authors identified associations between participant reflection and the impact of QI projects, participants' professional roles, and participants' involvement with projects. With further study, the authors anticipate that the new measure of reflection will be useful for determining meaningful engagement in MOC.

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