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Abstract：
Background Contemporary medical education emphasizes that postgraduate clinicians should look at their daily experiences as an opportunity to learn and advance their knowledge and practice of medicine. This is the concept of reflective practice. Internal medicine trainees (IMT) in the UK are encouraged to record written reflections in their electronic portfolios but it is not a mandatory requirement. There is literature suggesting that the level of engagement with these written reflections is varied and that when these are produced, they can be superficial. Thus, the aim of this research was to ascertain what percentage of trainees engaged in written reflections and the factors that affected the likelihood they would reflect. There are no studies that have attempted to quantify de novo engagement with reflective practice and to quantify the significance of different theorized barriers to reflection. Methods This study was in the form of a quasi-experimental cross-sectional study. A 15-item survey was sent out to the IMT in the northwest deanery of England (n=592). The survey remained open for approximately three months with periodic reminders sent out to the trainees. The survey was closed to further responses when the number of responses reached the predetermined sample size of 240 (5% margin of error at a confidence interval of 95%). The data were analyzed by chi-square testing and represented using descriptive statistics. Results There were 243 responses to this survey. A total of 81.5% (n=198) wrote reflections in their portfolio and 19.5% (n=45) did not write any reflections. The main content of written reflections were clinical outcomes (positive and negative), teaching, and new learning. Several background factors had a statistically significant influence on the likelihood that trainees would write reflections in their portfolios. These included their stage of training, years practicing medicine, location of primary medical training, first exposure to reflective practice, and whether they have ever been tutored on reflection. Concerns about legal or General Medical Council (GMC) use of reflective notes against trainees also significantly impacted on reflection. The main perceived barriers to written reflections were the fact that trainees felt they had no time to properly reflect and the lack of perceived benefits from reflections. Conclusion Most trainees wrote reflections in their portfolios, but the majority did not perceive any benefits in doing this. The varied backgrounds of trainees seem to have an impact on their likelihood to reflect and strategies to increase engagement would need to address this.
摘要：
背景当代医学教育强调研究生临床医生应该把他们的日常经验作为学习和推进他们的医学知识和实践的机会。这就是反思性实践的概念。鼓励英国的内科实习生（IMT）在其电子档案中记录书面反思，但这不是强制性要求。有文献表明，与这些书面反映的参与程度是多种多样的，当这些反映产生时，他们可能是肤浅的。因此，这项研究的目的是确定参与书面反思的受训者的百分比以及影响他们反映可能性的因素。没有研究试图量化与反思实践的从头接触，并量化不同理论上的反思障碍的重要性。方法本研究采用准实验横断面研究的形式。对英格兰西北部教务处的IMT进行了15项调查（n=592）。这项调查持续了大约三个月，并定期向受训者发出提醒。当响应数量达到240的预定样本量（置信区间为95％时，误差幅度为5％）时，调查对进一步的响应关闭。数据通过卡方检验进行分析，并使用描述性统计进行表示。结果本次调查共得到243份回复。共有81.5%（n=198）在他们的投资组合中写下反射，19.5%（n=45）没有写下任何反射。书面反映的主要内容是临床结果（阳性和阴性），教学,新的学习。几个背景因素对受训者在其投资组合中写下反思的可能性有统计学意义的影响。这些包括他们的训练阶段，多年行医，初级医学培训的地点，第一次接触反思练习，以及他们是否曾经接受过反思的辅导。对法律或普通医学理事会（GMC）对受训者使用反思笔记的担忧也对反思产生了重大影响。书面反思的主要障碍是受训者认为他们没有时间适当地反思，并且缺乏从反思中获得的收益。结论大多数学员在他们的投资组合中写下反思，但是大多数人认为这样做没有任何好处。学员的不同背景似乎对他们反思的可能性有影响，增加参与度的战略需要解决这个问题。
