Mixed methods analysis of reflective statements of residents following the developmental-behavioral pediatric rotation

Background: Reflection is important in the professional practice of medicine, and analyses of trainees’ reflection papers have been utilized to evaluate training outcomes. This study was to determine the degree of reflection of residents completing the developmental-behavioral pediatrics (DBP) rotation, which provides a high degree of interprofessional and family-centered experiences. We sought to explore whether level of reflection was correlated with timing of the rotation [earlier or later in training year, before or since the coronavirus disease 2019 (COVID-19) pandemic]. Methods: This retrospective study included deidentified reflection statements of Pediatrics (Peds) and Medicine-Pediatrics (Med-Peds) residents after their DBP rotation from 2017–2021. Level of reflection for each of four categories of prompts, leadership, interdisciplinary, family-centered, and equity (LIFE), which codifies 12 Maternal Child Health (MCH) competencies, and ideally reflect the principles of the DBP rotation. The prompts were coded using a five-point Castleberry rating. Results: Thirty-six residents completed reflections, 58% completed the rotation prior to the COVID-19 pandemic, and 44% completed the rotation early in their academic year. Mean Castleberry ratings were 3.2 [standard deviation (SD) =0.7], 2.7 (SD =0.8), 2.6 (SD =1.0), and 2.6 (SD =0.8) for LIFE, respectively. Wilcoxon rank-sum tests tested differences in Castleberry ratings for each facet of the LIFE framework by timing of rotation vis-a-vis the COVID-19 pandemic and early or late in the training year. We found statistically significant lower results for interdisciplinary (I) facet of the LIFE framework in those who completed the rotation late in the training year (W=214.50; P=0.02). Conclusions: Peds and Med-Peds residents reflect moderately on their DBP rotation, and more on leadership than other aspects integral to DBP practice. Future research is needed to compare reflections on the LIFE framework across different rotations, and thematic/sentiment analysis can reveal opportunities for guiding residents on the reflection process.