Thursday, April 19, 2018

Validation of Mayo Evaluation of Reflection on Improvement Tool (MERIT) for use in Pediatric Residency Programs

Mackenzie Frost
University of Texas Southwestern Medical Center
Background: Quality improvement education is a requirement at all stages of medical education training. Pediatric residency and fellowship programs are required to assess their trainees on quality improvement reflection and knowledge as part of the Pediatric Milestones. However, there is currently no validated tool for use in pediatrics to assess reflection on quality improvement opportunities. This study focused on validation of a previously published assessment tool, the Mayo Evaluation of Reflection on Improvement Tool (MERIT) for use in a pediatric residency program.

Methods: Using the MERIT tool, three faculty rated 150 resident reflections on quality improvement opportunities. Inter-rater and internal consistency reliabilities were calculated. 

Results: Item mean scores were highest for the Problem of Merit section (3.09 ) and lowest for the Reflection on System Characteristics of Quality Improvement (1.81 ). Inter-rater reliability was good to excellent for all items except one (intraclass correlation coefficient range: 0.75 - 0.92). Internal consistency reliability was excellent (Cronbach alpha 0.92 overall and 0.92 – 0.95 for sections). The Cronbach alpha did not improve if any single item was removed. Inter-item correlations were high for all three sections, but highest for the Problem of Merit section (0.66 – 0.92)

Conclusion: Validity evidence supports the use of MERIT in pediatric residency programs. My findings were consistent with the previously published validation study in an Internal Medicine residency program.