Reflective Judgment in Medicine – Developing the Reasoning about Medical Issues Test

There is growing awareness that epistemic cognition is a very important conceptual framework – not only but especially in medicine – in order to understand how individuals deal with ill-defined problems. Assessing epistemic cognition quantitatively, however, has proven to be difficult and there is no standard instrument for this purpose to date. Against this background we developed a questionnaire to capture epistemic cognition as outlined in the Reflective Judgment Model. We chose this particular model because it not only explicitly targets how individuals deal with ill-defined problems but also because it is a developmental model delineating how epistemic cognition evolves depending on age, education, experience etc. Our initial questionnaire comprised 31 items to be rated on a five-point category rating scale. Based on data from a cohort of 313 first and 189 third year medical students we performed confirmatory and exploratory factor analyses. The latter yielded a three-factor solution including 24 of the 31 items that resembled the macrostructure of the Reflective Judgment Model. However, the internal consistency of the scales was rather low (.57 / .65 / .67) indicating that further effort is needed to improve the instrument before it can be used for educational and diagnostic purposes.