Reflective practice Why do we need it? 1.To increase our knowledge and apply it. 2.To benchmark ourselves against our peers. 3.To widen our professional boundaries. 4.To develop as adaptive experts. 5.To develop personal insights to facilitate learning & remove blocks to learning

Knowledge Information is not knowledge Our use of information creates knowledge Knowledge is not wisdom Our reflective use of knowledge creates wisdom Everyone will do this differently knowledge does not exist outside of a person Because knowledge is part of our individuality gaining knowledge involves our feelings

ability to perform (rather than just “know”) is paramount.

Benchmarking and peer referencing. Learning alone can be fruitful......but it doesn’t tell you how good you are in comparison to your peers Methods helpful in benchmarking include: –clinical Audit –significant Event Analysis –talking with colleagues –peer groups –networking at seminars

Reflection and Professional Boundaries the adaptive expert. a reflective practitioner is sensitive to the unusual where the data doesn’t fit the pattern it is feeling this, and responding to it, that enables the practitioner to learn from experience

The adaptive expert Routine and Adaptive Expertise Routine expertise: practitioner performs well within guidelines and protocols Adaptive Expert: performs well within guidelines, but can also solve unusual problems and be more flexible The development of the adaptive expert requires reflective practice

Hindrances to reflective practice? Time Service Pressure Personal fear External Control – doing it for the college, not me Not seeing the reason for it Defensive attitude The major element is valuing the process of reflection

What is insight? insight is the ability to: have an internal conversation be able to articulate feelings and to take ownership of our own beliefs and actions thus, with experience, understand oneself

Insight persistent poor performance can be a sign of lack of insight those who perform effectively have insight lack of insight perpetuates bad practice

Insight and feelings Some encounters produce bad feelings, preventing reflection Acknowledging the discomfort can help you to manage it better If a patient makes your heart sink, don’t label the patient, analyse your feelings and beliefs Previous experiences and traumas can hinder the ability to have the internal conversation (because of feelings evoked)

Insight & Feedback The ability to handle feedback is a marker of insight Our performance is part of us So critique of our performance is a critique of us So, feedback must be given with sensitivity, lest it is hurtful Receiving feedback without feeling upset is thus a sign of insight

Exercise about receiving feedback: Recall the last time you received feedback on your performance. How did you react? What below most accurately describes your reaction? 1. Defensive 2. Head in the sand 3. Mildly anxious 4. Indifference (Take it or leave it ) 5. With open arms

Feedback Defensive response At its extreme the defensive response represents a lack of personal ownership Often a defensive response puts the responsibility on others: –“- Still waiting for the lab” –“The nurse advised it” –“The trains are always late” –“Not my fault”

Responses to feedback The head in the sand avoids challenge (“bad things will pass”) Indifference hides a mass of potential blockers If this is your preferred response, ask your self why and explore it with a trusted person such as a mentor

Responses to feedback Anxiety Mild anxiety is associated with more effective learning- should be welcomed!

Response to feedback With open arms Are you genuinely inviting critique? Is your enthusiasm for feedback a ploy to hide your anxieties? Are you hoping that your “open arms” approach will soften any criticism from your trainer? There must be open engagement with the feedback, not just passive listening to it

Learning from feedback requires the learner feel secure the person giving feedback must create a safe environment it cannot happen with humiliation

Learning from feedback Questions for everyone: Do you know what to do with the feedback being given to you? Can you own it, internalise it and learn from it?

Feelings feelings will have a major impact on your ability to hold a fluent functional internal conversation The internal conversation will enable you to have and develop insight and deep learning

the reflective record (many similar versions) What happened? What, if anything, happened subsequently? What did you learn? What will you do differently in future? What further learning needs did you identify? How and when will you address these?

Stages of reflection “Level 1”: incomplete learning cycle Observe activity Reflect Review performance New experience with applied knowledge R eflecting on a specific event or clinical area: E.g.: Why do I prescribe antibiotics for otitis media?

Stages of reflection “Level 2”: complete learning cycle Observe activity Reflect Review performance New experience with applied knowledge Reflect Review performance Reflecting on a specific event or clinical area: E.g.: Have I stopped prescribing antibiotics for otitis media?

Stages of reflection “Level 3”: reflecting on broader learning, with early insight Are there other clinical areas where my prescribing is out of line with guidelines? Should I audit other areas of my prescribing? I seem to be prescribing a lot of Ventolin inhalers recently; I wonder why?

Stages of reflection “Level 4”: reflecting on oneself as a clinician, developing further insights Why was I prescribing antibiotics so freely for otitis media? I knew the guidelines, so was I giving in to parental pressure, real or perceived? If I was giving in to pressure, why was that? How come others aren’t doing the same as me?

Stages of reflection “Level 5”: Deeper insights: reflecting on oneself as a person I think I was giving in to parental pressure Do I do that in other situations? If I am, does that matter? What does it say about me as a person?

Reflective practice Why do we need it? 1.To increase our knowledge and apply it. 2.To benchmark ourselves against our peers. 3.To widen our professional boundaries. 4.To develop as adaptive experts. 5.To develop personal insights to facilitate learning & remove blocks to learning