Reflection on practice Developing ‘knowing about knowing’ skills

What is Reflection Reflection is a metacognitive process that occurs before, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future encounters with the situation are informed from previous encounters. ( Sanders J 2009 )

Reflective Cycle Review Do Plan

Experiential Learning Cycle ( after What happened ? Concrete experience Analysis Reflective observation After Kolb 1984 Making generalisations Abstract conceptualisation Planning Future Action Active Experimentation

Aims of Reflection Reflection for learning; self directed learning, lifelong learning. Reflection on personal views, assumptions emotions and beliefs. Reflection to develop a therapeutic relationship. Reflection for self development. Encourages professional practice development.

When does reflection occur? Informally, within an individual during the days activities. More structured individual “ double loop learning “ activity. Semi formally during discussions, assessments and feedback sessions with a Tutor or mentor. Written reflection e.g. as part of a portfolio ordiary.

Reflective tools Critical event analysis/Significant event analysis. Audit or review of practice. Direct observation of Practice or video analysis. Assessment of written reflective work

Challenges of Reflection Self direction is always limited by one’s own view of self. Emotionally challenging situations can evoke complex responses which must be carefully facilitated. Danger of self rumination and introspection. Potential dichotomy between facilitator who is also an assessor for the learner.

Role of Facilitator Enhance motivation. Encourage by observation initially and gradually increase the process to goal setting. ( ALOBA feedback model) Prevent introspection. Encourage and develop a deeper understanding of the reflective process.

Written assessment of Reflection Increasingly used at Undergraduate and early Postgraduate level. University of Aberdeen has an e-portfolio from First Year in Medicine. Final year GP attachment includes a marked reflective log diary.

Levels of Reflection Committed Reflection. What has been learned, how it has affected the learner, how they have changed including evidence. Emotional Exploration. Slightly less evidence of change but reflection of impact. Objective Reporting. No reflection or discussion of personal impact. Diffuse Reporting. ( Neimi 1997)

Moon’s Grading Grade A. Explaining how experiencing an event has changed you. Grade B. Involving judgement in analysis. Grade C. Description but with some mention of feelings. Grade D. Description but recognising an area of importance. Grade E. Description without interpretation.

The Future Valuable component to future professional development. Lack of evidence of impact on patient care. Challenge to encourage undergraduates to see value in process. Use of multi media and internet.

References MOON JA(2004).AHandbookofReflective andExperientialLearning:Theory and Practice. Abingdon: Routledge Falmer NIEMI PM (1997). Medical Students’ Professional Identity: Self-Reflection During the Pre-Clinical Years. Medical Education, 31: Sandars J (2009). The Use of Reflection in Medical Education. AMEE Guide No.44. Medical Teacher, 31(8):

Structured Reflective Log DDiary Phase IV ( Final Year) General Practice attachment. Introduces reflective learning and includes examples and suggestions.

Clinical story and Learning points 6 Acute cases 4 Chronic cases 3 Mental Health cases 3 Chronic Disease or Health Promotion cases 3 Ethical Dilemmas In depth reflection on 3 of these cases.