Introduction to Critical Reflection Louise Aronson, MD MFA Marieke Kruidering PhD University of California, San Francisco

Learning Objectives Distinguish critical reflection from reflection Identify the role of critical reflection in MD professional development Discuss the 5 key steps for successful critical reflection

Critical Reflection…

Reflection v. Critical Reflection

A word with many meanings and uses Reflection A word with many meanings and uses

Reflection ! The bending or folding back of a part upon itself

The return of light after striking a surface Reflection The return of light after striking a surface

A thought occurring in consideration or meditation Reflection A thought occurring in consideration or meditation

Critical Reflection Is Different Goes beyond “consideration or meditation” A skill developed over time In medicine, a tool for learning and life-long professional development Mezirow, 1998; Boud, 1998; Sandars 2009

Critical Reflection Not just what happened (anecdote) More than personal opinion Requires Data gathering and analysis Integration of past, present and future Contextualizing and reframing Learning!

Critical Reflection: UCSF Definition The analysis of personal experience to enhance learning and improve future professional behavior and outcomes.

Critical Reflection What is it? Why should you care? How do you do it well?

Outcomes Data Sobral: ↑ student exam performance Blatt: ↑ student clinical performance with standardized patients Mamede: ↓ resident diagnostic errors Toy: ↑residents achieving rotation goals Pelgrim: trainees who reflect make better use of feedback, i.e do better Sobral 2001, Blatt 2007, Mamede 2008/2010, Toy 2009, Pelgrim 2013

The Reflective Practitioner … is able to identify essential professional problems, to challenge self-evident ‘truths’, to seek feedback and to use it for personal professional development. Schön, 1983

Critical Reflection What is it? Why should you care? How do you (help your learners) do it well?

Successful Reflection Structured guidelines more effective than prompt alone Feedback=essential Practice is the only way to achieve competence Aronson et al., 2011, 2012; Sargeant 2009

UCSF Approach LEaP Guidelines: Learning from your Experience as a Professional 5 key steps to critical reflection SOAP note format Aronson et al., MEP 2012 (1,2); Kruidering MEP 2013

Step 1 Critical Reflection Choosing the right experience A situation where reflector didn't have the necessary knowledge or skills that went well but reflector not sure why which was complex, surprising, uncomfortable or uncertain in which reflector felt personally or professionally challenged

Step 2 Critical Reflection “Subjective” Detailed consideration of experience What, how, why Intellectual & emotional responses Told so others can form own conclusions Not just good storytelling/writing

Step 3 Critical Reflection “Objective” (Outside perspective) Going beyond own impressions Outside input Feedback from others supervisors, other professionals, mentors, patients, families, peers Relevant research or data Should lead to a reframing of the experience

Step 4 Critical Reflection “Assessment” Synthesis of “S” and “O” Links current and past experience to identify an important, ongoing professional development challenge Explicitly identifies a learning issue

Step 5 Critical Reflection “Plan” Strategy for learning/future behavior Must be SMART Specific, Measurable, Attainable, Relevant and Timely Ideal if specifies follow up or check in

Successful Reflection Not just transcription of past learning Not self-aggrandizement Shows new learning or plan for new approach

Summing up Critical reflection is a skill Reflection and Critical Reflection are different both may be useful choice based on educational objectives Doing CR well takes effort, practice, feedback, mentoring and time

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