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

2. 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

3. Critical Reflection…

4. Reflection v. Critical Reflection

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

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

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

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

9. 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

10. 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!

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

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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

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

24. 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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