Developing Reflective Practice A Guide for Medical Students, Doctors and Teachers

The ability to reflect on practice is a fundamental component of effective medical practice. In a sector increasingly focused on professionalism and patient-centred care, Developing Reflective Practice is a timely publication providing practical guidance on how to acquire the reflective skills necessary to become a successful clinician.

This new title draws from a wide range of theoretical and practical multidisciplinary perspectives to assist students, practitioners and educators in embedding reflection in everyday activities. It also offers structures and ideas for more purposeful and meaningful formal reflections and professional development.

Developing Reflective Practice:

• Focuses on the developing practitioner and their lifelong learning and the development of professional identity through reflection
• Provides practical how-to information for students, practitioners and educators, including realistic case examples and practice-based hints and tips
• Examines and explains the theoretical and conceptual approaches to reflective practice, including its models and frameworks.

Professor Andrew Grant is Dean of Medical Education at Swansea University Medical School, UK.

Professor Judy McKimm is Professor of Medical Education and Director of Strategic Educational Development at Swansea University Medical School, UK.

Professor Fiona Murphy is Professor of Clinical Nursing at the University of Limerick, Ireland.

Acknowledgements xi

About the Authors xiii

Part I What is Reflection? 1

1 Perspectives on Reflection 3

Reflective Learning: Making a Difference – Andrew Grant 3

Start Early, Make it Routine – Judy McKimm 5

Some Challenges for Reflective Practice – Fiona Murphy 7

About the Book: Structure and Content Overview 8

2 What is Reflection and Why Do We Do It? 11

Why are Learners Required to Reflect? 11

The Place of Reflection in Professional Development 13

John Dewey’s Contribution 15

What can be Achieved by Reflection? 15

Getting the Most Out of Reflection 16

Summary 18

3 Theoretical Underpinnings of Reflection 19

Kolb 20

Freire 20

Applying and Integrating Learning Through Reflection 21

Knowledge – a Constantly-Changing Network 21

Deep and Surface Approaches to Learning 22

Reflection In Action, Reflection On Action – Donald Schon 23

The Uncertain World of Practice 24

Emotional Content of Learning 24

Summary 25

4 Frameworks for Reflection 27

Introduction 27

Frameworks for Reflection 28

Kolb: Learning from Experience 28

Borton’s Framework 29

Rolfe’s Framework for Reflexive Practice 30

Gibbs: Learning by Doing 31

Summary 35

Part II Learning Reflection 37

5 Reflecting in Practice 39

Capturing and Describing the Experience 39

‘Less than a Minute’ Techniques 40

Voice Recordings 40

The Reflective Selfie 40

Emoticons 40

Word Whips 41

One to Five Minute Techniques 41

The ‘Three a Day’ Technique 41

The Credit Card Technique 41

Time Limited 42

Analysing the Experience 43

Description: What Happened? 43

Feelings: What Were You Thinking and Feeling? 44

Evaluation: What Was Good and Bad About the Experience? 45

Analysis: How Can I Make Sense of This Experience? 45

Conclusion 47

Action Plan 48

Summary 49

6 Writing Reflectively 51

What is Reflective Writing? 51

Different Types of Reflective Writing 51

Creative Writing 52

Analytical–Academic Reflective Writing 55

Journal Writing 55

Learning Outcomes 57

Dialogical Writing 57

Critical Incident Analysis 58

Reflective Essay 59

A Description of the Experience 60

Interpretation and Analysis 60

An Outcome 60

Portfolio Writing 61

Some Issues with Reflective Writing 61

Summary 62

7 Reflective Activities 63

Types of Reflective Learning Activity 63

Problem‐Based Learning 63

Case‐Based Learning 65

Supporting Reflective Learning 65

Supervision 65

Appraisal 66

Coaching and Mentoring 66

Coaching 68

Mentoring 70

Summary 70

8 Reflection, Critical Thinking and Action Research 71

Connecting Reflection and Knowledge Generation 71

Connecting Reflection, Knowledge and Research through Critical Thinking 72

1. Identifying and Challenging Assumptions 74

Our Autobiography 74

Our Patients’ and Clients’ Eyes 75

Our Colleagues’ Experiences 75

Theoretical Literature 75

2. Recognizing the Importance of Context 76

Constructing 76

Deconstructing 76

Confronting 76

Reconstructing 77

3. Exploring and Imagining Alternatives 77

4. Reflective Scepticism 78

Action Research: Connecting Reflection, Knowledge and Critical Thinking 78

Examples of Action Research 81

Summary 82

Part III Facilitating Reflection 83

9 Teaching and Supporting Reflection 85

Aims, Goals and Purpose 86

Supporting Learners to Get Started as Reflective Learners 87

Selecting the Right Method of Reflective Learning 88

Using Learning Technologies to Enable Reflection 93

Peer Learning 94

Reflection as Part of Developing Professional Identity 95

Evaluating Reflective Learning and Teaching 97

Summary 98

10 Assessing Reflection 99

What are You Looking For in Reflective Assessment? 100

Marking Reflective Work – a Cause of Potential Conflict 100

Effects of Making Reflective Learning Compulsory 101

Strategies to Discourage Students from Writing What They Think the Tutor Wants to Read or Will Gain Them Good Marks 102

Creating a Robust, Defensible Assessment for Your Students’ Reflective Work 104

Ensuring Robust, Valid, Reliable Assessment 105

Summary 107

Part IV Developing as a Reflective Practitioner 109

11 The Role of Reflection in Developing Professional Identity 111

How Does Reflective Practice Form Professional Identity? 112

How Can Reflection Be Challenging to Professional Identity? 113

Self Theories, PIF and Reflective Practice 114

How Can Guided Reflection Be Challenging Without Being Threatening? 116

Summary 117

12 Reflection, Revalidation and Appraisal 119

Adult Learning – Andragogy 119

1. The Need to Know 120

2. The Learners’ Self-Concept 120

3. The Role of the Learners’ Experiences 121

4. Readiness to Learn 121

5. Orientations to Learning 121

6. Motivation 121

Maximizing Learning Return on Effort 122

A Curriculum Based on Your Experience 123

Learning that is Intrinsically Rewarding 125

Keeping a Record for CPD, Appraisal and Revalidation 126

Demonstrating Learning and Development over Time 127

Summary 128

References and Resources 129

References 129

Further Resources 135

Index 137

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