reflection in medical education
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In the name of God. Reflection in medical education. M. Hassani. So how is reflective practice learned?. Objectives. Provide an overview of the concept & its role in learning and self-direction Provide practical advice for the effective implementation - PowerPoint PPT PresentationTRANSCRIPT
M. Hassani
In the name of God
Provide an overview of the concept & its role in learning and self-direction
Provide practical advice for the effective implementation
Assessment of reflection in undergraduate, postgraduate and continuing medical education
Latin origins: ‘to bend’ or ‘to turn back’
From physics to education
Reflection is a metacognitive process
that occursbefore, during and after situations
with the purpose of developing greater understanding of
both the self and the situation so that
future actions can be informed by this understanding.
The use of reflection in medical education: AMEE Guide No. 44. Sandars J et al. Med Teach. (2009)
A metacognitive process that occursbefore, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future actions can be informed by this understanding.
A metacognitive process
Thinking about thinking’
A self-regulatory process that selects, monitors and evaluates a cognitive process
A process that can be controlled
A metacognitive process that occursbefore, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future actions can be informed by this understanding.
Before, during and after situations
Before an experience (anticipatory reflection)
During an experience (reflection-in- action)
Following experience (reflection-on- action)
(Westberg and Jason, 2001)
A metacognitive process that occursbefore, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future actions can be informed by this understanding.
Understanding of both the self and the situation
Paying deliberate, analytical attention to:1.One’s own actions in relation to intentions2.From an external observer’s perspective
A metacognitive process that occursbefore, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future actions can be informed by this understanding.
Future actions can be informed by this understanding
Making sense of a situation will not improve practice unless these insights can
change future responses to situations.
I’m always late for work
That was a awful holiday
I’ve had a very productive weekend
I keep running out of money before the end of the month
I failed my exam
Personal experiences Personal beliefs and values Interactions with patients Interactions with colleagues Learning gains and needs Observations What went well What they were thinking Any new goals that emerged Any assumptions or biases What others were feeling
(Westberg and Jason, 2001)
A patient death
Some students wrote about problems with preceptors, the limits of medicine, and other difficult topics.
Noticing the contrast in a preceptor's negative attitude in treating a suicide survivor ("voluntarily" ill) with attitude in caring for an older, dying patient
Sometimes, students’ experience evoked unexpected thoughts and questions about medical practice.
Students questioned themselves when suddenly faced with difficult ethical situations
Feeling ethically challenged in the face of a dying patient who refuses care
(Westberg and Jason, 2001)
1. Reflection for learning
2. Reflection to develop a therapeutic relationship
3. Reflection to develop professional practice
1. Reflection for learning
2. Reflection to develop a therapeutic relationship
3. Reflection to develop professional practice
Reflection for learning
Kolb's experiential learning cycle (1984)
What happened
Analysis
Make generalizations
Planning future
actions
1. Reflection for learning
2. Reflection to develop a therapeutic relationship
3. Reflection to develop professional practice
Reflection for learning
Simplified Kolb’s learning cycle
1. Reflection for learning
2. Reflection to develop a therapeutic relationship
3. Reflection to develop professional practice
Reflection to develop a therapeutic relationship
A ‘good’ clinician:1. Appropriate knowledge and
skills2. Establish and maintain a
therapeutic relationship with patients and their carers
Effective reasoning is a mainly subconscious process with modulation of logical information processing by emotions (personal belief and value systems)
1. Reflection for learning
2. Reflection to develop a therapeutic relationship
3. Reflection to develop professional practice
Reflection to develop professional practice
Reflective Practice
“Critical thinking in Action on Action”
(Neil Thompson 2009)
Masters of your own lifelong learning
Reflective Practice Capacity - Blood Supply of Professionalism
The Effective reflective practitioner is able to recognise and explore confusing or unique (positive or negative) events that occur during practice
The Ineffective practitioner is confined to repetitive and routine practice, neglecting opportunities to think about what he/she is doing
1. Motivation for reflection
2. Metacognitive skills for reflection Noticing Processing Future action
3. Reflective storytelling and writing
4. Personal development plans and portfolios
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Motivation for reflection
Recognizing importance of Reflection
Clear goals:1. Internal factors:
• Self-efficacy• Perceived ease of the task
2. External factors:• Assessment (assessed
portfolio for personal and professional reflective learning)
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Altered future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Metacognitive skills for reflection
Developing metacognitive skills to monitor and evaluate the key aspects of reflection:
1. Noticing2. Processing3. Altered Future action
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Noticing
The recognition of when our existing mental
models and personal theories are being challenged by the
experience of a particular event or situation.
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Noticing
Techniques for noticing:
1. Self monitoring:• Participating in mindful
practice• ‘Thought catching’ approach
(hindsight bias)
2. Feedback from others:• Sarcastic comment• Non-verbal behavior
3. Critical incidents and significant event analysis• ‘Moments of surprise’
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Processing
To develop an understanding of
both the self and the situation with several techniques depending on the intention of
reflection.1. Reflection for learning2. Reflection to develop a
therapeutic relationship
3. Reflection to develop professional practice
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Future action
The aim of reflection isto inform future actions
which respect the context to which they are
being applied; so that they can be more
purposiveand deliberate.
Gibbs (1988) reflective cycle
Guided reflection (John’s model of reflection)
The What? model of structured reflection by Driscoll
1. Descriptio
n
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
Stage 1: Description of the event
Where was I? Who else was there? Why was I there? What was I doing? What other people were
doing? What the context of the
event was? What happened? What my part was? What parts the other people
played? What the result was?
1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
Stage 2: Feelings
How was I feeling at the beginning?
What was I thinking about at the time?
How it made me feel? What did other people’s
actions make me think / feel? How did I feel about the
outcome of the event? What do I think about it now?
1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
Stage 3: Evaluation
What was good about the experience for me, the patient, others?
What was bad about the experience for me, the patient, for others?
1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
Stage 4: Analysis
Breaking it down What went well? What did I do well / not so
well? What did others do well? Did it go as expected? Why / why not? What theory / research helps
me understand the experience?
What went wrong or did not turn out how it should have done?
Which way I, or others, contributed to this?
1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
Stage 5: Conclusion
Could I have done anything differently?
What are the key things I have learned from this incident - about me, my performance, others and their performance?
Can this be evidence of achievement of placement outcomes / competencies?
1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
Stage 6: Action Plan
What would I do in a similar situation in the future?
What aspects of my knowledge / skills could I develop?
How will I do this? What goals can I set myself
for the future? What outcomes /
competencies do I need to focus on now?
Experiences resulting in challenge and change are usually associated with the presence of strong emotions
Consequences of these experiences
Role of facilitator
A description of events (What?)
An analysis of events (So What?)
Proposed actions following events (Now What?)
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Reflective storytelling and writing
Add a different perspective or clarity to your initial thoughts
Allows the learner to release emotion
Evidence to include in your portfolio to help you achieve your placement outcomes
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Starting reflective writing
Have a pen and paper available at all times (’Putting your thoughts on paper)
Oral, written, using new media (audio recording, blogs, or digital storytelling)
Write down ideas as they come to you
Don’t worry about structure, order, spelling, grammar
Make sense later with the help of a more formalised structure
1.Motivation for reflection
2.Metacognitive skills for reflection Noticing Processing Future action
3.Reflective storytelling and writing
4.Personal development plans and portfolios
Personal development plans and portfolios
To encourage and assess reflective learning:
1. Identification of learning needs:“not having knowledge about the latest treatment for diabetes”
2. Developing a plan to meet the identified learning needs:“attending a training course or reading an article”
3. Measurable learning outcomes which provide the evidence that the learning needs have been fulfilled
A safe overall environment
Inability to shut off thoughts and anxious attention to self
Confidentiality: when the assessor is also the facilitator
Improve critical thinking ability
Help ourselves to make more sense of difficult and complex practice
Enhance personal development by leading to self-awareness
“Remind us that there is no end point to learning about their everyday practice”
Experiment with different approaches until you find one that ‘fits’
See it as an essential aspect to your practice rather than an ‘add on’.
Start small and work up to the big issues
Be willing to challenge your assumptions and practices
Be spontaneous – it is from the frank and honest self that important insights arise
Express yourself freely – you don’t need to observe the normal academic practices involved in writing
Remain open to ideas – early conclusions can inhibit further insights and solutions
When you reflect on a situation you do not simply see more, you see differently
Remember the purpose of reflection is to learn from an experience
One small step…