Guidance on Reflection
‘Medical education has traditionally focussed on the assimilation of vast amounts of knowledge and on clinical apprenticeship as the ‘hallmark’ of good training, and has undervalued reflection in learning. Today, however, medical and dental education needs to prepare students for lifelong learning. It must foster professionals who take a deep approach to learning and equip students to determine their own learning needs, set their own learning goals and monitor the occurrence of continuing progress. To achieve this, a more reflective approach is called for’ (Pee et al, 2000).
It is important that students develop a habit of assessing their own learning needs, developing strategies to meet them and reflecting on their own learning and personal development.
‘Reflection - the conscious weighing and integrating of views from different perspectives – is a necessary prerequisite for the development of a balanced professional identity … acquiring knowledge and practical skills alone are not enough to become a medical professional. Reflecting on education and clinical experiences in medical practice, including one’s own behaviour, becomes crucial’ (Boenink et al, 2004).
Introduced as a concept for many professions in the 1980s
Means that we learn by thinking about things that have happened to us and seeing them in a different way.
There are three components
- Experiences – that happen to a person
- Reflective process – that enables a person to learn from their experience
- Action – resulting from the new perspective taken as a result of the reflection
Reflection as a learning activity comes from educational theory, Kolb (1984) describes a cycle of stages that are gone though in learning from experience:
CONCEPT DEVELOPMENT and THEORISING
Levels of Reflection
Goodman (1984) describes three levels of reflection:
- Level 1: Reflection to reach given objectives – criteria for reflection are limited to technocratic issues of efficiency, effectiveness and accountability i.e. students gives an account of an incident and demonstrates some learning
- Level 2: Reflection on the relationship between principles and practice – there is an assessment of the implications and consequences of actions and beliefs as well as the underlying rationale for practice i.e. students begin to link theory to practice and to extrapolate their experiences to other similar situations
- Level 3: Reflection which besides the above incorporates ethical and political concerns – issues of justice and emancipation enter the deliberations over the value of professional goals and practice and the practitioner makes links between the setting of everyday practice and broader social structure and forces e.g. health economics and resources.
Frameworks for Reflection
There are many frameworks that can be used to encourage and support reflection; the choice of framework depends on the student’s skills and experience and may change as students become more expert in their reflections. A range of frameworks and tools follow:
Helping students to reflect:
Consider what you did on your placement visit today…did anything that happened during the day surprise you? Has anything that happened during the day contradicted or challenged your ideas or expectations? Have your views changed? For example:
If you met a patient:
How did the patient’s life experiences differ from your own?
Did you feel able to empathise with the patient?
If you were shadowing a health care professional:
Did anything about the person’s role surprise you? Do you think the roles of all members of the MDT are valued? How do you feel about team working with other professionals?
Have you identified gaps in your knowledge or skills? How might you go about addressing these?
Or you might like to use one of the following frameworks to reflect on your experience:
A Learning Experience (Pee et al, 2002)
Briefly describe what happened.
- Describe your feelings at the time this happened.
- Why do you consider this experience to be worthy of reflection?
- What strengths in your clinical practice did this experience demonstrate?
- What learning needs did this experience reveal to you?
Gibbs Reflective cycle (1988)
Action Plan Feelings
(If it arose again what (what were you
would you do?) thinking and feeling?)
(What else could you (What was good and bad about
Have done?) the experience?)
(What sense can you make of the situation?)
Borton’s Developmental Framework (1970)
This is a simple model that is suitable for novice practitioners, at its simplest it’s three steps can be summarised as:
i.e. the What questions such as: What happened?, What was I doing? Serve to identify the experience and describe it in detail.
The So what? Questions include questions like: So what do I need to know in order to understand this situation? So what does this tell me about me? About my relationship with the patient? With the other members of the team? I.e. the student breaks down the situation and tries to make sense of it by analysing and evaluating in order to draw conclusions.
The Now what? Questions e.g. Now what do I need to do to make things better? Now what might be the consequences of this action? At this stage the student plans intervention and action according to personal theory devised.
Johns Model of Structured reflection (1994)
Core questions – What information do I need to access in order to learn through this experience?
Compiled by Maria Hayfron-Benjamin,
Lecturer in Medical Education,
Barts and the London School of Medicine and Dentistry
Boenink AD, Oderwald AK, deJonge P, vanTilburg W and Smal JA (2004) Assessing student reflection in Medical Practice. Medical Education, 38, 368 – 377.
Borton, T. (1970) Reach, Touch and Teach. :
Gibbs, G. (1988) Learning by Doing. Polytechnic,
Goodman, J. (1984) Reflection and teacher education: a case study and theoretical analysis. Interchanges, 15, 9 – 26
Jasper, M. (2003) Beginning Reflective Practice. Nelson Thornes, .
Johns, C. (2000) Becoming a Reflective Practitioner. Blackwell Science, .
Palmer, A., Burns, S. and Bulman, C. (1994) Reflective Practice in Nursing. Blackwell, .
Pee B, Woodman T, Fry H, and Davenport E. (2000) Practice-based learning: views on the development of a reflective learning tool. Medical Education, 34, 754 – 761.
Pee B, Woodman T, Fry H and Davenport E. (2002) Appraising and assessing reflection in students’ writing on a structured worksheet. Medical Education, 36, 575 – 585
Examples of Rubrics
Several examples of rubrics that can be found on the web are linked below to aid in the development of rubrics for post secondary education settings.
Template for Creating a Rubric
The below link is to a MSWord file that contains a template for a rubric and instructions for how to use and modify the template to meet individual grading needs. Instructors can download this file and modify it as needed to construct their own rubric.
AAC&U VALUE Rubrics
The AAC&U VALUE initiative (2007-09) developed 16 VALUE rubrics for the LEAP Essential Learning Outcomes. Elements and descriptors for each rubric were based on the most frequently identified characteristics or criteria of learning for each of the 16 learning outcomes. Drafts of each rubric have been tested by faculty with their own students’ work on over 100 college campuses.
The VALUE rubrics contribute to the national dialogue on assessment of college student learning. The AAC&U web is widely used by individuals working in schools, higher education associations, colleges, and universities in the United States and around the world.
Instructors can use the rubrics in their current form. They can also modify the language and rubric elements to meet the specific needs of their assignment or assessment goal.
Access to the VALUE Rubrics is free. AAC&U requests that users register before downloading PDF or Word versions of the rubrics to assist their research on rubric use.
External link to AAC&U Rubric download page: http://www.aacu.org/value-rubrics
Collections of Rubric Links
Interactive Quality of an Online Course
Student Peer Review
Theses and Dissertations
Updated: 06/20/16 gb