Podcast
Questions and Answers
What is the primary purpose of empathy in the patient-doctor relationship?
What is the primary purpose of empathy in the patient-doctor relationship?
Which stage of Gibbs' Reflective Cycle asks about what could have been improved?
Which stage of Gibbs' Reflective Cycle asks about what could have been improved?
Which of the following best describes the balance a healthcare provider must achieve?
Which of the following best describes the balance a healthcare provider must achieve?
What type of questions does each stage of Gibbs' Reflective Cycle include?
What type of questions does each stage of Gibbs' Reflective Cycle include?
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What is a common misconception about empathy in healthcare?
What is a common misconception about empathy in healthcare?
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What is the primary intention of reflective practice in professional settings?
What is the primary intention of reflective practice in professional settings?
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How should reflection on experiences be characterized?
How should reflection on experiences be characterized?
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Which of the following is NOT a benefit of engaging in reflective practice?
Which of the following is NOT a benefit of engaging in reflective practice?
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What is a key characteristic of medical professionalism?
What is a key characteristic of medical professionalism?
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Which aspect is included in reflective practice?
Which aspect is included in reflective practice?
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What role does reflection play in a doctor's everyday practice?
What role does reflection play in a doctor's everyday practice?
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Which statement about honest discussions regarding clinical events is true?
Which statement about honest discussions regarding clinical events is true?
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What is the focus of reflective practice according to its definition?
What is the focus of reflective practice according to its definition?
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What is the primary purpose of Reflective Practice?
What is the primary purpose of Reflective Practice?
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Which theory is associated with Reflective Practice?
Which theory is associated with Reflective Practice?
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How does reflection contribute to Continuous Professional Development?
How does reflection contribute to Continuous Professional Development?
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According to the content, what is a significant consequence of medical errors in the USA?
According to the content, what is a significant consequence of medical errors in the USA?
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What does the conclusion stage of Gibbs' Reflective Cycle emphasize?
What does the conclusion stage of Gibbs' Reflective Cycle emphasize?
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Which aspect of behavior is highlighted as influential during an interaction with a patient?
Which aspect of behavior is highlighted as influential during an interaction with a patient?
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What does the statement 'To Err is Human' suggest about health care professionals?
What does the statement 'To Err is Human' suggest about health care professionals?
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What key quality should be developed when interacting with patients according to the reflection?
What key quality should be developed when interacting with patients according to the reflection?
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What does Hippocrates imply about the role of a physician?
What does Hippocrates imply about the role of a physician?
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What should reflective practitioners demonstrate through their learning?
What should reflective practitioners demonstrate through their learning?
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In the context of Gibbs' Reflective Cycle, what does the action plan involve?
In the context of Gibbs' Reflective Cycle, what does the action plan involve?
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What should be the initial step if faced with a similar situation again according to the action plan?
What should be the initial step if faced with a similar situation again according to the action plan?
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What is a key insight from the quote by Epictetus regarding reflection?
What is a key insight from the quote by Epictetus regarding reflection?
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What is one recommended approach to remain effective during patient interactions?
What is one recommended approach to remain effective during patient interactions?
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What is a helpful prompt to consider for future improvement in interactions with patients?
What is a helpful prompt to consider for future improvement in interactions with patients?
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What impact can a practitioner's behavior have on patients during assessments?
What impact can a practitioner's behavior have on patients during assessments?
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What was the intern's main responsibility during their first month?
What was the intern's main responsibility during their first month?
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What was a significant factor that negatively impacted the intern's performance in the theatre?
What was a significant factor that negatively impacted the intern's performance in the theatre?
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What type of training was the intern receiving while in the theatre?
What type of training was the intern receiving while in the theatre?
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What role did the Clinical Director play in the intern's situation?
What role did the Clinical Director play in the intern's situation?
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Which feeling was likely evoked in the intern during this experience?
Which feeling was likely evoked in the intern during this experience?
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What was likely a consequence of the intern's poor performance during the wound closure procedure?
What was likely a consequence of the intern's poor performance during the wound closure procedure?
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What aspect of the situation could have been considered 'good' by the intern?
What aspect of the situation could have been considered 'good' by the intern?
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What reflective questioning might help the intern analyze the experience?
What reflective questioning might help the intern analyze the experience?
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What is the primary focus of the action plan in Gibbs' Reflective Cycle?
What is the primary focus of the action plan in Gibbs' Reflective Cycle?
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Which aspect of dementia patient behavior is highlighted in the context?
Which aspect of dementia patient behavior is highlighted in the context?
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What key outcome does the individual expect from increased exposure to situations?
What key outcome does the individual expect from increased exposure to situations?
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What method is mentioned as crucial for understanding patient behavior in the content?
What method is mentioned as crucial for understanding patient behavior in the content?
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What challenge does the individual face when dealing with dementia patients?
What challenge does the individual face when dealing with dementia patients?
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What is a major approach used in Gibbs' Reflective Cycle?
What is a major approach used in Gibbs' Reflective Cycle?
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What does the phrase 'become more proactive' suggest about future actions?
What does the phrase 'become more proactive' suggest about future actions?
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How does the individual view their progress towards handling unexpected situations?
How does the individual view their progress towards handling unexpected situations?
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What kind of shifts was the intern asked to cover during their first month?
What kind of shifts was the intern asked to cover during their first month?
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What was the primary reason for the intern's poor performance in the theatre?
What was the primary reason for the intern's poor performance in the theatre?
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What is a primary benefit of reflection for healthcare practitioners?
What is a primary benefit of reflection for healthcare practitioners?
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How does reflection support employability according to the content?
How does reflection support employability according to the content?
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What reflective question helps determine the intern's feelings about the experience?
What reflective question helps determine the intern's feelings about the experience?
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What is a characteristic of a learning health system?
What is a characteristic of a learning health system?
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Which of the following could have been a positive aspect of the intern's experience?
Which of the following could have been a positive aspect of the intern's experience?
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Which statement about lifelong learning in the context of reflection is correct?
Which statement about lifelong learning in the context of reflection is correct?
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What should practitioners reflect upon to improve their resilience?
What should practitioners reflect upon to improve their resilience?
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What might be a consequence for others due to the intern's poor performance?
What might be a consequence for others due to the intern's poor performance?
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How does effective reflection influence an individual's understanding of good practice?
How does effective reflection influence an individual's understanding of good practice?
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Which reflective stage encourages examining the consequences of the experience for oneself?
Which reflective stage encourages examining the consequences of the experience for oneself?
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What core idea does the learning health system concept rely on?
What core idea does the learning health system concept rely on?
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What aspect of the intern's role involved emotional challenges?
What aspect of the intern's role involved emotional challenges?
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Why is self-awareness considered vital for healthcare practitioners?
Why is self-awareness considered vital for healthcare practitioners?
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What is a key reflection prompt that can help analyze one’s attitude towards a situation?
What is a key reflection prompt that can help analyze one’s attitude towards a situation?
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Which aspect is NOT implied by reflecting on one's clinical performance?
Which aspect is NOT implied by reflecting on one's clinical performance?
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What does the term 'Now What?' signify in the reflective cycle?
What does the term 'Now What?' signify in the reflective cycle?
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Which reflection question aims to analyze learned lessons from a situation?
Which reflection question aims to analyze learned lessons from a situation?
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What does 'So What?' prompt participants to evaluate?
What does 'So What?' prompt participants to evaluate?
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Which question is least effective for analyzing the underlying reasons behind behavior in a situation?
Which question is least effective for analyzing the underlying reasons behind behavior in a situation?
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What factor should not be allowed to impede training and clinical performance, according to the reflective practice approach?
What factor should not be allowed to impede training and clinical performance, according to the reflective practice approach?
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In reflective practice, what aspect related to improving outcomes can be learned from past experiences?
In reflective practice, what aspect related to improving outcomes can be learned from past experiences?
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What is the first step in Greenaway's 4F’s model of active reviewing?
What is the first step in Greenaway's 4F’s model of active reviewing?
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Which aspect of the 4F's model focuses on emotional reactions to a situation?
Which aspect of the 4F's model focuses on emotional reactions to a situation?
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What does the 'Future' component of the 4F's model emphasize?
What does the 'Future' component of the 4F's model emphasize?
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Which model is more widely used within teaching professions according to the provided content?
Which model is more widely used within teaching professions according to the provided content?
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What does the term 'Schwartz Rounds' refer to in the context of reflective practice?
What does the term 'Schwartz Rounds' refer to in the context of reflective practice?
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What is expressed in the 'Findings' step of the 4F's model?
What is expressed in the 'Findings' step of the 4F's model?
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What does the acronym 'DO-REVIEW-PLAN' represent in reflective practice?
What does the acronym 'DO-REVIEW-PLAN' represent in reflective practice?
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Which of the following prompts is NOT a component of any reflective model discussed?
Which of the following prompts is NOT a component of any reflective model discussed?
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What is the primary intention of reflective practice in a medical context?
What is the primary intention of reflective practice in a medical context?
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How should reflection on experiences be characterized according to the guidelines?
How should reflection on experiences be characterized according to the guidelines?
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Which of the following is NOT considered a benefit of engaging in reflective practice?
Which of the following is NOT considered a benefit of engaging in reflective practice?
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What is a key aspect of medical professionalism according to the material?
What is a key aspect of medical professionalism according to the material?
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What is a significant component of reflective practice as stated in the content?
What is a significant component of reflective practice as stated in the content?
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What type of situations can trigger reflection in a medical professional's practice?
What type of situations can trigger reflection in a medical professional's practice?
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Which statement best characterizes the outcome of engaging in reflective practice?
Which statement best characterizes the outcome of engaging in reflective practice?
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What should healthcare professionals avoid when reflecting on clinical events?
What should healthcare professionals avoid when reflecting on clinical events?
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What aspect is crucial for understanding the behavior of dementia patients according to the action plan?
What aspect is crucial for understanding the behavior of dementia patients according to the action plan?
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According to the action plan, what is expected to increase the individual's confidence in dealing with dementia patients?
According to the action plan, what is expected to increase the individual's confidence in dealing with dementia patients?
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What does 'becoming more proactive' imply about the individual's future approach?
What does 'becoming more proactive' imply about the individual's future approach?
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What are two contrasting behaviors observed in dementia patients as mentioned in the content?
What are two contrasting behaviors observed in dementia patients as mentioned in the content?
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Which question should be considered in the reflection process according to the content?
Which question should be considered in the reflection process according to the content?
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What is a significant realization the individual has about their future handling of unexpected situations?
What is a significant realization the individual has about their future handling of unexpected situations?
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Which part of Gibbs’ Reflective Cycle emphasizes what can be improved in future practices?
Which part of Gibbs’ Reflective Cycle emphasizes what can be improved in future practices?
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What can be inferred about the individual's attitude towards their learning from experiences with dementia patients?
What can be inferred about the individual's attitude towards their learning from experiences with dementia patients?
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What is the primary outcome of Continuous Quality Improvement (CQI) in health care?
What is the primary outcome of Continuous Quality Improvement (CQI) in health care?
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What aspect does reflective practice emphasize as a mechanism for learning?
What aspect does reflective practice emphasize as a mechanism for learning?
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Which statement best describes the role of personal values in communication within health care?
Which statement best describes the role of personal values in communication within health care?
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What is meant by the concept of reflective practice as metacognition?
What is meant by the concept of reflective practice as metacognition?
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What defines reflective thought according to John Dewey?
What defines reflective thought according to John Dewey?
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How should concerns about patient care be communicated within an organization?
How should concerns about patient care be communicated within an organization?
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According to the theories mentioned, what is the impact of deep learning compared to surface learning?
According to the theories mentioned, what is the impact of deep learning compared to surface learning?
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Which of the following concepts is central to achieving effective reflective practice?
Which of the following concepts is central to achieving effective reflective practice?
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How is reflection characterized in the context provided?
How is reflection characterized in the context provided?
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What is the fundamental goal of reflection on experience?
What is the fundamental goal of reflection on experience?
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What is the primary distinction between reflection and mere diary writing?
What is the primary distinction between reflection and mere diary writing?
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Which approach is essential for continuous improvement in patient care?
Which approach is essential for continuous improvement in patient care?
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What does Piaget's Constructivist Learning Theory suggest about the role of reflection?
What does Piaget's Constructivist Learning Theory suggest about the role of reflection?
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What does self-reflective practice emphasize about cognitive abilities?
What does self-reflective practice emphasize about cognitive abilities?
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How is the transformation from surface learning to deep learning facilitated?
How is the transformation from surface learning to deep learning facilitated?
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What cognitive outcome is expected from engaging in reflective practice?
What cognitive outcome is expected from engaging in reflective practice?
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Which element is essential for the success of Learning Health Systems (LHS)?
Which element is essential for the success of Learning Health Systems (LHS)?
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What does the PDSA Cycle primarily aim to achieve?
What does the PDSA Cycle primarily aim to achieve?
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What key recommendation emerged from the Williams Review regarding healthcare errors?
What key recommendation emerged from the Williams Review regarding healthcare errors?
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Which aspect of the PDSA Cycle was originally introduced by Walter Shewhart?
Which aspect of the PDSA Cycle was originally introduced by Walter Shewhart?
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How did the GMC respond to concerns about reflective practice being used against doctors?
How did the GMC respond to concerns about reflective practice being used against doctors?
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In the context of Learning Health Systems, what is a primary use of large electronic health data sets?
In the context of Learning Health Systems, what is a primary use of large electronic health data sets?
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What was a significant concern raised in the Williams Review about healthcare negligence?
What was a significant concern raised in the Williams Review about healthcare negligence?
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Which of the following elements is NOT part of the Learning Health Systems framework?
Which of the following elements is NOT part of the Learning Health Systems framework?
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What distinguishes reflection-in-action from reflection-on-action in Schon’s model?
What distinguishes reflection-in-action from reflection-on-action in Schon’s model?
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In the context of Driscoll’s reflective practice model, what does 'Now What?' primarily address?
In the context of Driscoll’s reflective practice model, what does 'Now What?' primarily address?
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How does Schon suggest practitioners should engage with reflective practice during professional activities?
How does Schon suggest practitioners should engage with reflective practice during professional activities?
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Which of the following best describes the purpose of using new information in reflection-on-action?
Which of the following best describes the purpose of using new information in reflection-on-action?
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What role do feelings play in Schon’s reflective process?
What role do feelings play in Schon’s reflective process?
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Which component is NOT part of Schon’s reflective practice methodology?
Which component is NOT part of Schon’s reflective practice methodology?
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What is the significance of ‘thinking about what you might do differently’ in Schon’s reflective framework?
What is the significance of ‘thinking about what you might do differently’ in Schon’s reflective framework?
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How is the concept of 'Knowing in action' characterized in Schon’s theory?
How is the concept of 'Knowing in action' characterized in Schon’s theory?
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What is the main goal of Schwartz rounds in healthcare settings?
What is the main goal of Schwartz rounds in healthcare settings?
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Which component is NOT part of building a reflective practice mindset?
Which component is NOT part of building a reflective practice mindset?
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What does the ERA model in reflective practice stand for?
What does the ERA model in reflective practice stand for?
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During Schwartz rounds, which aspect is primarily avoided in discussions?
During Schwartz rounds, which aspect is primarily avoided in discussions?
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What benefit can attending Schwartz rounds provide to healthcare staff?
What benefit can attending Schwartz rounds provide to healthcare staff?
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What is a key benefit of reflective practice over time?
What is a key benefit of reflective practice over time?
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Which of the following best encapsulates the essence of the Schwartz rounds according to the provided content?
Which of the following best encapsulates the essence of the Schwartz rounds according to the provided content?
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The RESPECT Rubric is primarily used for what purpose in reflective assignments?
The RESPECT Rubric is primarily used for what purpose in reflective assignments?
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What does the conclusion stage of Gibbs' Reflective Cycle aim to summarize?
What does the conclusion stage of Gibbs' Reflective Cycle aim to summarize?
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In the context of reflective practice, which action can enhance a healthcare provider's performance during patient interactions?
In the context of reflective practice, which action can enhance a healthcare provider's performance during patient interactions?
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What is a key component of the action plan stage in Gibbs' Reflective Cycle?
What is a key component of the action plan stage in Gibbs' Reflective Cycle?
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Which of the following best captures a common dilemma healthcare providers face when interacting with patients?
Which of the following best captures a common dilemma healthcare providers face when interacting with patients?
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What is an essential takeaway from reflecting on body language during patient assessments?
What is an essential takeaway from reflecting on body language during patient assessments?
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What type of questions are encouraged to facilitate deeper reflection during the action plan stage?
What type of questions are encouraged to facilitate deeper reflection during the action plan stage?
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Which feeling is highlighted as crucial for healthcare providers to manage during assessments?
Which feeling is highlighted as crucial for healthcare providers to manage during assessments?
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How can a healthcare provider prepare to act differently in future patient interactions according to the action plan?
How can a healthcare provider prepare to act differently in future patient interactions according to the action plan?
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Which of the following stages represents the process of actively testing what has been learned from an experience in Kolb's Learning Cycle?
Which of the following stages represents the process of actively testing what has been learned from an experience in Kolb's Learning Cycle?
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What is a primary benefit of engaging in reflective practice for healthcare practitioners?
What is a primary benefit of engaging in reflective practice for healthcare practitioners?
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Which stage of Kolb's Learning Cycle involves gaining insights or understanding from past experiences?
Which stage of Kolb's Learning Cycle involves gaining insights or understanding from past experiences?
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In the context of Gibbs' Reflective Cycle, which element emphasizes considering what you learned and how it could be applied in the future?
In the context of Gibbs' Reflective Cycle, which element emphasizes considering what you learned and how it could be applied in the future?
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Which element in Kolb's Learning Cycle emphasizes reflecting on what has been experienced and observed?
Which element in Kolb's Learning Cycle emphasizes reflecting on what has been experienced and observed?
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What prompt would be most beneficial for someone in the Active Experimentation stage of Kolb's Learning Cycle?
What prompt would be most beneficial for someone in the Active Experimentation stage of Kolb's Learning Cycle?
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What aspect of the learning process is emphasized by the Concrete Experience stage in Kolb's Learning Cycle?
What aspect of the learning process is emphasized by the Concrete Experience stage in Kolb's Learning Cycle?
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Which of the following best describes the role of reflection in continuous professional development for healthcare professionals?
Which of the following best describes the role of reflection in continuous professional development for healthcare professionals?
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What is a key element in Kolb's conception of experiential learning?
What is a key element in Kolb's conception of experiential learning?
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According to Mezirow's Transformational Learning Theory, what does reflection primarily help to clarify?
According to Mezirow's Transformational Learning Theory, what does reflection primarily help to clarify?
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What essential practice allows healthcare professionals to learn and improve from their experiences?
What essential practice allows healthcare professionals to learn and improve from their experiences?
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Which concept focuses primarily on the relationship between experience and conscious critical thought in learning?
Which concept focuses primarily on the relationship between experience and conscious critical thought in learning?
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What aspect of learning does Moon identify as one of the six areas where reflection is beneficial?
What aspect of learning does Moon identify as one of the six areas where reflection is beneficial?
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In the context of healthcare, what should a practitioner do if they identify a system impairing patient care?
In the context of healthcare, what should a practitioner do if they identify a system impairing patient care?
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What does metacognition refer to in the context of reflection?
What does metacognition refer to in the context of reflection?
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What is a key outcome of Continuous Quality Improvement in healthcare settings?
What is a key outcome of Continuous Quality Improvement in healthcare settings?
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In the context of reflection, which of the following does not describe its function?
In the context of reflection, which of the following does not describe its function?
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Which statement accurately reflects the contribution of reflection according to Schön?
Which statement accurately reflects the contribution of reflection according to Schön?
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Which term best describes the process of using past experiences to shape new understandings and theories?
Which term best describes the process of using past experiences to shape new understandings and theories?
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What is a misconception about the role of reflection in learning?
What is a misconception about the role of reflection in learning?
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What aspect of personal values is essential in a healthcare setting according to the information provided?
What aspect of personal values is essential in a healthcare setting according to the information provided?
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How does Loughran's perspective contribute to understanding the problem-solving process?
How does Loughran's perspective contribute to understanding the problem-solving process?
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How is knowledge characterized in relation to reflective practice?
How is knowledge characterized in relation to reflective practice?
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What type of approach should healthcare professionals adopt for continuous improvement?
What type of approach should healthcare professionals adopt for continuous improvement?
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What does the 'Findings' stage in Greenaway's 4F's Model emphasize?
What does the 'Findings' stage in Greenaway's 4F's Model emphasize?
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In the context of reflective practice, what does the term 'Future' refer to in the 4F's Model?
In the context of reflective practice, what does the term 'Future' refer to in the 4F's Model?
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Which of the following stages does Greenaway's initial model 'DO-REVIEW-PLAN' correspond to in reflective practice?
Which of the following stages does Greenaway's initial model 'DO-REVIEW-PLAN' correspond to in reflective practice?
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Which aspect of the 4F's Model primarily focuses on participants' emotional responses to situations?
Which aspect of the 4F's Model primarily focuses on participants' emotional responses to situations?
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What is the primary focus of Schwartz Rounds in the context of reflective practice?
What is the primary focus of Schwartz Rounds in the context of reflective practice?
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What role do prompts play within the reflective stages according to the described models?
What role do prompts play within the reflective stages according to the described models?
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How is the application of Greenaway’s 4F's model primarily characterized in professional settings?
How is the application of Greenaway’s 4F's model primarily characterized in professional settings?
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What does the 'Facts' stage in the 4F's Model entail?
What does the 'Facts' stage in the 4F's Model entail?
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Which of the following stages of Gibbs’ Reflective Cycle focuses on developing an understanding of feelings during an experience?
Which of the following stages of Gibbs’ Reflective Cycle focuses on developing an understanding of feelings during an experience?
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What is essential to include in reflective writing according to the guidelines provided?
What is essential to include in reflective writing according to the guidelines provided?
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In reflective writing, why is it recommended to use the past tense almost exclusively?
In reflective writing, why is it recommended to use the past tense almost exclusively?
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Which aspect of reflective practice emphasizes the importance of planning future actions based on past experiences?
Which aspect of reflective practice emphasizes the importance of planning future actions based on past experiences?
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What characterizes habitual action as opposed to critical reflection?
What characterizes habitual action as opposed to critical reflection?
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Which component is least likely to be included in an effective reflective writing structure?
Which component is least likely to be included in an effective reflective writing structure?
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What does the term 'critical reflection' entail in the context of medical education?
What does the term 'critical reflection' entail in the context of medical education?
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What role does analysis play in Gibbs' Reflective Cycle?
What role does analysis play in Gibbs' Reflective Cycle?
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What is an important factor to consider when dealing with the behavior of dementia patients?
What is an important factor to consider when dealing with the behavior of dementia patients?
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How can exposure to more situations affect confidence in handling unexpected behavior from dementia patients?
How can exposure to more situations affect confidence in handling unexpected behavior from dementia patients?
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What should individuals focus on to improve their understanding of dementia patient behavior?
What should individuals focus on to improve their understanding of dementia patient behavior?
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What action does the individual plan to prioritize in the future to address challenges faced in similar situations?
What action does the individual plan to prioritize in the future to address challenges faced in similar situations?
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Which question type is suitable for the analysis stage of Gibbs' Reflective Cycle?
Which question type is suitable for the analysis stage of Gibbs' Reflective Cycle?
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In the context of Gibbs' Reflective Cycle, what does 'So What?' primarily encourage the individual to think about?
In the context of Gibbs' Reflective Cycle, what does 'So What?' primarily encourage the individual to think about?
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What mindset should be adopted in dealing with unexpected behavior from dementia patients?
What mindset should be adopted in dealing with unexpected behavior from dementia patients?
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What role does peer advice play in developing confidence when interacting with dementia patients?
What role does peer advice play in developing confidence when interacting with dementia patients?
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Study Notes
Learning Objectives
- Define Reflective Practice
- Describe Reflective Practice Theory and Gibb's Reflective Cycle
- Understand the role of Reflection in Continuous Professional Development
- Discuss the application of Reflection to learning from Clinical Scenarios
Reflective Practice
- A cognitive process that helps gain insights, rethink practice, learn from experiences, and cope with similar situations in the future.
- Rolfe, G., Freshwater, D., and Jasper, M. (2001).
"Don't just say you have read books..."
- Show that through them you have learned to think better, to be a more discriminating and reflective person.
- Epictetus
Ars Longa, Vita Brevis
- Life is short, and art is long...
- the crisis fleeting; experience perilous, and decision difficult.
- The physician must not only be prepared to do what is right himself, but also make the patients, the attendants, and externals cooperate.
- Hippocrates of Kos
To Err is Human
- In USA 98,000 people die in any given year from medical errors that occur in hospitals.
- That's more than die from MVA, breast cancer, or AIDS.
- Indeed, more people die annually from medication errors than from workplace injuries.
- To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.
- Sir Liam Donaldson (2004)
Reflective Practice: IMC
- Developing insight into professional practice is important to improve standards of care.
- Reflective practice includes:
- Formal Reviews through audit and outcome data.
- Informal Reflection on how personal values may affect communication with patients, colleagues or others, and ultimately the care provided to patients.
Learning Culture & Safety: IMC
- Medical treatment involves some degree of risk.
- We should strive to minimise risk and learn from harm.
- "You should promote a culture of patient safety"
- Adverse events result in unintended outcomes for patients as a result of clinical interventions or omissions, or the systems or processes used in managing patient care.
- "If you are involved in an adverse event, you should report it, learn from it and take part in any review of the incident".
Reflective Practice: AoMRC
- The process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible
- Situation may be observed, or directly involved, or part of formal learning.
- Reflection happens with both positive and negative events, either to reinforce behaviour or to change it.
Reflective Practice: GMC, AoMRC & COPMED
- Doctors must feel able to have honest and open discussions about clinical events and should be confident that engaging in reflection provides them:
- Improved opportunities to learn
- Evidence of a professional approach to self-development
- Changes leading to improvement of patient care where appropriate
- Reflection should not be a detailed description, nor an attribution of blame, but should focus on feedback and descriptions of the increased understanding gained which has led to an affirmation of, or change of, practice.
Royal College of Surgeons in Ireland Definition
- Medical Professionalism: "Values, behaviours and attitudes that promote professional relationships, public trust and patient safety"
Continuous Improvement
- Continuous Quality Improvement (CQI) in Health Care is a structured organizational process that involves physicians and other personnel in planning and implementing ongoing proactive improvements in processes of care to provide quality health care outcomes.
Reflective Practice Theory
- This is a theoretical concept within the broader topic of reflection.
What is Reflection
- Reflection allows the reflector's learning and knowledge to benefit from conscious thought.
- Two main conceptions:
- Reflection on Experience - using experiences as a foundation for learning and updating personal understanding of existing theories
- Reflection as Metacognition - particularly focusing on a problem, conception, or an idea.
- Knowledge is a continual development and is shaped by its relationship with experience or conscious critical thought.
What is not Reflection
- Writing a diary
- Gazing at the clouds
Reflective Thought (Dewey)
- He defines reflective thought as an active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and further conclusion to which it tends.
- Thinking about a problematic situation that needs to be resolved
- the function of reflective thought is, therefore, to transform a situation in which there is experienced obscurity, doubt, conflict, disturbance of some sort, into a situation that is clear, coherent, settled, harmonious
- converts action that is merely appetitive, blind and impulsive into intelligent action.
Reflection: Active Learning and Consolidation
- Piaget (1971) Constructivist Learning Theory Reflection
- forces students to engage with content matter and contextualise it with their own experience.
- Marton & Saljo (1976) “Deep Learning”
- Students who engage more deeply with material will learn and retain principle ideas better.
Reflection: Definition
- Cognition, can be defined as "the mental acquisition of knowledge through thought, experience, and the senses".
- Reflection, is a cognitive process that helps us to gain insights into the "big picture" and rethink our practice, learn from their experiences and help us to cope with similar situations in the future.
- Self-Reflective Practice is a "meta-cognitive" ability, meaning that it involves thinking about and reflecting on one's own mental processes.
Reflection: on Experience
- In adult education the benefit of learning from experience, rather than passively through knowledge transfer, is established.
- Donald Schön (1983) highlighting the importance of experience as a tool for updating professional theories and through reflection using them to improve practice.
- Kolb (1984) formalised the modern conception of experiential learning:
- Allowing the student to reflect on their experience is essential for the student to extract meaningful elements and incorporate them into a personal knowledgebase.
Reflection: Metacognition
- Metacognition: awareness and understanding of one's own thought processes
- Jack Mezirow (1991) Transformational Learning Theory
- suggests that reflection is useful to understand the content and premise of the problem as well as the problem-solving process itself.
- This is obtained by stepping back and looking at one's thinking process - reflection therefore becomes "thinking about thinking" and how to do so effectively.
- Loughran (1996) highlights problem solving by reflection and learning from experience
Reflection: Critical Thought (Moon)
- Moon (2004) highlights six different areas where reflection can be helpful:
- Critically reviewing our own behaviour, the behaviour of others, or the product of our behaviour.
- Building general theories from observing, or being involved in practical situations.
- Making decisions or resolving uncertainty.
- Considering the process of our own learning, in other words engaging in 'thinking about thinking' or metacognition.
- Engaging in personal or self-development.
- Empowering or emancipating ourselves as individuals or within our social group.
Reflecting on Experience
- Reflective Models can help with structure, guidance and questions.
- Gibbs' “Reflective Cycle” (1988)
- Driscoll's or Rolfe's Reflective Practice Model "What? So what? Now what?"
- Kolb's learning Cycle (1984)
- Schon's Reflective Practitioner (1991)
- Bassot's “The Integrated Reflective Cycle"
- Greenaway's “The Active Reviewing Cycle" of "four F's”
Reflection and Professional Development
- Reflection leads to higher self-awareness and make one more likely to effectively plan their professional and personal development.
- Cunningham & Moore (2017) particularly highlight how being taught reflection allows healthcare practitioners to effectively recognise development opportunities.
- Identifying suboptimal practice, the individual is well placed to think about what good practice looks like, and reflect on what excelling looks like.
Employability
- Employability “a set of achievements – skills, understandings and personal attributes - that makes graduates more likely to gain employment and be successful in their chosen occupations, which benefits themselves, the workforce, the community and the economy."
- Reflect on what skills you have developed over the last week/month/year and how you will be able to evidence these skills with examples.
- Reflect to identify the skills that are required in the sector you want to end up in and start developing these by setting goals and objectives
- Reflect on how you deal with challenges and how you can improve your approach and resilience.
- Reflect on the range of experiences you have and find ways to expand this range.
- Ensure you don't neglect life-long learning.
Learning Health System: Learning Cycle
- Learning health systems (LHS) are healthcare systems in which knowledge generation processes are embedded in daily practice to produce continual improvement in care.
- LHS can be described as having four key elements:
- Organizational architecture that supports the formation of communities of patients, healthcare professionals and researchers who collaborate to produce and use "big data".
- Large electronic health data sets, i.e. "big data".
- Quality improvement at the point of care for each patient using new knowledge generated by research.
- Research done in routine healthcare settings.
Quality Improvement and PDSA Cycle
- The Deming Wheel, or Deming Cycle, also know as PDCA (Plan, Do, Check, Act) Cycle was first introduced to Dr Deming by his mentor Walter Shewhart.
- It has evolved to become The PDSA Cycle (Plan-Do-Study-Act), a systematic process for gaining valuable learning and knowledge for continual improvement of a product, process, or service.
Reflections as Evidence: GMC
- Williams Review of Gross Negligence Manslaughter in Healthcare (2018)
- Professor Sir Norman Williams Review in the wake of the Dr Bawa Garba controversy considered wider concerns among healthcare professionals.
- Errors could result in prosecution for gross negligence manslaughter, even if they happen in the context of broader organisation and system failings.
- It's recommendations support a more just and learning culture in the healthcare system. It covers:
- the process for investigating gross negligence manslaughter
- reflective practice of healthcare professionals
- the regulation of healthcare professionals
Reflective Practice Models (Gibbs')
- This is a sub-topic under reflecting on experience
- Reflective Models and models involved in the topic of Reflection
Kolb's Learning Cycle
- Promotes “learner centred pedagogy” and acknowledges that people learn in different ways
- It has been adapted to four Stages of Reflection:
- Concrete Experience, actually having an experience
- Reflective Observation, reflecting on the experience
- Abstract Conceptualisation, learning from the experience
- Active Experimentation, trying out what you have learnt
- Each stage has helpful questions (prompts)
Gibbs' Reflective Cycle
- Graham Gibbs (1988) gives structure to learn from (repeated) experiences
- It covers six stages:
- Description of the experience
- Feelings and thoughts about the experience
- Evaluation of the experience, both good and bad
- Analysis to make sense of the situation
- Conclusion about what you learned and what you could have done differently
- Action plan for how you would deal with similar situations in the future, or general changes you might find appropriate
Schon's Reflective Practitioner
- Effective professional practice and human thought
- Knowing in action
- Reflection-in-action
- Reflection-on-action
What? So what? Now what?
- Driscoll (1994), proposed one of the simplest reflection frameworks.
- Also known as Rolfe's Reflective Practice Model (2001).
- It is based on three simple questions:
- What? The experience of the situation
- So what? The implications of the situation
- Now what? The action plan
The four F's of active reviewing
- Facts: An objective account of what happened
- Feelings: The emotional reactions to the situation
- Findings: The concrete learning that you can take away from the situation
- Future: Structuring your learning such that you can use it in the future
Schwartz Rounds
- The Point of Care Foundation describe Schwartz rounds as: A structured forum where all staff, clinical and non-clinical, come together regularly to discuss the emotional and social aspects of working in healthcare.
- The purpose of Rounds is to encourage compassion in healthcare to understand the challenges and rewards that are intrinsic to providing care.
Reflective Practice
- Building a reflective practice mindset typically involves:
- An ability and willingness to reflect and learn
- Repeating reflection over a series of related experiences adds value
- Reviewing and reflecting on an extended period to identify patterns
- Setting and reflecting on goals and objectives
Reflective Assignments
- Wald (2012) The RESPECT Rubric for assessing reflective writing
- Academic Reflections have a specific language and structure
- General language points are:
- Be succinct; stick to word-count
- Use “I” and other personal nouns
- Almost always use the past tense
- Use subject-specific language and terminology (medical professionalism)
- Description, Thoughts and Feelings, Analysis/Interpret/Evaluating, Concluding and Planning
Reflection Examples (Gibbs' and Rolfe's)
Gibbs' Reflective Cycle
Helpful Questions: Gibbs' Reflective Cycle
- What happened?
- When and where did it happen?
- Who was present?
- What did you and the other people do?
- What was the outcome of the situation?
- Why were you there?
- What did you want to happen?
Evaluation: Gibbs' Reflective Cycle
- Evaluation, evaluate what worked and what didn't work.
- Helpful questions:
- What was good and bad about the experience?
- What went well?
- What didn't go so well?
- What did you and other people contribute to the situation (positively or negatively)?
Analysis: Gibbs' Reflective Cycle
- Analysis, chance to make sense of what happened (meaning).
- Helpful questions:
- Why did things go well?
- Why didn't it go well?
- What sense can I make of the situation?
- What knowledge can I make of the situation?
- What knowledge - my own or others (for example academic literature) can help me understand the situation?
Conclusions: Gibbs' Reflective Cycle
- Conclusions, summarise learning and highlight positive changes.
- Helpful questions:
- What did I learn from this situation?
- How could this have been a more positive situation for everyone involved?
- What skills do I need to develop for me to handle a situation like this better?
- What else could I have done?
Action Plan: Gibbs' Reflective Cycle
- Action Plan, what you would do differently in similar situation in future.
- Helpful questions:
- If I had to do the same thing again, what would I do differently?
- How will I develop the required skills I need?
- How can I make sure that I can act differently next time?
Conclusions
- At the end of this talk you will:
- Discuss his/her reflection on a clinical scenario encountered.
- Describe how after reflection he/she would act differently the next time they encounter a similar clinical scenario.
- Identify the benefits of reflection including continuous improvement
- Describe what a Learning Health System is.
- Discuss the benefits of a Learning Health System.
Bibliography
- A list of sources used in the presentation. (Includes links to websites and publications)
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Test your knowledge on the role of empathy in the patient-doctor relationship and the stages of Gibbs' Reflective Cycle. This quiz covers common misconceptions and the balance healthcare providers must maintain while caring for patients. Challenge yourself to improve your understanding of these important concepts.