Reflective Practice in Medical Education

Introduction to Reflective Practice

• Reflective practice is a cognitive process enabling insight, practice re-evaluation, and future situation coping.
• It leverages experience for similar future situations.

Learning Objectives

• Define reflective practice
• Understand reflective practice theory and Gibb's reflective cycle
• Explain reflection's role in continuous professional development
• Apply reflection to learning from clinical scenarios

Reflective Practice

• A cognitive process used to gain insights into practice.
• Involves rethinking practice, learning from experiences, and dealing with similar future situations.

Quote by Epictetus

• "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."

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 the USA, 98,000 people die annually from medical errors in hospitals— exceeding deaths from motor vehicle accidents (MVA), breast cancer, and AIDS.
• Medication errors are more frequent than workplace injuries.
• The problem isn't bad people; it stems from flawed systems that need improvement.
• Individual poor behaviour can negatively affect patients

Reflective Practice: IMC

• Core behaviors and processes forming the foundation for high-quality care.
• Developing professional insight improves care standards.
• Includes both formal reviews (e.g., audit) and informal reflection on personal values affecting patient communication and care.

Learning Culture & Safety: IMC

• Medical treatment necessarily involves risk.
• Promotes a culture minimizing risk.
• Learning from adverse events is crucial.
• Reporting, learning from, and reviewing adverse events is vital for improvement.

Reflective Practice: AoMRC

• Reflective practice involves analytically thinking about professional practice with a goal of improving practice.
• Reflection can be part of formal learning or involve active or passive observation of a situation.
• Reflection can be positive (reinforcing good practice) or about negative situations, leading to behavioral change.

Reflective Practice: GMC, AoMRC & COPMED

• Doctors need honest and open discussions on clinical events; engaging in reflection is crucial.
• Reflection enables professional learning, self-development, and improvement of patient care.
• Reflection should focus on understanding gained, not on blame, but on affirmation or change of practice.

Royal College of Surgeons in Ireland Definition

• Medical professionalism involves values, behaviors, attitudes, promoting relationships, trust, safety.
• Specific sub-headings like Cultural Sensitivity, Self-Care, Compassion, etc. are discussed further on subsequent slides.

Continuous Improvement

• Continuous Quality Improvement (CQI) is a structured process, involving employees in planning and conducting ongoing improvements to provide quality healthcare.

Reflective Practice Theory

• The theoretical framework explaining how reflection operates to improve practice is discussed here.

What is Reflection?

• Reflection uses conscious thought to enhance learning and understanding.
• Two main perspectives emerge: reflection on experience and metacognition about a problem or concept.

What is not Reflection?

• Simple writing in a diary or day-dreaming does not count as reflection.

Reflection Thought (Dewey)

• Reflective thought involves careful contemplation of beliefs, exploring supporting evidence, and evaluating conclusions.
• Thought converts mere impulses and desires into intelligent action to effectively resolve problems.

Reflection: Active Learning and Consolidation

• Constructivist learning theory emphasizes contextualization with experience for better retention and engagement in the material.
• Deep learning, focusing on core concepts and principles, improves understanding and retention compared to surface learning.

Reflection: Definition

• Cognition refers to mental knowledge acquisition via thought, experience, and senses.
• Reflection is a cognitive process for insightful practice rethinking leveraging experience, and future similar situation coping.
• Self-reflective practice represents meta-cognitive skill; it involves reflecting on the own mental processes.

Reflection: on Experience

• Learning through experience is essential in adult education—Donald Schon(1983).
• Kolb (1984) emphasized reflective practice—meaningful element extraction and incorporation into personal knowledge base is necessary for deep learning.

Reflection: Metacognition

• Metacognition involves self-awareness and understanding one's thought processes.
• Jack Mezirow (1991) indicates that reflection is essential for grasping the content, premise, and process of problems and problem-solving.
• Problem-solving through reflection entails untangling problems and developing solution ways.

Reflection: Critical Thought (Moon)

• Reflection has six key domains: reviewing behaviour; building theories from observation; resolving uncertainty; considering the learning process; engaging in personal development; and empowering oneself socially.

Reflecting on Experience (Models)

• Various reflection frameworks, such as Gibbs' Reflective Cycle and Kolb's Learning Cycle, are discussed—allowing structure in reflective practice for guidance and posing questions.
• Other models, including Driscoll's/Rolfe's, Schon's, and Greenaway's, are presented for practical application.

Reflection and Professional Development

• Reflection enhances self-awareness, facilitating better professional and personal development planning.
• Cunningham and Moore (2017) highlight how being taught reflection helps healthcare professionals identify and improve their practice.

Employability and Reflection

• Employability requires a blend of achievements and attributes.
• Employable graduates must reflect on developed skills over time; analyze how these skills can be demonstrated in the context of professional roles.
• Reflect on the required skills, developing goals and objectives for self-improvement, and build on prior experiences.

Learning Health System: Learning Cycle

• Learning Health Systems (LHS) are healthcare systems where knowledge generation and improvement are embedded in daily practice.
• Based on evidence-based medicine, and developed by the US Institute of Medicine (2006).

Quality Improvement and PDSCA

• Quality improvement is a systematic process (e.g., the Deming Cycle).
• Continual improvement of services, processes, or products using a four-step cycle where planning, doing, observing, and acting are key.

Reflections as Evidence: GMC

• The Williams Review (2018) highlights concerns about simple errors leading to gross negligence manslaughter charges.
• Reflection is useful to understand these issues and learn about organizational and system issues alongside individual practice.
• Sir Terence Stephenson advised that reflection for doctors is fundamental to professionalism, needing safeguarding and legal protection measures to support reflection.

Kolb's Learning Cycle

• Kolb's learning cycle encompasses concrete experience, reflective observation, abstract conceptualization, and active experimentation, adaptable to reflective practice. Each stage provides helpful questions.

Gibbs' Reflective Cycle

• Gibbs’ reflective cycle, with six stages, offers a structured framework for learning from experience: description, feelings, evaluation, analysis, conclusion, action plan; to examine repeated experiences for their positive outcomes.

Schön's Reflective Practitioner

• Schon (1991) presents the reflective practitioner model.
• The model encourages reflective practitioners to reflect on their activities when they are in the workplace, which will aid in improving practice and thought.

What? So What? Now What?

• The three stages (or questions) encourage the learner to introspect.
• The questions reflect upon the situation's experience (What), the implications from the experience (So What), and the consequent action plan (Now What).

Clinical Learning Environment

• The Macy Foundation (2018) defines this environment in terms of social interaction, organizational structure, and physical space to address learners' experiences.
• Learners are important in healthcare systems because they drive service quality and safety.

Reflection for Self-Awareness

• Self-awareness of professional strengths and weaknesses is helpful for professional development and work performance improvement.
• Questioning oneself about strengths and weaknesses helps gain insights into both effective and ineffective aspects and areas requiring further development.
• Engaging with others (e.g., a critical friend, mentor) for insights and feedback is also useful.

Reflection on Feedback

• Sargeant et al.(2009) found that reflection is important in using feedback constructively and effectively to evaluate or reassess practice.
• Feedback that challenges one's self-belief can be effectively analyzed, addressed, and converted into personal knowledge/action-taking.

Reflection: Professional Development

• Reflection promotes higher self-awareness and helps plan professional and personal development.
• Cunningham and Moore (2017) highlight how reflection enables identification of development opportunities to effectively improve practice.

Principles of Adult Learning

• Andragogy, the art and science of helping adults learn, emphasizes individual readiness, self-direction, varied motivation, and active learning.
• Learning styles, attitudes, experience, incentives, and feedback are particularly crucial for adult learners.

Life Long Learning

• Continuous learning through life with improving knowledge, skills, and professional competences—encompassing personal, civic, and professional contexts.
• Life-long learning encompasses formal education and informal experiences.

Thank You

This quiz explores key concepts of reflective practice, particularly within the context of medical education. Participants will assess their understanding of when and how reflection should occur, as well as its benefits and challenges. Engage with thought-provoking questions related to professionalism and feedback in clinical settings.