Abstract
Reflective learning focuses on the development of critical-thinking skills through the internal process of examining strengths and exploring areas for improvement. The positive impact of reflective learning has been well documented to challenge misconceptions and provide clarity into one’s thinking patterns and actions. In this article, GP trainer, Dr Kunal Chawathey provides useful tips for AiTs to reflect effectively, thereby enhancing their learning experience.
The process of reflection occurs in many aspects of our lives, whether it’s personal or professional – the events of a weekend or a recent problem we encountered. We often wonder how we might have handled it differently, with the benefit of hindsight. People consciously reflect in order to understand events in their lives and as a consequence hopefully add meaning to their actions. When used effectively and purposefully, reflection facilitates ongoing personal and professional learning. Reflection can provide a structure in which to make sense of learning, so that concepts and theories become embedded in practice. Constant thought and innovation are simultaneously fostered. Reflective practice has been increasingly recognised to aid all healthcare providers and is now an integral part of healthcare delivery.
What is reflection
Reflection is a meaning-making process that moves a learner from one experience into the next with deeper understanding; it is the thread that makes continuity of learning possible and ensures the progress of the individual.
Reflection can be defined as a purposeful deliberate act of inquiry into one’s thoughts and actions through which a thoughtful, reasoned response might be tested out. In essence, it is how we make sense of the experiences we have had and how and what we have learnt from them.
Benefits of reflective learning
Reflective learning helps us to analyse not only what we have learned but also how we have learned it It demonstrates how one’s thinking grows and develops over time It assists with making connections between what you already know and what you are learning It helps you learn from mistakes by identifying how you would do things differently next time
The four levels of reflection
A description of the experience is integral to conceptualisation. However, to be truly reflective, students need to move beyond this and relate their experience in a wider context. The four levels of reflection are as follows.
Descriptive writing: This involves description of the events and answers the question, ‘what happened?’ Descriptive reflection: In this stage the trainee is able to justify and explain why it has happened, giving adequate reasons and explanations Dialogic reflection: In this stage, the trainee is able to stand back from the event and analyse what has happened – this involves being able to appreciate and acknowledge the emotions and possible prejudices related to the event, and analyse them objectively Critical reflection: Here the trainee demonstrates an awareness of the wider context, namely that events may be located in and influenced by past experiences and biopsychosocial constructs.
Writing reflective entries
The following baseline questions can serve as an aid memoir to make reflective entries in your ePortfolio:
What happened? What, if anything, happened subsequently? What did you learn? What will you do differently in future? What further learning needs did you identify?
We can dive deeper into the reflective process by attempting to answer the following probing questions related to the experience. These questions were proposed by Christopher Johns, a pioneer of reflective practice in 1990 s and starts with the core question: ‘What information do I need access to in order to learn through this experience?’ The core question is probed further with the help of the following ‘cue questions’.
Description of experience
Describe the ‘here and now’ experience
What essential factors contributed to the experience?
What are the significant background factors to this experience?
What are the key processes for reflection in this experience?
Reflection
What was I trying to achieve?
Why did I intervene as I did?
What were the consequences of my action for myself/patient/team/organisation?
How did I feel about the experience as it was happening?
How did patient/others feel?
How do I know what patient/others felt?
Influencing factors
What internal factors influenced my decision making?
What external factors influenced my decision making?
What sources of knowledge did/should have influenced my decision making?
Could I have dealt better with the situation?
What other choices did I have?
What would be the consequences of these choices?
Learning
How do I feel about the experience now?
How have I made sense of this experience in the light of past experience and future practice?
Has this experience changed my ways of knowing, thinking, doing or me personally?
Role of peers and trainers
While reflective practice can be a solitary exercise, clinical supervisors and trainers play a pivotal role in helping and supporting trainees. In addition, ‘buddying’ via cluster groups can foster group reflective learning. Cluster groups are usually led by a training programme director or a senior trainer to provide further insights into the cases discussed.
Learning does not always occur as a light-bulb moment; it can be hard to pinpoint due to its gradual and ongoing nature. During their placements, trainees do not attend as buckets to be filled up with what the trainer knows already. As knowledge is co-produced in all sorts of venues and in all sorts of ways, reflective learning methods become the exact opposite of ‘filling empty buckets’ style of teaching with the tutor helping the trainee to rediscover what is already in them.
