Reflection Win May

Reflection Purposeful form of thought provoked by unease in the learners when they realize that their understanding is incomplete John Dewey (1933)

Reflection Metacognitive activity Provides a means for practitioners to consider reasons for success or lack of it Allows tacit knowledge to become explicit

Reflection Purposeful thinking about medical practice

Cycle of Reflection

Why Reflect? Adapt professional functioning to patient’s needs or new circumstances Transformation into new knowledge and practice Lifelong personal and professional learning Aukes et al. (2007)

Why Reflect? Develop deeper and more integrated style of learning Connects new to prior learning Promotes critical thinking Exposes pattern of reasoning Provides insight into attitudes

Reflective practitioner 3 cognitive-emotional levels Clinical reasoning (reflection-in-action) Scientific reflection (reflection-on-action) Personal reflection (reflection-on-experience) Aukes et al. (2007)

Groningen Reflection Ability Scale (GRAS) 3 factors: Self-reflection Empathetic reflection Reflective communication Aukes et al. (2007)

Levels of reflection Descriptive Comparative Personal Critical Jay,J. (2002) Descriptive: Describe the matter for reflection. . . . What is happening? Is this working, and for whom,? For whom is it not working? How do I know? How am I feeling? What am I pleased or concerned about? What do I not understand? Does this relate to any of my stated goals, and to what extent are they being met? Comparative: Reframe the Matter for reflection in light of alternative views, other perspectives, research etc. . . . What are alternative views of what is happening? How do other people who are directly or indirectly involved describe and explain what is happening? What does the research contribute to an understanding of this matter? How can I improve what’s not working? Is there a goal, what are some other ways of accomplishing it? How do other people accomplish this goal? For each perspective and alternative, who is served and who is not? Critical: Having considered the implications of the matter, establish a renewed perspective . . . What are the implications of the matter when viewed from these alternative perspectives. Given these various alternatives, their implications, and my own morals and ethics, which is best for this particular matter? What is the deeper meaning of what is happening? What does this matter reveal about the moral and ethical dimensions of this patient? How does this reflective process inform and renew my perspective?

Activity In pairs, determine the level of reflection of the learners, from their written self-reflections.

Reflective practice in medicine 5 sets of behaviors Deliberate induction Deliberate deduction Test predictions and synthesize new understanding Openness towards reflection Meta-reasoning Mamede et al. (2008)

Research findings Reflective practice - positive effect on diagnosis of complex, unusual cases. For routine clinical cases - non-analytic reasoning just as effective Mamede at al. (2008)

Attention With expertise Some cognitive activities become automatic More cognitive space for reflection Moulton et al. (2007)

“Slow down when you should” Moulton et al. (2007)

Summary Reflection deepens learning Reflective practice improves diagnostic accuracy minimizes error “Slow down when you should”