1. Reflection
Win May

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

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

4. Reflection
Purposeful thinking about medical practice

5. Cycle of Reflection

6. 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)

7. 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

8. 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)

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

10. 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?

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

12. 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)

13. 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)

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

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

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