Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement: a qualitative study

Twelve tips for maximizing the potential of reflective writing in medical education

Reflective writing (RW) is a popular tool in medical education, but it is being used in ways that fail to maximize its potential. Literature in the field focuses on why RW is used - that is to develop, assess, and remediate learner competencies - but less so on how to use it effectively. The emerging literature on how to integrate RW in medical education is haphazard, scattered and, at times, reductionist. We need a synthesis to translate this literature into cohesive strategies for medical educators using RW in a variety of contexts. These 12 tips offer guidelines for the principles and practices of using RW in medical education. This synthesis aims to support more strategic and meaningful integration of RW in medical education.

'Oh yes, that is also reflection'-Using discursive psychology to describe how GP registrars construct reflection

INTRODUCTION

Learners in medical education generally perceive that reflection is important, but they also find that reflection is not always valuable or practically applicable. We address the gap between the potential benefits of reflection and its practical implementation in medical education. We examined the perspective of Dutch GP registrars who (must) reflect for their GP specialty training to understand their participant perspective on reflection. Our aim is stimulating alignment between reflective activities that occur in a medical curriculum and the ideals of reflection as a valuable educational activity.

METHODS

We conducted, video-recorded and transcribed seven focus group sessions with GP registrars in 2021 across two Dutch GP educational programmes. We used discursive psychology to analyse the focus group data by focusing on 'assessments of reflection'. We analysed their discursive features (how something was said) and content features (what was said) and related these to each other to understand how GP registrars construct reflection.

RESULTS

Participants constructed reflection with nuance; they combined negative and positive assessments that displayed varied orientations to reflection. First, their combined assessments showed complex orientations to norms and experiences with reflecting in practice and that these are not simply negative or positive. Second, GP registrars constructed reflection as a negotiable topic and showed how reflection and its value can be variably understood. Third, through combined assessments, they displayed an orientation to the integration of reflection with other educational tasks, which impacts its value.

CONCLUSIONS

Generally, GP registrars speak positively about reflection, but the value of reflection partly depends on its proper integration with other educational tasks. When meaningful integration fails, activities to stimulate reflection can overshoot their own goal and hamper learner motivation to reflect. Developing a healthy 'reflection culture' could mitigate some challenges. Therein, reflection is treated as important while learners also have adequate autonomy.

Physical therapy student perception of self-reflection activities in a musculoskeletal course: A mixed-method study

BACKGROUND

Deliberate reflection is an effective method to aid in professional development. Most documented self-reflection activities (SRA) occur during clinical experiences. Literature on SRA within the didactic component of entry-level physical therapy education is lacking.

PURPOSE

The purpose of this mixed-method study was to evaluate student perception of in-class SRA.

METHODS

A convenience sample of 61 students in a DPT program was recruited. Students were enrolled in a musculoskeletal course and participated in six 10-minute SRA. At the end of the course, students completed a survey to assess perception.

RESULTS

Fifty-nine (97%) students completed the anonymous survey. Most reported they would continue SRA in future courses (92%, 55/60) and as a professional (95%, 57/60). Thematic analysis identified SRA promote the professional qualities of self-evaluation, confidence, and clinical excellence. Quiet time, self-evaluation, and sharing with others were identified as benefits of SRA. Curricular threading of SRA in entry-level physical therapy education was strongly suggested.

CONCLUSION

Self-reflection activities can be implemented into the didactic portion of entry-level physical therapy education and be perceived positively by students. Future research can assess the impact of SRA on clinical reasoning development during the didactic portion of entry-level physical therapy education.

Health professionals and students' experiences of reflective writing in learning: A qualitative meta-synthesis

BACKGROUND

Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: "What are the experiences of health professionals and students in applying reflective writing during their education and training?"

METHODS

We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals' and students' experience using reflective writing during their academic and in-service training by performing a meta-synthesis.

RESULTS

We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users' experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one's own and others' emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified.

CONCLUSIONS

The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.

Utilizing widely available podcasts to create a reflection activity for pharmacy students

BACKGROUND AND PURPOSE

Creative strategies can be employed to encourage development of affective domain skills. The purpose of this article is to describe and assess the creation of a written self-reflection assignment utilizing podcasts. Educational activity and setting: Second year pharmacy students (N = 122) in a skills laboratory course completed two written reflections that asked them to: (1) examine and reflect on personal beliefs, biases, motivations and emotions that were challenged while listening to a podcast; and (2) identify knowledge, skills, and abilities of a pharmacist that may impact the situation presented in the podcast. Students chose from a list of podcasts curated by faculty and completed two 450 to 600-word reflections. Students completed a pre-post modified Questionnaire for Reflective Thinking (mQRT). A one-tailed, paired t-test was used to assess the mQRT. The post-questionnaire survey also included questions related to student perceptions of the reflections. Descriptive statistics were used to summarize student perceptions.

FINDINGS

Out of 122 students, 116 (95.1%) completed both the pre- and post-mQRT and survey. The majority of students responded affirmatively that the reflections made them think about healthcare in a different way (91.4%) and challenged their beliefs/biases (81.9%). Students reported applying information from previous course material to the podcast concepts (75%) and vice versa (77.6%).

SUMMARY

Assignments using podcasts are a unique way of engaging student learners. These assignments may help to assess affective educational outcomes and be a way to increase self-reflection, self-awareness, and metacognition in pharmacy students.

Reflective Practice in Physical Therapy: A Scoping Review

BACKGROUND

Many practitioners experience complex, uncertain, and unique clinical practice situations that can be navigated with reflection. Little is known about the theoretical and pragmatic perspectives of reflection in physical therapy.

PURPOSE

The purpose of this paper was to examine the literature on reflection in physical therapy and identify gaps in the literature.

DATA SOURCE

The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EMBASE, Scopus, and PsycINFO were used to identify articles.

STUDY SELECTION

Studies were selected to describe: (1) theoretical concepts related to reflection, (2) examples of reflection, and (3) the use of reflection in clinical or educational contexts.

DATA EXTRACTION

Authors, year of publication, country of origin, publication type or source, methodology, conceptual approach (including terminology used, definition of terminology used), and practical approach (including theoretical underpinning, context of reflection/reflective practice, and target group) guided the data extraction.

DATA SYNTHESIS

A total of 46 articles were reviewed spanning from 1992 to 2017, which included research studies, field articles, editorials, and a review article. Theoretical underpinnings of reflection were based on the thoughts of Donald Schön. Written approaches to reflection were most common, and reflection was used to inform education, clinical practice, and professional growth.

LIMITATIONS

As with any review paper, there is a certain level of interpretation required when collating and interpreting data.

CONCLUSIONS

Reflection in physical therapy could be advanced by a thorough conceptualization of reflective practice, a broader and deeper pool of research to inform optimal implementation of reflection across the career span from learners to experts, and a clear definition and linkage of reflection to epistemologies of physical therapy practice.

A Retrospective Study on Students' and Teachers' Perceptions of the Reflective Ability Clinical Assessment

Objective. To evaluate student and teacher perceptions of the utility of the Reflective Ability Clinical Assessment (RACA) in an undergraduate pharmacy curriculum at an Australian university. Methods. A mixed-method study comprising the administration of a 7-item student survey on a 6-point Likert-type scale and a 45-minute focus group/phone interview with teachers. Results. Student (n=199) and teaching staff respondents (n=3) provided their perceptions of the implementation of the new educational tool. Student responses showed significant positive correlations between self-directed learning, counseling skills, relevance to future practice, and performance in an oral examination. Seven key themes emerged from the teacher interviews. Conclusion. The study revealed both students and teachers perceive the RACA as an effective educational tool that may enhance skill development for future clinical practice.

The Effect of Reflective Activities on Reflective Thinking Ability in an Undergraduate Pharmacy Curriculum

Objective. To determine the effectiveness of integrating reflective practice activities into a second-year undergraduate pharmacy curriculum and their impact on reflective thinking ability. Design. A cross-over design with repeated measures was employed. Newly developed reflective modules based on real hospital and community pharmacy cases were integrated into the second-year pharmacy practice curriculum. A novel strategy, the Reflective Ability Clinical Assessment (RACA), was introduced to enhance self- and peer reflection. Assessment. Student responses (n=214) to the adapted Kember et al(1) Reflective Thinking Questionnaire (RTQ) were compared before and after reflective activities were undertaken. Significant improvement in three indicators of reflective thinking was shown after students engaged in reflective activities. Conclusion. Integration of reflective activities into a pharmacy curriculum increased the reflective thinking capacity of students. Enhancing reflective thinking ability may help students make better informed decisions and clinical judgments, thus improving future practice.

Shared Practices in Articulating and Sharing Rationale

This paper reports a classroom study in which group learners brainstormed ideas in virtual group space and justified their ideas through articulating their rationales in the shared rationale space. The investigation focused on the learners' practices of articulating and sharing rationales. The results suggest that group members would brainstorm the ideas and generate rationales to justify the ideas before reading the others' ideas and rationales. Also, the members in general brainstormed all the ideas first and then elaborated the rationales to justify the ideas; and grouped the shared rationales according to their authors. The group members' reasoning styles were examined by using Rhetorical Structure Theory to analyze the shared rationales. It was found that similar reasoning styles existed across the groups. Additionally, the group context seemed to have affected the members' strategies of using contextual and additional information to justify their ideas. Several design implications are presented to support the practices of articulating and sharing rationales in virtual group workspace. The authors also articulate how their work contributes to other research areas such as project management, crowdsourcing, and online deliberation. Based on their study, the authors argue for a rationale-based knowledge management approach to complex collective activities in the online environment.

Reflective practice and its implications for pharmacy education

Pharmacy students require critical-thinking and problem-solving skills to integrate theory learned in the classroom with the complexities of practice, yet many pharmacy students fall short of acquiring these skills.(1-2) Reflective practice activities encourage learning from the student's own experiences and those of others, and offer a possible solution for the integration of knowledge-based curricula with the ambiguities of practice, as well as enhance communication and collaboration within a multidisciplinary team. Although reflective practices have been embraced elsewhere in health professions education, their strengths and shortcomings need to be considered when implementing such practices into pharmacy curricula. This review provides an overview of the evolution of theories related to reflective practice, critically examines the use of reflective tools (such as portfolios and blogs), and discusses the implications of implementing reflective practices in pharmacy education.