Using theories of professional knowledge and reflective practice to influence educational change

Medical Teacher, Vol. 20, No. 1, 1998

Using theories of professional

knowledge and re¯ ective practice

to in¯ uence educational change

PATRICIA L. W ILLIAMS

Faculty of Health Care and Social Work Studies, University of Salford, UK

SUMMARY Theories of professional knowledge and re¯ ective

practice were used in the development of a new postgraduate

programme. Central to the curriculum design was the acknowl-

edgement that a wealth of knowledge creation takes place

outside the academic setting. The existing experience of practi-

tioners is an important source of knowledge, and the ability to

re¯ ect on and share experience is a powerful form of learning.

These concepts were integrated into the curriculum, and the

paper gives a number of examples to demonstrate how the

programme works in practice.

Introduction

The purpose of this paper is to describe how the expanding

and changing role of radiographers in¯ uenced the develop-

ment of a new postgraduate curriculum. In order to under-

stand the types of knowledge which are necessary to under-

take new professional roles, the concept of professional

knowledge is explored. It is argued that professional

knowledge should be interpreted with the broadest poss-

ible meaning, and the context in which knowledge is

acquired should be viewed as a signi® cant factor. Because

of the value which practitioners place upon the importance

of their practical experience, the advantages of re¯ ecting

on and learning from existing experience are contrasted

with the acquisition of knowledge which has no useful

professional purpose. It will be maintained that the use of

re¯ ective practice both assists in the integration of theory

with practice and enables practitioners to improve their

skills of clinical reasoning.

There has been a revolution in radiography practice in

the last ® ve years. Central to the aspects driving this

transformation have been technological advances, socio-

economic factors and the impact of government policy on

hospital care. First, technological advances have created

expert practitioners and have resulted in changes in the

structure of the workforce especially in the breaking of

traditional boundaries between professions, as in the adop-

tion by nurse practitioners and radiographers of tasks pre-

viously performed by doctors (Chapman, 1993; Loughran,

1994). Second, the in¯ uence of socioeconomic factors has

placed greater emphasis on the consumer: for example,

meeting the expectations of patients/clients for better treat-

ment and for their inclusion in the decision making about

the treatment they receive. This emphasis has placed

greater demands on radiographers whose practice places

them at the critical interface between the consumer and

their diagnosis and treatment. Third, the impact of govern-

ment policy on the health service will radically change the

context for the delivery of health and social care, with a

shift in the proportion of work currently undertaken in

hospitals to primary and community settings. Coupled

with the change in medical practice, which is shifting the

balance between curative and preventive medicine, this

policy raises questions as to the appropriateness of hospi-

tals as the major places in which radiographers will work

(Department of Health, 1989a, 1989b, 1992; Williams and

Berry, 1997).

Central to all of these changes is the importance of

effective interpersonal communication. There is an in-

creasing requirement for radiographers’ work to involve

more challenging interactions with patients. Examples of

these include the discussion of procedures, their risks,

bene® ts and alternatives and the need to assess and cater

for a wide range of individuals. The result is the develop-

ment of a climate in which open-ended transactions are

created of the kind which characterize a professional± client

relationship (Barnett, 1994). This shift in emphasis of the

role of the radiographer has created the need for a prac-

titioner who takes a holistic approach to patient care, and

who balances technological expertise with skill in com-

munication (Castle, 1988; Caseldine, 1994). But how do

radiographers acquire this new knowledge? For the ma-

jority, a large amount of learning will occur in the work-

place and in general it has been accepted that practical

experience is at the centre of professional learning (Bines &

Watson, 1992). Moreover, it is argued that, without this

focus, it is unlikely that the skills required for competent

practice will be achieved (Palmer et al., 1994). However,

the knowledge underpinning practice is elusive, and for

descriptive purposes is often characterized in several differ-

ent ways (Oakeshott, 1962; Ryle, 1949; Polanyi, 1967).

Correspondence: Faculty of Health Care and Social Work Studies, Department

of Radiography, Allerton Building, University of Salford, Salford, M 6 6PU.

0142-159X/98/010028-07 Ó 1998 Carfax Publishing Ltd28

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Using theories of professional knowledge and re¯ ective practice

Therefore, the following part of this paper aims to describe

professional knowledge, and will argue that such knowl-

edge is a composite from which it is dif® cult to isolate its

separate parts. This argument will be developed to show

how learning from experience can be associated with a high

level of cognitive content so that the knowledge acquired in

practice can be legitimately incorporated into higher edu-

cation.

Professional knowledge

It has been stated that the nature of professional knowl-

edge is complex and dif® cult to isolate (James, 1993).

However, for the purpose of description, several authors

have attempted to tease out its essential meaning into

several explicit strands. Oakeshott (1962), following Aris-

totle, makes a clear distinction between `technical’ knowl-

edge and `practical’ knowledge. Technical knowledge is

understood by reference to the sciences, for example bi-

ology and physics, and is capable of being assembled into

a published form. By contrast, practical knowledge is ex-

pressed only in practice and learned only through experi-

ence with practice (Eraut, 1985). The tendency to separate

theoretical from practical knowledge has been followed by

Ryle (1949) who used the terms `knowing that’ and `know-

ing how’ to describe the distinction. Moreover, Polanyi

(1967) observed that much of our knowledge is implicit or

`tacit’ and cannot always be revealed. However, the separ-

ation of knowledge into two categories neatly side-steps the

complexity of its derivation. Eraut (1994), asserts that the

whole ® eld of professional knowledge is lacking in trans-

parency owing to a neglect in conceptualizing the different

types of knowledge. In an attempt to provide guidance,

Eraut uses the terms `propositional, personal and process’

to characterize and de® ne professional knowledge. Accord-

ing to Eraut (1994), propositional knowledge comprises

the disciplined-based theories and concepts which are de-

rived from bodies of systematic knowledge, and is the

traditional means by which higher education constructs its

syllabi. Aligned to these theories are practical principles

which stem from the applied sphere of professional activity

with speci® c examples of tried and tested cases. The ma-

jority of this knowledge is in a publicly available, codi® ed

form, although it is argued that personal knowledge is

in® ltrated by propositions, and that publicly available

knowledge is open to personal interpretation (Grif® ths &

Tann, 1992).

In contrast with the systematized knowledge which is in

a published form, personal knowledge is individually ac-

quired by experience. Eraut (1994) citing Schutz (1967),

maintains that individuals construct schemes of experience

which are a composite of our contact with the external

world and our own personal inner thoughts and feelings.

Many experiences are simply lived through unless the `act

of attention’ halts the process and confers a meaning on

the experience, the depth of which depends upon the

purpose of the attention. Much of this knowledge will be

taken for granted and not subjected to further analysis.

However, should attention be focused deeply upon experi-

ence then it can be comprehended in a meaningful way.

Schutz (1967) argues that:

¼ the re¯ ective glance will penetrate more or less

deeply into lived experience depending on its

point of view. (p. 105)

For purposes of description, both personal and proposi-

tional knowledge are easy to separate, but during pro-

fessional practice, the two strands are inextricably inter-

twined. Nevertheless, these two forms of knowledge are

not adequate when explaining the nature of professional

work: a third dimension is required to complete the pic-

ture. This is because the majority of professional activity is

concerned with the performance of techniques and proce-

dures which Eraut (1994) calls `processes’ . According to

Eraut, process knowledge can be de® ned as:

¼ knowing how to conduct the various processes

that contribute to professional action. This in-

cludes knowing how to access and make good use

of propositional knowledge. (p. 107)

So, embedded in process knowledge is both personal and

propositional knowledge. In order to illustrate the features

of process knowledge, Eraut (1994) names ® ve types of

process which are typical of professional action. These are,

acquiring and giving information, skilled behaviour, plan-

ning and decision making, and the metaprocesses which

are used to direct and control one’ s own activities. Each of

these aspects of process knowledge is dependent to some

extent upon the personal and propositional knowledge of

the individual. For example, giving information is a major

part of the role of many professionals. In oral communi-

cation, the key to a successful encounter is to listen care-

fully and to interpret information into a form which a

client can easily understand. However, this interpersonal

process draws on the propositional knowledge of the indi-

vidual as well as his/her personal experience of previous

situations. Should a similar kind of analysis be applied to

any of the other types of process knowledge, it would be

revealed that it is impossible to describe professional ac-

tivity in the discrete forms which are so useful for the

purpose of conceptualization. The reason for this mis-

match between the concept and the reality lies in the true

nature of practice. During professional action, knowledge

becomes a dynamic integrated `whole’ which is shaped and

adapted to ® t each situation which is encountered. There-

fore, the context in which knowledge is acquired and used

is an important factor.

According to Eraut (1985), there are three main types

of context. First, the academic context which is character-

ized by written communication in traditional formats, for

example research papers, essays or dissertations. Second,

the organizational context of policy discussion where a

group of people exchange views and opinions about certain

policies and practices. Finally, there are a range of action

contexts, in which the professional practitioner is in a

`doing’ situation. In contrast with the previously men-

tioned contexts, here the emphasis is on action rather than

theory. Moreover, because they take responsibility for their

actions, practitioners require both self-conviction and in-

tuition; as guiding principles they rely on ® rst-hand experi-

ence rather than abstract concepts.

Therefore, in the action context, practitioners draw on

their personal experience rather than theoretical knowl-

edge. Eraut (1994) maintains that:

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P. I. Williams

The result is an essentially pragmatic orientation

¼ there is a certain subjectivism in the approach,

a scepticism about `book-learning’ and a belief in

the individuality of each distinct case. (p. 52)

The primacy which practitioners place upon the import-

ance of their practical experience is in marked contrast

with the views of those involved in higher education. For

example, Barnett (1994) maintains that the incorporation

of nurse education and other professions into the universi-

ties has resulted in a downgrading of their distinctive forms

of knowledge because of the `high marks’ that higher

education accords to science and the theory-based tradi-

tions of learning. However, the value of knowledge which

is of central importance to providing a service to patients

and clients is becoming increasingly recognized as valid

(Schon, 1987; Hewson, 1991; Cross, 1993). This view is

supported by empirical evidence from a range of profes-

sions which has found that knowledge that is not perceived

as professionally relevant is given a low priority by stu-

dents. It does not matter to students that it is included in

their curriculum. They will learn such knowledge in order

to pass examinations, but it will soon be forgotten. Subse-

quently, unless it is used for a professional purpose, then it

does not become part of professional knowledge (Eraut,

1994). From this perspective, knowledge should be inter-

preted with the broadest possible meaning, and once it is

accepted that all kinds of knowledge are necessary to

effective professional performance, each should be given

equal value by higher education.

The foregoing argument has many implications for

professional education because its conclusions are in direct

opposition to the existing system. Currently, there is a

tendency by educators to `frontload’ curricula with theory

(propositional knowledge) at the expense of knowledge

which is useful and pertinent to practice. Evidence from

many studies con® rm this view. For example, Gott (1984),

Melia (1987), Baylis (1987) and Grahn (1989) all con-

cluded that education programmes for health care practi-

tioners provided students with an idealized theoretical view

which failed to prepare them for the real world of practice.

Therefore, questions must be raised as to whether a two-

step approach of developing knowledge/theory within a

classroom, and then applying it to practice, can really

develop the skills required to respond to the unique situa-

tions encountered during clinical experience. According to

Eraut (1985), this `applicative’ approach to the theory ±

practice relationship limits both the potential use of theory,

and the capacity to interpret, re® ne and improve practice.

By its nature, it almost bypasses the process of clinical

reasoning.

Although much of the foregoing evidence stemmed

from research into initial professional education (IPE), the

argument can also be applied to curricula which are de-

signed for continuing professional education (CPE). Gen-

erally, when CPE is supported by employers, the emphasis

is likely to be on the acquisition of new knowledge rather

than improving the quality of current practice. This leads

to a situation where there is rarely an attempt to regenerate

existing knowledge. Always there is a focus on new knowl-

edge from the outside rather than to encourage the devel-

opment of new knowledge by sharing with others the

accumulated work experience of problems and cases (Er-

aut, 1985, 1994). Therefore, learning from experience can

help professionals to reconstruct their theories of practice,

especially when this is facilitated in the presence of col-

leagues. Nevertheless, Eraut (1994) concludes that such

learning depends upon the ability to integrate speci® c

experiences with other knowledge, and also on the time

which is devoted to re¯ ection.

In exploring the features of professional practice, Schon

(1983) advocates a model of professional education where

students learn by re¯ ecting on their experience. In contrast

with the approach which ® rst delivers knowledge in an

`academic ’ area, followed by period of practice in which

this knowledge is applied, re¯ ective practice uses the clini-

cal setting as the key place in which knowledge and skills

are developed.

The previous discussion has argued that the conceptu-

alization of professional knowledge is different from the

reality. In practice, professional knowledge is the inte-

gration of personal, process and propositional knowledge

into a dynamic whole. Nevertheless, from a professional

point of view, the only knowledge which is useful is that

which is used for a professional purpose. Therefore, in

contrast with the preoccupation with the acquisition of

new knowledge which is typical of the design of pro-

grammes for CPE, it is suggested that the existing experi-

ences of professionals could be used as a focus. Central to

the success of this model is the time set aside for students

to share professional experience and to re¯ ect on their

practice. The next part of this paper will describe re¯ ective

practice, and explain how this concept was integrated into

a postgraduate curriculum.

Re¯ ective practice

Boyd & Fales (1983) offer a useful de® nition of re¯ ection,

suggesting that it is:

¼ the process of internally examining and ex-

ploring an issue of concern, triggered by an ex-

perience, which creates and clari® es meaning in

terms of self, and which results in a changed

conceptual perspective. (p. 100)

Re¯ ection is often initiated by a realization that the knowl-

edge one was applying to a situation was not itself

suf® cient to explain what was happening. The focus of

learning is upon critical analysis of these unique practice

situations. Because re¯ ection is often accompanied by an

awareness of uncomfortable feelings and thoughts, it is

important that any analysis involves an examination of

both feelings and knowledge, so that the knowledge

required for professional practice is illuminated. In

describing his theory of re¯ ective practice, Schon (1987)

distinguishes between two types of re¯ ection: re¯ ection-

in-action and re¯ ection-on-action. It is maintained that

re¯ ection-in-action occurs whilst practising, and in¯ uences

the decisions made and the action taken. Eraut (1985)

characterizes this as `hot action’ , and maintains that, in

order to cope, practitioners must develop habits and rou-

tines. Moreover, self-awareness is dif® cult, because there

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Using theories of professional knowledge and re¯ ective practice

is little opportunity to think things through. The aspect of

time is one which has raised many questions about the

term `re¯ ection-in-action’ (Munby & Russell, 1989;

Eraut, 1994). This is because, when time is short, deci-

sions have to be made quickly and the opportunity for

re¯ ection is extremely limited. Eraut (1994) maintains

that, in these circumstances, re¯ ection is best seen as a

`metacognitive process’ in which there is rapid interpre-

tation of information and decision making in the midst

of action. By contrast, re¯ ection-on-action is more con-

sidered. It takes place after the event, and although there

may still be pressures of time, the interface between

thought and action is displaced so there is more scope for

trial and experiment. Although the theoretical distinction

between Schon’ s two types of re¯ ection is clearly de-

scribed, in practice the difference is blurred. Eraut (1994),

in a critique of Schon’ s (1983) model of re¯ ective practice,

concludes that:

There is insuf® cient discrimination between the

rather different forms of re¯ ection depicted in his

many examples; and this overgeneralisation

causes confusion and weakens his theoretical in-

terpretations. (p. 145)

Nevertheless, it is useful to view re¯ ection as a theory of

metacognition which directs skilled behaviour during pro-

fessional activity or assists in the deliberative processes

which occur during problem solving. The ® ne distinction

between re¯ ection in, and re¯ ection on practice can thus

be maintained.

Although re¯ ective practice is dif® cult to conceptualize

(James & Clarke, 1994), many advantages are claimed for

its use. Chief amongst these is the view that professionals

need to retain critical control over the more intuitive

aspects of their practice by regular re¯ ection, self-evalu-

ation and the opportunity to learn from colleagues. By

these means, practice does not remain at a standstill, but is

open to challenge and review. Therefore, in creating a

learning environment in which re¯ ective practice is en-

couraged, the gap between theory and practice can be

explored and new theories developed. In explaining this

concept, Argyris & Schon (1974) contend that individuals

work with two types of theories: `espoused’ (or published)

theories, which are used to justify behaviour, and implicit

`theories-in-use’ which govern actual behaviour. Many

people tend to keep these two types of theory separate,

because they are dif® cult to integrate. Eraut (1985) at-

tributes the problem to the fact that the process of becom-

ing a professional involves learning to deal with cases

quickly and ef® ciently. In order to cope with this workload,

practitioners reduce the range of possible ways of thinking

to manageable proportions. This leads to an intuitive re-

liance on the shared traditions of professional groups,

whilst potentially valuable `espoused theories’ are never

aired. Moreover, the practical use of new ideas cannot be

applied without ® rst thinking through the implications.

This issue is of particular importance when dealing with

patients and clients. Therefore, it is argued that the use of

re¯ ection encourages practitioners to make explicit the

knowledge which helps them interpret practical situations

(theories-in-use), and compare them with publicly ac-

knowledged or espoused theories. The individual’ s sub-

sequent critical appraisal exposes the theory ± practice div-

ide, and personal theories can then be con® rmed and

challenged.

Grif® ths & Tann (1992) give a lucid explanation:

¼ central to the spirit of re¯ ective practice is

re¯ ection on the professional and personal con-

cerns ¼ The re¯ ective practitioner re¯ ects on his

or her own practice. The theories which are used

are taken on wholeheartedly and criticised open-

mindedly. (p. 71)

So the use of re¯ ective practice can promote the links

between theory and practice. In fact, it is argued that

professionals can be assisted to `theories from their prac-

tice’ , at different levels of re¯ ection (Grif® ths & Tann,

1992). However, the knowledge development potential of

practitioners has rarely been exploited, mainly because

there is no established framework for re¯ ection or dis-

cussion in work-based contexts. Likewise, the development

of practice-based knowledge has not been a priority for the

academic community. In support of this view, Barnett

(1994) maintains that:

The academic world, left largely to its own

devices, has for too long operated with a narrow

and usually unre¯ ected set of knowledge policies.

(p. 49)

Because of the divergence between higher education and

the professions, Eraut (1985) presents a case for reconcep-

tualizing their relationship. In particular, he suggests the

development of programmes of continuing education for

professionals which assists them:

¼ to re¯ ect on their experience, make it more

explicit through having to share it, interpret it

and recognise it as a basis for future learning.

(p. 131)

In developing a new postgraduate course, it was decided to

incorporate many of the features which are said to encour-

age re¯ ection and self-evaluation. The following section

will therefore describe key aspects of the conceptual frame-

work of the curriculum and will provide a number of

examples to demonstrate how the programme works in

practice.

Developing the curriculum

The conceptual framework

Current theories of professional knowledge have moved

beyond the notion that knowledge is simply divided into

`technical’ and `practical’ . Rather, knowledge is viewed as

a dynamic whole with both personal and process knowl-

edge taking centre stage with knowledge which is seen to

be theory-based. Moreover, the value of knowledge which

is of central importance to providing a service for patients

and clients is increasingly recognized as valid. Such knowl-

edge is perceived by practitioners to be `useful’ and be-

comes embedded in their professional repertoire.

When the opportunity is created for professionals to

share their accumulated experience and to re¯ ect on their

practice, the theory ± practice divide is explored and new

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P. I. Williams

knowledge is generated. In this way practitioners learn to

theorize from their practice, and to recognize it as a basis

for future `lifelong’ learning. The new postgraduate pro-

gramme used many of these concepts as a basis for devel-

oping the curriculum, and the next part of this paper will

explain how this was achieved.

The curriculum in practice

When designing the curriculum, several key principles

were observed:

· The clinical setting was recognized as the key place

where professional knowledge is developed.

· A strong emphasis was placed on the attainment of

work-based skills.

· The concept of re¯ ective practice was seen as a funda-

mental feature of the programme.

The following part of the paper will describe how each of

these principles was translated into practice.

The clinical setting: a practice-led curriculum

From the outset, the course was designed with two main

aims: ® rst, to develop new knowledge and second, to

regenerate the existing knowledge of experienced practi-

tioners who would be enrolling on the programme. To

achieve the ® rst aim, areas of specialist practice were

identi® ed. Generally, these were associated with new tech-

nology which students would not normally encounter in

their initial professional education.

Because it was acknowledged that learning knowledge

and using knowledge are interdependent processes, the

clinical setting was used as the focus for student learning.

The programme was structured so that 50% of the stu-

dents’ time was spent in placement developing the new

skills required to practise in their chosen area. In order to

identify the professional knowledge necessary for effective

professional performance, pilot studies were set up in

collaboration with experienced practitioners in the ® eld. A

case study approach was used to collect data from a variety

of sources, including:

· observation of skilled practitioners;

· discussion and interviews with experts in the ® eld.

From an analysis of the results, four key areas of pro-

fessional practice were identi® ed which formed the basis of

the curriculum. These focused on:

· patient management;

· procedure management;

· imaging;

· pattern recognition.

Clinical learning outcomes were written which re¯ ected

the professional knowledge required to be an effective

practitioner, and these were integrated with aims and phi-

losophy of the whole programme (see Appendix 1). The

remaining course time was used to deliver keynote lec-

tures, seminars and group work with the content of the

curriculum being derived from the professional practice

areas previously identi® ed. Initial blocks of propositional

knowledge are kept as short as possible, and the remainder

are timed so that students have the opportunity to use that

knowledge in practice-related processes. These practice-

based modules are called Professional Studies modules.

It will be recalled that the second aim of the course was

to regenerate the existing knowledge of experienced practi-

tioners. Although this concept was integrated throughout

the programme, a core module named Re¯ ective Practice

was developed. Its aim is to involve practitioners as partic-

ipants in their own clinical experience by means of an

individually designed action research project which is de-

veloped through interaction with other professionals, and

which forms the assessment of the module. Students are

asked to focus on a concern about their current practice,

and to plan and implement a small study in collaboration

with practitioners in the ® eld. The project is developed in

dialogue with others on the programme by means of action

learning sets. Thus, a framework is created where

re¯ ection and discussion enhance the knowledge derived

from practical experience, and enable it to be used for

further development. Students are encouraged to re¯ ect on

their experience and to make it more explicit through

having to share it; they learn to `escape’ from their experi-

ence in the sense of challenging traditional assumptions,

and acquiring new perspectives.

The attainment of work-based skills

Because an important aim of the programme was to de-

velop new knowledge in speci® c areas of practice, students

are expected to reach an effective level of performance in

the specialism by the end of the Professional Studies

modules. Therefore, the management, organization and

assessment of the clinical component is a vital aspect. A

clinical management team comprising the course leader, a

clinical coordinator and the student’ s work-based mentor

organizes the learning experience in association with stu-

dents. A learning contract is drawn up at the start of the

programme. This provides a speci® c and individual path-

way for each student which takes into account his/her past

professional experience and future educational needs. The

contract requires students to re¯ ect on and evaluate their

past experiences in the context of the future. It is negoti-

ated and agreed with the student for the duration of his/her

clinical experience; however, there is a reappraisal of the

contract midway through each module to agree any necess-

ary modi® cations.

As well as 50% of the course time being spent in

placement, students are expected to gain an additional 14

hours per week experience in their chosen area. Before

commencing the module, students must complete a bridg-

ing course in the specialism, in which they reach a prede-

termined level of experience which is authenticated by the

mentor. The skills and knowledge are built around the four

key areas of professional practice which were identi® ed in

the pilot studies as forming the basis of the curriculum

(patient and procedure management; imaging and pattern

recognition).

The high value attributed to students’ clinical skills and

knowledge is re¯ ected in the assessment scheme: 60% of

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Using theories of professional knowledge and re¯ ective practice

the weighting of the assessment of each module is given to

a Clinical Pro® le which is the prospective element of a

portfolio and enables students to chart their development

in a particular area (40% of the assessment weighting is

allocated to a Health Technology assignment). The pro® le

comprises a collection of evidence which demonstrates that

students have acquired both the capability and perform-

ance commensurate with the learning outcomes of the

module. Included in the pro® le are:

· the negotiated learning contract;

· evidence to support effective performance in the four key

areas of professional practice;

· a log of clinical cases (to record the range and type of

clinical experience);

· evidence of re¯ ective practice;

· the mentor’ s formative assessment reports on the stu-

dent’ s progression.

An important `value added’ feature of the assessment of

students’ clinical practice is that it brings together the

higher education institution and the professional com-

munity in the common goal of improving professional

practice. Moreover, because the programme is practice led

there is explicit acknowledgement that a wealth of knowl-

edge creation takes place outside the academic setting. The

continuing discourse between lecturers and practitioners

on both sites demonstrates their shared commitment to

knowledge creation, knowledge use and continuing edu-

cation.

Re¯ ective practice as a fundamental feature

Evidence that the model of re¯ ective practice underpins

the whole programme is demonstrated in a number of

ways. First, the rationale, aims and learning outcomes of

the programme are devised to ensure that students are

critically aware and re¯ ective. Second, all participants are

required to complete the core module Re¯ ective Practice,

which is designed to enhance and regenerate the knowl-

edge-development potential of individuals. Next, the

methods of assessment of clinical practice ensure that

re¯ ection is embedded in every component, for example

the learning contract and evaluative case reports. Finally,

students are encouraged to engage in dialogue with col-

leagues on the programme and in the clinical setting, to

share experiences and to justify their actions in the light of

accepted practices. The resulting discourse leads to a dy-

namic learning environment in which there is scope for

continuous development. To cite from a student’ s

re¯ ective report:

The more in depth your understanding becomes,

the more important the art of critical re¯ ection

becomes ¼ and you begin to notice how little

this art is used in the clinical setting. It is said

that we all learn from our mistakes, but no effort

is made by professionals to critically re¯ ect or to

discuss their own experiences with others to im-

prove their practice. It’ s almost as if in discussing

certain incidents, practitioners would expose

themselves as being less competent. With the

inner con® dence I now feel, I am trying to re-

educate our team ¼ that we are not trying to

catch people out, but only to improve our exist-

ing good practice. We are aiming to create struc-

tures which will allow us to incorporate re¯ ective

practice as part of our normal working routine ¼

with the ultimate goal of continuous learning and

improvement ¼ for ourselves, for our patients

and for the service as a whole.

Notes on contributor

Patricia L. Williams is Head of Department of Radiography which

is one of seven departments in the Faculty providing health and

social work education. Her research interests focus on the educa-

tional implication of changing roles and competence.

References

ARGYRIS, C. & SCHO N, D.A. (1974) Theory in Practice: Increasing

Professional Effectiveness (San Francisco, Jossey Bass).

BARNETT , R. (1994) The Limits of Competence (London, SHRE).

BAYLIS, K. (1987) Integrated trainingÐ a topical approach, Radi-

ography, 52, pp. 95 ± 97.

BINES, H. & WATSON , D. (1992) Developing Professional Education

(Buckingham, Society for Research into Higher Education and

Open University Press).

BO YD , E.M. & FALES, A.W. (1983) Re¯ ective learning: key to

learning from experience, Journal of Humanistic Psychology, 23,

pp. 99± 117.

CASELDIN E, J. (1994) The radiographer’ s role in health promotion

and educationÐ the breast screening programme, Radiography

Today, 60, pp. 21 ± 22.

CASTLE , A. (1988) Concepts of health in diagnostic radiography,

Radiography, 54, pp. 25 ± 28.

CHAPM AN , J. (1993) The case for radiographers performing barium

enemas, British Journal of Hospital Medicine, 50, pp. 371 ± 374.

CRO SS, V. (1993 ) Introducing physiotherapy students to the idea of

re¯ ective practice, Medical Teacher, 15, pp. 293 ± 307.

DEPARTMENT OF HEALTH (1989a) Working for Patients, The White

Paper (London, HMSO).

DEPARTMENT OF HEALTH (1989b) Caring for People: Community

Care in the Next Decade and Beyond (London, HMSO).

DEPARTMENT OF HEALTH (1992) The Health of the Nation, a Strategy

of Health in England (London, HMSO).

ERAU T, M. (1985) Knowledge creation and knowledge use in pro-

fessional contexts, Studies in Higher Education, 10, pp. 117± 133.

ERAU T, M. (1994) Developing Professional Knowledge and Competence

(London, Falmer Press).

GOTT , M. (1984) Learning Nursing (London, Falmer Press).

GRAHN , G. (1989 ) Educational situations in clinical settings, Radi-

ography Today, 55, pp. 26± 27.

GRIFFITHS, M. & TANN , S. (1992) Using re¯ ective practice to link

personal and public theories, Journal of Education for Teaching, 18,

pp. 69± 84.

HEW SO N, M.G. (1991) Re¯ ection in clinical teaching: an analysis of

re¯ ection-on-action and its implications for staf® ng residents,

Medical Teacher, 13, pp. 227± 231.

JAMES, C. (1993) Professional knowledge: what do we know? paper

presented to the English National Board Conference on Pro-

fessional Knowledge, September.

JAMES, C.R. & CLARKE , B.A. (1994) Re¯ ective practice in nursing:

issues and implications for nurse education, Nurse Education

Today, 14, pp. 82 ± 90.

LOUGHRAN , C.F. (1994) Reporting of fracture radiographs: the

impact of a training programme, British Journal of Radiology, 67,

pp. 945± 950.

MELIA, K. (1987) Learning and WorkingÐ the Occupational Socialisa-

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P. I. Williams

M UNBY, H. & RUSSELL, T. (1989) Educating the re¯ ective teacher:

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PO LANYI , M. (1967) The Tacit Dimension (London, Routledge).

RYLE, G. (1949) The Concept of the Mind (London, Hutchinson).

SCHON , D.A. (1983) The Re¯ ective Practitioner: How Professionals

Think in Action (New York, Basic Books).

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Appendix 1: Aims and learning outcomes of the MSC/PGD in

advanced radiography practice

The aims of the course are to:

(1) engender a continuing and independent approach to learning

such that students will be able to comprehend, to contribute

and to apply advances in the scienti® c disciplines which under-

pin radiography;

(2) develop students’ cognitive skills, including the ability to think

logically; to be re¯ ective and critical of scienti® c hypotheses; to

analyse, synthesize and be creative;

(3) foster an enthusiasm for the student’ s chosen area of radiogra-

phy and to develop a commitment to lifelong learning;

(4) provide a framework for the acquisition of core skills and

understanding of complex concepts; to relate these to each

other and the continuing professional context;

(5) cater for the personal and continuing professional development

needs of existing practitioners.

The learning outcomes of the course are that, after successful

completion of this course, the student will be able to:

(1) demonstrate knowledge and understanding of the theoretical

foundation of the selected professional areas;

(2) apply the theoretical concepts to appropriate areas of pro-

fessional radiography practice;

(3) appraise and evaluate critically their own professional practice

and its theoretical framework;

(4) integrate relevant clinical developments into professional prac-

tice or into new situations;

(5) use effectively the skills of re¯ ective practice, as a catalyst for

change and continuous improvement;

(6) apply the skills acquired for continued self-managed personal

and professional development;

(7) perform radiographic procedures, in their selected professional

area, to a speci® ed level of competence.

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