Developing Reflective Practice

Developing Reflective Practice

A guide for medical students, doctors and teachers

Andrew GrantJudy McKimmFiona Murphy

This edition first published 2017 © 2017 by John Wiley & Sons Ltd

Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial offices:9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK111 River Street, Hoboken, NJ 07030-5774, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell

The right of Andrew Grant, Judy McKimm and Fiona Murphy to be identified as the authors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data applied for

9781119064749

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design: WileyCover image: © Andy Roberts/Gettyimages

Set in 10/12pt Warnock by SPi Global, Chennai, India

10 9 8 7 6 5 4 3 2 1

v

Contents

Acknowledgements xiAbout the Authors xiii

Part I What is Reflection? 1

1 Perspectives on Reflection 3Reflective Learning: Making a Difference – Andrew Grant 3Start Early, Make it Routine – Judy McKimm 5Some Challenges for Reflective Practice – Fiona Murphy 7About the Book: Structure and Content Overview 8

2 What is Reflection and Why Do We Do It? 11Why are Learners Required to Reflect? 11The Place of Reflection in Professional Development 13John Dewey’s Contribution 15What can be Achieved by Reflection? 15Getting the Most Out of Reflection 16Summary 18

3 Theoretical Underpinnings of Reflection 19Kolb 20Freire 20Applying and Integrating Learning Through Reflection 21Knowledge – a Constantly-Changing Network 21Deep and Surface Approaches to Learning 22Reflection In Action, Reflection On Action – Donald Schön 23The Uncertain World of Practice 24Emotional Content of Learning 24Summary 25

Contentsvi

4 Frameworks for Reflection 27Introduction 27Frameworks for Reflection 28

Kolb: Learning from Experience 28Borton’s Framework 29Rolfe’s Framework for Reflexive Practice 30Gibbs: Learning by Doing 31

Summary 35

Part II Learning Reflection 37

5 Reflecting in Practice 39Capturing and Describing the Experience 39‘Less than a Minute’ Techniques 40

Voice Recordings 40The Reflective Selfie 40Emoticons 40Word Whips 41

One to Five Minute Techniques 41The ‘Three a Day’ Technique 41The Credit Card Technique 41Time Limited 42

Analysing the Experience 43Description: What Happened? 43Feelings: What Were You Thinking and Feeling? 44Evaluation: What Was Good and Bad About the Experience? 45Analysis: How Can I Make Sense of This Experience? 45Conclusion 47Action Plan 48

Summary 49

6 Writing Reflectively 51What is Reflective Writing? 51Different Types of Reflective Writing 51Creative Writing 52Analytical–Academic Reflective Writing 55

Journal Writing 55Learning Outcomes 57Dialogical Writing 57

Contents vii

Critical Incident Analysis 58Reflective Essay 59

A Description of the Experience 60Interpretation and Analysis 60An Outcome 60

Portfolio Writing 61Some Issues with Reflective Writing 61Summary 62

7 Reflective Activities 63Types of Reflective Learning Activity 63

Problem‐Based Learning 63Case‐Based Learning 65

Supporting Reflective Learning 65Supervision 65Appraisal 66Coaching and Mentoring 66

Coaching 68Mentoring 70

Summary 70

8 Reflection, Critical Thinking and Action Research 71Connecting Reflection and Knowledge Generation 71Connecting Reflection, Knowledge and Research through Critical Thinking 721. Identifying and Challenging Assumptions 74

Our Autobiography 74Our Patients’ and Clients’ Eyes 75Our Colleagues’ Experiences 75Theoretical Literature 75

2. Recognizing the Importance of Context 76Constructing 76Deconstructing 76Confronting 76Reconstructing 77

3. Exploring and Imagining Alternatives 774. Reflective Scepticism 78Action Research: Connecting Reflection, Knowledge and Critical Thinking 78

Examples of Action Research 81Summary 82

Contentsviii

Part III Facilitating Reflection 83

9 Teaching and Supporting Reflection 85Aims, Goals and Purpose 86Supporting Learners to Get Started as Reflective Learners 87Selecting the Right Method of Reflective Learning 88Using Learning Technologies to Enable Reflection 93Peer Learning 94Reflection as Part of Developing Professional Identity 95Evaluating Reflective Learning and Teaching 97Summary 98

10 Assessing Reflection 99What Are You Looking For in Reflective Assessment? 100Marking Reflective Work – a Cause of Potential Conflict 100Effects of Making Reflective Learning Compulsory 101Strategies to Discourage Students from Writing What They Think the Tutor Wants to Read or Will Gain Them Good Marks 102Creating a Robust, Defensible Assessment for Your Students’ Reflective Work 104Ensuring Robust, Valid, Reliable Assessment 105Summary 107

Part IV Developing as a Reflective Practitioner 109

11 The Role of Reflection in Developing Professional Identity 111How Does Reflective Practice Form Professional Identity? 112How Can Reflection Be Challenging to Professional Identity? 113Self Theories, PIF and Reflective Practice 114How Can Guided Reflection Be Challenging Without Being Threatening? 116Summary 117

12 Reflection, Revalidation and Appraisal 119Adult Learning – Andragogy 1191. The Need to Know 1202. The Learners’ Self-Concept 1203. The Role of the Learners’ Experiences 1214. Readiness to Learn 1215. Orientations to Learning 121

Contents ix

6. Motivation 121Maximizing Learning Return on Effort 122A Curriculum Based on Your Experience 123Learning that is Intrinsically Rewarding 125Keeping a Record for CPD, Appraisal and Revalidation 126Demonstrating Learning and Development over Time 127Summary 128

References and Resources 129References 129Further Resources 135

Index 137

xi

We would like to thank our students and many colleagues over the years in helping us to develop and shape the ideas set out in the book. In particular, we would like to acknowledgethe Swansea Medical School Graduate Entry Medicine and Leadership Masters’ students who generously provided exam-ples of reflective writing, the help given by Sam May in the authorship of Chapter 9 and the administrative support provided by Charly Cope. Finally, we would like to thank our partners (Alistair, Andy and Phil) and our families for their unfailing support for our writing endeavours.

Acknowledgements

xiii

Andrew Grant

Professor Andrew Grant is Dean of Medical Education at Swansea University Medical School. His PhD thesis (completed in 2005) was based on reflective learning in 3rd year medical students. He has gained experience with reflective learning in undergraduate medical education in a number of settings. As a practising GP, Andrew completes a portfolio for appraisal each year. This expe-rience of having to keep a reflective portfolio has given him a great deal of insight into the practicalities of recording written reflections while working as a busy practitioner and educator. Andrew worked as a GP in North West London for ten years before moving into a full‐time academic career in medi-cal education.

Judy McKimm

Professor Judy McKimm is Director of Strategic Educational Development and Professor of Medical Education at Swansea University Medical School. From 2011–2014, she was Dean of Medical Education at Swansea and before that worked in New Zealand from 2007‐2011, at the University of Auckland and as Pro‐Dean, Health and Social Care, Unitec Institute of Technology. Judy ini-tially trained as a nurse and has an academic background in social and health sciences, education and management. She was Director of Undergraduate Medicine at Imperial College London until 2004 and led the curriculum devel-opment and implementation of the new undergraduate medical programme. She has worked on over sixty international health workforce and education reform projects for DfID, AusAID, the World Bank and WHO in Central Asia, Portugal, Greece, Bosnia & Herzegovina, Macedonia, Australia and the Pacific. She writes and publishes widely on medical education, leadership and profes-sional identity and runs health professions’ leadership and education courses and workshops internationally.

About the Authors

About the Authorsxiv

Fiona Murphy

Professor Fiona Murphy is Professor of Clinical Nursing in the Department of Nursing and Midwifery at the University of Limerick. Before that she was an associate professor at Swansea University with extensive involvement in deliv-ering programmes to healthcare practitioners at all levels. She has much expe-rience in facilitating teaching and learning in reflective practice to healthcare professionals, in particular debriefing and analysis of critical incidents from clinical practice. Fiona trained as a nurse and public health nurse and has worked extensively in the United Kingdom, Ireland and the United States.