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Reflection: Taking a Deeper Dive Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha, NE

Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

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Page 1: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection: Taking a Deeper Dive

Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha, NE

Page 2: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Overview

Legacy of ReflectionShoulders of GiantsSorting our terms

Reflection and ExpertiseMaking connectionsAdaptive expertise

Reflective Practice Exploring what we know…Where do we go from here??

Page 3: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection legacy from John Dewey to Donald Schön

Page 4: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection Legacy

John DeweyHow We Think (1933)Education and ExperienceReflective thinking

Reflective thinkingInitial stage: State of doubt/perplexity/uncertaintyAct of inquiry to understand nature of the problem

Suspense of the uncertaintyAction – deliberate action

Page 5: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Donald Schon

Reflective Practitioner (1983)Educating the Reflective Practitioner (1987)The Reflective Turn (1991)Argument:

Dominant Model of Professional KnowledgeTechnical rationality

Swampy lowland of practiceDemanded reflection-in-action

Page 6: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Jesuits: Ignatian Pedagogical Paradigm (1540 – Ignatius of Loyola)

Context(where)

Experience(what)

Reflection(why/how)

Action(what next)

Evaluation(how well)

Page 7: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Theory in Practice (Argyris and Schon, 1974 and 1991)

What is professional competence?How is competence learned?How can professional education be redesigned to develop competent practice?

Page 8: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Schön’s research: Reflective practice(Harris I, 1993)

What is the nature of professional practice?What knowledge and competencies are needed?What are the possibilities for codifying professional practice?What modes of education are appropriate for professional practice?

Page 9: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Schön assumptions

Knowing-in-action (tacit knowing)Everyday knowledge used by skilled practitioners

Reflection-in-action and reflection-about-action

Both central to the art or way in which practitioners deal with uncertainty

Page 10: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Schön assumptions

Reflection is a critical skill for developing expertiseGoal of practice is WISE action

Use of specialized knowledgeAlong with practical knowledge (know-how)

Knowing-in-actionRequires reflective competenciesReflection-in-action and Reflection-about-action

Page 11: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Schön’s Case Studies on Practice

Professional develop practical knowledgeBY practicing their practice

Declarative knowledge (knowing that)Facts, theories

Procedural knowledge (knowing how)How to do something – knowledge in practice

Page 12: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Professional Education Clinical Practice

Declarative Knowledge

Course work emphasis• Facts and information• Theoretical knowledge

DeclarativeKnowledge

ProceduralKnowledge

(how to do things)

Clinical Practice Uncertainty

REFLECTION In and on practice

Practical reasoning

RIGHT Answers

Page 13: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection•Professional practice•Professional education•Critique technical rationality

Reflection•Development of expertise•Novice development •Adaptive expertise

Reflection•Thinking•Clinical reasoning•Meta-cognition•Workplace learning

Page 14: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

When someone reflects-in-action, he becomes a researcher in the practice context… thinking is notseparated from doing… his experimenting is a kind of action…built into his inquiry…. (Schon, 1983)

Page 15: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Sorting out terms

REFLECTION

Reflection-on-action

Reflection-in-action

Meta-cognition

Self-monitoringDeliberate action

Critical self-reflection

Inductive reasoningDeductive reasoning

Situation awareness

Mindfulness

Page 16: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Sorting out Terms

ReflectionReflection-in-actionReflection-on-actionCritical self-reflection

Meta-cognitionSelf-monitoringDeliberate actionTransformative learning

Page 17: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection (Mezirow, 1990; 1995,2000; Musolino/Mostrom, 2005; Kitchenham, 2008)

Reflection: examination of justification for beliefs that guide action/reassess efficacy of strategies and procedures; necessary for self-evaluationCritical reflection: assessment of the validity of assumptions or presuppositions of one’s own meaning perspectives, sources and consequencesCritical self-reflection: examination of one’s own meaning perspectives

Page 18: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection (Eva/Regeher, 2008)

Reflection: a conscious and deliberate reininvestment of mental energy aimed at exploring and elaborating one’s understanding of the problem one is facing rather than just trying to solve the problem

Page 19: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Sorting out Terms

Meta-cognition: thinking about your thinking; to critically review one’s own assumptions or beliefs and feeling about feelingSelf-assessment: overall personal judgment of one’s ability versus awareness in the moment or when a current situation is not going wellSelf-monitoring: self-awareness – in the moment – when something is not going well; slowing down when one should

Page 20: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Strategies for Self-Reflection(Meta-cognition)

THINK about your THINKINGStructureCollaboration“Never satisfied”Self-knowledgeHabits of mind

Page 21: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Self-Monitoring (Epstein, Siegel, Silberman 2008; Eva, Regehr, 2007;McConnell, Regehr, Wood, Eva,

2012)

Ability to attend moment to moment to our own actionsCuriosity to examine the effects of those actionsWillingness to use observations to improve behavior or patterns of thinking in the futureAbility to self-monitor performance in the moment of action is critical for safe, effective care

Page 22: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflection and Expertise

Is reflection a non-negotiable ability for the development of expertise?

Page 23: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Knowledge

Skills

Judgment

Thinking

Better memory?

More experience?

Motivation?

Method of expertise?

Expert-like novices?

Page 24: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Capacity for Expertise:Challenging the Assumptions/Stereotypes

Must experts be specialists?Is expertise just another word for problem solving?Is there a method of expertise?Is expertise a characteristic of careers or people?Can you have “expert like” novices?

Page 25: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Shared Characteristics of Experts(Ericsson, Charness, Feltovich, Hoffman; 2006; Benner 1984,1999; Chi,Glaser, Farr. 1988; Ericsson, 2009)

Bring more organized knowledge to the problemCan figure things out – can detect and recognize deep structure of the situationAnalyze a problem qualitatively Self- monitoring - can self-correct (reflection-in-action) Develop skills through intense, focused practiceInsightful -- see entire problem/context

Page 26: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Experts can fall short(Ericsson, Charness, Feltovich, Hoffman; 2006)

Domain specificityOverly confidentMay miss surface detailsContextual cues limited to the domain of expertiseTendency for inflexibilityInaccurate prediction of novice performance

Page 27: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Expertise: Current thinking…(Boshuizen, Bromme, Gruber, 2004; Ericsson, 2009; Bereiter, Scardamalia, 1993)

Expertise is more of a process or continuum of developmentNot a static state through gathering years of experienceExpertise as a CHARACTERISTIC of a career rather than a person…

The problem is not how to turn novices into experts faster…but to ensure that novices develop into experts rather than experienced nonexperts

Page 28: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

The career of the expert is one of progressively advancing on the problem constituting a field of work,

whereas

The career of the nonexpert is one of graduallyconstricting the field of work so that it more closely conforms to the routines the nonexpert is prepared to do Bereiter and Scardamalia

Page 29: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Flexible or Adaptive ExpertiseWhat is flexible expertise? Flexible or adaptive expertise - Focus on DEVELOPMENTEmphasis on Flexibility and Innovation There is more to expertise than KNOWLEDGE

Page 30: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Precursors for Development of Flexible EXPERTISE(Bereiter and Scardamalia, 1993; Birney, Beckmann, Wood, 2012)

Self-reflection (meta-cognitive skills)“self-regulatory knowledge or metacognition”

Knowledge that controls the application of other knowledge

Page 31: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Thinking

Knowledge

LEARNING

Page 32: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Precursors for Development of Flexible EXPERTISE(Bereiter and Scardamalia, 1993; Birney, Beckmann, Wood, 2012)

Deliberate practiceHighly structuredRequires effortEmphasis on improving performance beyond “sufficient”Progressive problem solving

Page 33: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,
Page 34: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective Practice:

Exploring what we know…..

Page 35: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective Practice: Teaching and Learning

Structure facilitates the reflective processQuestionsJournalsDe-briefing processes

CollaborationPeer interactionMentor-mentee interaction

Teaching/learning reflectionRequires educators to engage in reflection

Page 36: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Levels of Reflection(van Manen, 1977)

CriticalWhat ought to be?

InterpretiveWhat does this mean?

What is? How to?Knowing about or how

Page 37: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective practice: “slow down”(Moulton C, Regehr G, Mylopoulos M, MacRae ; 2007; McConnell M, Regehr G, Wood T. ; 2012)

Self-monitoring in practiceSlowing down for situational awareness can avoid potential errorsPaying attention

Moment to moment self-monitoring is distinct from “summative self-assessment” and more accurate

Page 38: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective PracticeBehaviors/Reasoning Processes (Mamede, Schmidt , 2004, 2005;Mamede, Schmidt, Rikers; 2006)

Meta-reasoningOpenness for reflectionDeliberate deductionDeliberate inductionTesting and synthesizing

Page 39: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective Practice: Reasoning Processes

Meta-reasoning: ability to reflect on own thinking processOpenness towards reflection: as a means of solving patient problems

Page 40: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective Practice: Reasoning Processes

Deliberate induction: response to a difficult situation – seeking alternative explanationsDeliberate deduction: tendency to deduce from alternative explanations new predictions that could be testedTest/synthesis: willingness to test predictions and synthesize new understandings

Page 41: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Shulman: Connecting Learning and Experience(2004,pg 19)

One does not learn from experience alone but from reflection on the experience…The great challenges for professional learning is that experience occurs where design and intention and collide with chance. Without the violation of expectations, it is impossible to learn from experience.

Page 42: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Commonplaces of Professions(Shulman 2004)

ProfessionAs Service

Theory for Practice

PracticeWork is done

Learning from experience Community of PracticePublic and communal

Judgment under

UncertaintyTechnical/moral

Page 43: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Where do we go from here??

Page 44: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Change our perspective……

Page 45: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective Questions(Epstein, 2008)

If there were data I ignored, what might they be?What about this situation was surprising or unexpected?Did I avoid premature closure?Is there another way I could formulate the patient’s story or my response?

Page 46: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Reflective Questions(Epstein, 2008)

What are important aspects of the situation that differ from previous situations? How might prior experiences be affecting my response?What would a trusted peer say about how I am managing or feeling about this situation?Can I SIFT my mind and examine (Sensations, Images, Feelings, Thoughts)

Page 47: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Strategies to get the inside outBridge learning research and teaching(Ambrose, Bridges, DePietro, Lovett, Norman, 2010)

Tools for finding out how student organize knowledge

Concept mapsOrganizational structures

Models to help students monitor and control their learning

Check for understandingEvaluate strengths and weaknessesFreedom to create own plan

Page 48: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Opportunity for Interprofessional Educational Research

Across professional education programsNovice development

Developing residency programsClinical teachingTeaching/learning strategies focused on uncertainty…..Strategies to gain insight into student, resident, practitioner thinking

Page 49: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

What are the 5 states the border Nebraska?

Page 50: Gail M. Jensen, PhD, PT, FAPTA Dean, Graduate School, Vice Provost for Learning and Assessment, Professor of Physical Therapy Creighton University, Omaha,

Thank you….


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