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Rethinking reflection: using online reflectivelearning in professional practice forindigenous health workersMiranda Rose a & Elizabeth Devonshire aa Sydney, Australiab Yooroang Garang: School of Indigenous Health Studies , The University ofSydney , PO Box 170, Lidcombe, NSW 1825, AUSTRALIA E-mail:Published online: 12 Oct 2011.

To cite this article: Miranda Rose & Elizabeth Devonshire (2004) Rethinking reflection: using online reflectivelearning in professional practice for indigenous health workers, Educational Media International, 41:4,307-314, DOI: 10.1080/09523980410001680897

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Educational Media International

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DOI: 10.1080/09523980410001680897

Rethinking Reflection: Using Online Reflective Learning in Professional Practice for Indigenous Health Workers

Miranda Rose and Elizabeth Devonshire,

Sydney, Australia

Taylor and Francis Ltdremi41311.sgm10.1080/09523980410001680897Educational Media International0000-0000 (print)/0000-0000 (online)Original Article2004Taylor & Francis Ltd4130000002004MirandaRoseYooroang Garang: School of Indigenous Health StudiesThe University of SydneyPO Box 170LidcombeNSW 1825AUSTRALIAm.rose@fhs.usyd.edu.au

Abstract

This paper reports on an innovative use of online learning, within a distributed learning environment (DLE), to supportstudents in an undergraduate programme in Indigenous health and community development to reflect on their experiencesin professional placements. The professional practice curriculum at Yooroang Garang School of Indigenous Health Studies,University of Sydney includes professional placements, for which students submit written reflections. As a response to thelack of analysis in students’ writing, an interactive online reflection activity was developed, using an explicit four-step processto assist students explain and critically reflect on their placement experiences. Initial observations suggest the learningdesign has enabled students to reflect more deeply about key events and issues, while the online environment has enabledlecturers to provide more immediate and specific feedback. This paper outlines the rationale for the activity design anddiscusses the benefits and challenges it presents for lecturers and students within a DLE. Student reflections are incorpo-rated to illustrate the activity’s contribution to learning outcomes.

Réflexion reconsidérée : l’utilisation de la formation en ligne dans la pratique professionnelle des salariés de santé indigène

Cet exposé décrit comment un usage innovatif de la formation en ligne dans un environnement de formation décentral-isée (DLE) soutient les étudiants dans un programme de développement de santé et de communauté indigène et reflètesur leurs expériences de stages professionnels. Le programme des études professionelles à l’École d’Études de SantéIndigène à l’Université Yooroang Garang de Sydney inclut les stages pour lesquels les étudiants soumettent des élabora-tions. Comme réponse au manque d’analyse dans ces élaborations, un reflet interactif en ligne a été développé, utilisantun explicite procès de quatre étapes pour aider les étudiants à expliquer et reflèter critiquement leurs expériences destage. Des observations initiales suggèrent que le concept de formation permet aux étudiants de refléter plusprofondémment sur les événements clés et leurs problèmes, pendant que l’environnement en ligne permet aux profes-seurs de fournir un plus grand nombre de réactions immédiates et spécifiques. Cet exposé décrit le raisonnement de ceconcept interactif et les profits et défis qu’il représente pour les professeurs et étudiants dans un environnement deformation décentralisée. Les reflèts des étudiants sont incorporés pour illustrer la contribution des résultats deformation.

Überdenken von Betrachtungsweisen: Verwendung des reflektiven Online-Lernens in der beruflichen Praxis für einheimische Arbeiter im Gesundheitswesen

Dieser Bericht beschreibt wie die innovative Verwendung des Online-Lernens innerhalb eines dezentralisiertem Lernum-felds (DLE) Studenten bei einem Studentenprogramm der Einheimischen Gesundheits- und Öffentlichkeitsentwicklungund bei ihren Erfahrungen mit Praktika unterstützen soll. Der berufliche Praxis-Lehrplan der Yooroang Garang Schule derEinheimischen Gesundheitsstudien an der Universität von Sydney schließt Praktika ein, für die Studenten schriftliche Ausar-beitungen einreichen. Als Reaktion auf das Fehlen von Analysen in Studentenausarbeitungen wurde ein Konzept interak-tiven Gedankenaustauschs entwickelt, das einen expliziten Vier-Stufen-Prozess einbindet, um Studenten bei ihrenErklärungen und kritischen Betrachtungen bezüglich ihrer Praktikumserfahrungen zu unterstützen. Anfängliche Beobach-tungen deuten an, dass dieses Lernkonzept Studenten ermöglicht hat, tiefer über Schlüsselereignisse und -themen nach-zudenken, während das Online-Umfeld Dozenten mehr direktes und spezifisches Feedback ermöglicht. Dieser Bericht gehtauf die Hintergründe des Konzepts ein und beschreibt die daraus resultierenden Vorteile und Herausforderungen fürDozenten und Studenten in einem dezentralisierten Lernumfeld. Studentische Betrachtungsweisen sind mit einbezogenum den Gedankenaustausch am Lernergebnis zu veranschaulichen.

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Introduction

For Indigenous students undertaking tertiary study in block mode programmes (consisting of regular teachingblocks of short duration), a distributed learning environment (DLE) creates opportunities for strengtheninglearning experiences and outcomes. A component of DLEs that is potentially very useful for improvingstudents’ access to the university and its resources is online learning. As a DLE is ‘a situation wherein time andplace are no longer a primary consideration’ (Crawford, 2001, p. 68), online activities can become an integraland cost effective feature of this situation. Where students are only on campus during teaching blocks, onlineactivities can increase their connection with lecturers, learning materials and study processes.

To facilitate these connections, an online reflection activity was designed and incorporated across the 4-yearundergraduate professional practice curriculum at Yooroang Garang: School of Indigenous Health Studies,University of Sydney. This paper describes the design of the online activity. It begins by outlining the learningcontext for professional practice, the specific learning needs of the student cohort and the role of reflectionin professional practice curriculum. It also discusses associated challenges and opportunities of the DLE, drawson examples of student reflections and concludes with observations on the design and use of online activitiesin the context of professional practice curriculum.

The learning context

The professional practice curriculum is a core component of the Bachelor of Health Science (AboriginalHealth and Community Development) at Yooroang Garang. The block mode of this programme providesaccess to tertiary education for Indigenous adult students who are not able to participate in semester-basedcourses because of community, family and work responsibilities. Block mode also affords students greater flex-ibility and allows them to maintain a greater sense of control and autonomy over their learning (Bourke

et al

.,1996). However, this delivery mode has limitations, including reduced face-to-face teaching time, competingdemands of content versus process and study between blocks that requires students to have proficient inde-pendent study skills.

Each unit of study in the professional practice curriculum constitutes a distributed learning environment. Itincludes three week-long campus-based teaching blocks, print based materials, one-to-one interactions viaphone or e-mail, a professional placement and an associated online reflection activity. The placement is acentral component that provides students with opportunities to experience a range of workplace settings andprofessional contexts, practice new skills and develop knowledge and skills required for expertise. The place-ment is a situated learning experience that enables students, in Billet’s (1999, p. 152) terms, to ‘authenticallyintegrate learning, and provide access to the different kinds of knowledge required for workplace perfor-mance’. The associated online activity is a key element of the DLE that provides an avenue for the lecturer toprepare, guide and assess students’ learning during the placement experience. This expert guidance supportsstudents as they develop and refine their reflective skills and is particularly useful for meeting the learningneeds of Indigenous students.

Student cohort

Despite recent improvements in Indigenous education outcomes, research reveals Indigenous students inAustralia ‘experience lower progress and completion rates than their non-Indigenous peers’ (DEST, 2002,pp. ix–x). In an effort to overcome this educational disadvantage, special entry schemes have been intro-duced over the last couple of decades to improve Indigenous students’ access to tertiary education. However,students often gain university entry only to find their literacy and academic study skills are a further barrierto success. Other potential barriers for Indigenous students include the difficulty of returning to formalstudy after years of absence, multiple competing responsibilities, geographical and cultural isolation and lowsocio-economic status (DEST, 2002). A distributed learning environment provides opportunities forovercoming some of these barriers and contributes to students achieving academic outcomes equivalent tothose of their non-Indigenous peers.

Developing reflective practice

Reflective practice is a major objective in preparing students to become professional practitioners who are ableto manage the complex and ‘messy’ nature of professional work (Schön, 1987). Learning to manage profes-sional contexts can be facilitated by reflective processes that guide understandings of ‘relatively complex or

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unstructured ideas for which there is not an obvious solution’ (Moon, 1999, p. 23). This observation is echoedby Boud

et al

. (1985), who equate the term

reflection

with ‘those intellectual and affective activities in which indi-viduals engage to explore their experiences in order to lead to new understandings and appreciations’ (p. 19).Reflection is a demanding metacognitive task that requires students to focus their attention, relate new infor-mation to what is already known, identify relationships between theory and practice, validate ideas and feelingsand make this knowledge their own (Boud and Walker, 1991, p. 21).

For these reasons, demonstrating reflective competence requires a range of sophisticated skills that studentswith limited formal education often find difficult to develop. Traditionally, teaching of reflective practice hasemployed theoretical models of reflection, such as Boud and Walker’s (1991), cited above. These models treatreflective practice as a cognitive process, but they also implicitly assume the literacy skills that enable learnersto turn their reflections into written text. To overcome the mismatch between these approaches and the needsof our students, we decided it was critical to rethink our teaching approaches, to ‘unpack’ and demystify thegenre of reflective writing.

Activity design

The online reflection activity design is informed by theories of learning influenced by the work of Vgotsky(1978), including the cognitive apprenticeship model (Collins, 1997) and situated learning approaches (Laveand Wenger, 1991). A key principle of Vgotsky’s model is that learners perform at a higher level in interactionwith a teacher, than they can independently, a process termed ‘scaffolding’ by Ninio and Bruner (1978).Following these models, the online activity is designed to build students’ skills in reflection, using a four-stepprocess of guiding and responding to students’ written reflections. We reasoned that building reflective skillsinvolves first identifying the object of reflection – an event or issue in professional practice, secondly describingthe event or issue, thirdly explaining how or why it occurred and fourthly synthesizing this explanation withsimilar examples, with previous experience and with the broader context of practice.

The online activity we developed from this theoretical model takes advantage of the tools of Learning Manage-ment Systems (LMS). Advantages of LMS tools include the simplicity of designing online activities withoutsophisticated programming skills, simplicity of communication tools for users at both ends, such as teachersand students, password protection that provides a ‘safe space’ for interactions and housing of administrativefunctions within the LMS. In addition, university support makes this online technology accessible to studentsand staff.

The online activity can be accessed from any location, while students are on placement or on campus. Itconsists of a sequence of four types of prompts, to which students respond in writing. Each step builds on theprevious one and requires a separate student response. The first prompt asks students to

identify

four criticalevents or issues in their placement experience and students respond by naming the events or issues. Thesecond prompt then asks them to

describe

each event or issue and students write a paragraph recounting ordescribing each one. The third prompt then asks them to

explain

the events or issues that they have describedand the fourth prompt asks them to

synthesize

these reflections with their experience as Indigenous health prac-titioners and with the broader contexts of Indigenous health. These four steps and associated prompts forsecond year students are set out in table 1.

On completion, the activity is submitted online to the lecturer, who is then able to respond immediately, whilethe student is still on their placement. This structure enables the lecturer to provide feedback at each of thefour steps and to identify where students’ reflections require further guidance. Feedback provided in this waymakes it possible for the lecturer to make the reflective process explicit and to guide students in developingtheir reflective writing skills. A numerical score is also provided to tell students how well their reflections areimproving.

The content of the activity changes over the 4 years of the professional practice curriculum, as students developas practitioners through their placements. In their first year placement, students are considered to be noviceswith limited experience, in their second and third years they are developing as practitioners and by the end ofthe fourth year they have become competent practitioners. These stages in students’ development as practitio-ners are set out in table 2.

Students use of the online activity expands as they progress through the curriculum. In the first year, studentsare introduced to the reflective processes in print form, so they can become familiar with reflective writingwithout the additional load of learning to use the online environment. In subsequent years, students areoriented and complete the first online activity during the teaching block prior to commencing their

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placements. This orientation provides them with practice using the technology and understanding the activityin a supported environment. It also enables the lecturer to provide extra support and direction for thosestudents who lack confidence. The number of online activities students complete then depends on the dura-tion of their placements: second and third year students complete three online activities, while fourth yearstudents complete five. As students progress through the degree, the activity design broadens and extendstheir understanding of practice, moving reflections from the local and specific in first year through to wideranging but integrated perspectives in the fourth year.

Evaluation

The evaluation process is ongoing and has included written student feedback, teacher observations andreflections. Students were asked to use e-mail and the online reflection activity to provide feedback about thereflection task. This feedback indicated students found the online activity helpful. One student reported that

Table 1

Steps in the online reflection activity for professional practice

Reflection steps Student prompts in year 2

Step 1: Identify what’s happened Identify four key events, activities or critical incidents that you have observed or participated in this week.

Step 2: Describe and prioritise what’s happened

Describe the key events in more detail and then organize them from most to least important, according to what you think is important for Indigenous health and professional practice.

Step 3: Explain what’s happened Explain and give reasons for the events/issues you have described and prioritized in Step 2. Your explanation should be based on your understandings of primary health care and the roles of Indigenous health practitioners and should include a discussion of why the events/issues are important.

Step 4: Interpret what’s happened Interpret your reflection so far and consider what the events/issues mean for you personally as an Indigenous health practitioner. For example, you may like to consider how these issues affect your role as a member of a multi-disciplinary team or independent practitioner.

Table 2

Students’ development as practitioners

Curriculum Stage Focus of Placement and Reflection Activity

Year 1: Novice Observer on 2 week placement

:

Students reflect on what they have learnt during their placement

Year 2: Beginner Supervized practice on 2 week placement

:

Students reflect on what they have learnt and apply this to their role as an Indigenous health or community development practitioner.

Year 3: Advancedbeginner

Supervized practice on 2 week placement

:

Students reflect on what they have learnt, apply this to their role as an Indigenous health/community development practitioner and consider what this means for Indigenous health and the community.

Year 4: Competentpractitioner

Supervized practice on 4 week placement

:

Students reflect on what they have learnt, apply this to their role as an Indigenous health/community development practitioner and consider the implications for existing and future policy directions in Indigenous health at state and national levels.

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he ‘liked the way the task was broken down into steps – it made it clear what you wanted me to do’, whileanother highlighted their appreciation of lecturer feedback:

You’re right … I need to explain things properly. I just wasn’t myself that day … You have certainly shown me the rightprocess of [writing] the journal which I never knew, I will look at this [feedback] in a positive way and gain from it.

Other student feedback indicated the online environment, despite its challenges, enabled the development ofa range of skills. For example, a fourth year student noted:

I feel that reflection online is a challenge, which I hope will help me to gain a lot more understanding of using the computer.I know this will help me gain more skills and help me within my workplace, with writing my reports and case planning.However, I do feel a little stressed about the whole thing but I guess we only learn through trial and error, so here goes.

Teacher observations and reflections were also a component of the evaluation process. These were faciliatedthrough meetings with a critical friend, in which the implementation and impact of the activity across thecurriculum was considered.

Outcomes

The most significant outcome of the trial was an improvement in students’ reflective writing over two timescales: first over the four steps of the reflective activity and secondly between successive reflective activities. Theimprovement between each step of the activity was a result of the students focusing attention on issues andthe prompts given for each step specifying the task. The improvement between each reflective activity was theresult of the experience of reflective writing and the feedback and guidance from the lecturer. Improvementsin both these dimensions are illustrated here with excerpts from reflective writing activities from two studentsin second and fourth years of the Bachelor of Health Science programme.

The first student is a second year student who is an experienced Health worker. His placement was at anAboriginal Community Controlled Medical Service in the health promotion unit. The four key events/issuesthat this student identified were: ‘a sexual health congress’ he attended, ‘a health expo at a Murri school’(Murri and Koori are names that Aboriginal Australians use for themselves), ‘dealing with homeless kids livingin the park’ and ‘an interagency meeting’. The prompt for the next step asked the student to ‘describe … andorganize the events/issues from most to least important. This scaffolded the student to prioritise and describethese issues. The student ranked the interagency meeting as third in importance and described it as follows:

During the [interagency] meeting we spoke about the need for work to be done in partnership with non-government andgovernment agencies for us to reach our target population.

Here the student has described the meeting by outlining the topics discussed and how agencies interacted atthe meeting. However, note this reflection of the event is already leading to an explanation of why, ‘for us toreach our target population’, and its relation to the student’s broader practice: ‘in partnership with non-government and government agencies’.

The next prompt asks the student to ‘give reasons for the events/issues … and why the events/issues are impor-tant’. In this step, the student focused on explaining the significance of the events/issues. For example:

The interagency meetings are always important because they give organizations a chance to work in partnership with eachother and to address a range of health issues which impact on communities’ lives.

Here the student explains why the meetings are important, ‘to work in partnership’, and he is already relatingit to broader practice ‘to address a range of health issues’.

The fourth prompt asks the student to ‘review and interpret what the events/issues mean for you personally… and how these issues affect your role’.

The interagency meeting was a great chance for me to meet new workers and reacquaint myself with workers I had not hadcontact with for a while. It was a chance for me to sell myself and my expertise to other organizations that were there.

Here the student is interpreting the event in terms of his personal and professional development: ‘reacquaintmyself with workers … and sell my expertise’. However, it also illustrates a pattern that students frequentlyfollow in the interpretation step to express their personal feelings: ‘a great chance for me’. For example, in hisinterpretation of the ‘homeless children’ issue, this student wrote:

When you see children as young as 10 years old living in conditions that animals live in, it really does break your heart …One instance will stay with me for the rest of my life. We arrived at the site … a young 10 year old child walked up to me at

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the van and asked, ‘Uncle can I make you a cup of tea?’ I nearly cried, here is this child with no roof over her head … asking

me

this.

This type of response is prompted by asking students what the ‘events/issues mean for you personally’. Thisprompt allows students to express their personal reactions to their professional placements in an academiccontext, this powerfully validates the relation between practice and theory, i.e. the academy.

The second student is a fourth year student who is also an experienced Health worker. Her 4 week place-ment was with a community housing project. The four key events/issues the student identified in the firststep include: client service visits, housing assistance provided to a single mother and her two children, ameeting with the Koori elders to discuss housing issues in the local area and a community barbecue sheattended. In the second step, the student ranks the client service visits as the most important and describesthese.

Client service visits are conducted by myself and the Client Services Officer … I am involved when there are a number ofissues relating to a tenant sustaining their tenancy. If there are any problems associated with the social side … the team refersto me and we try to mediate between the Department of Housing and the tenant.

In this response, the student has already begun to explain the context rather than describe the event. Sheexplains why and when she is involved in tenancy issues with Indigenous clients. This has provided an orienta-tion for a description of an event which she gives in Step 3.

There had been a history of neighbourhood disputes … I received a phone call … stating children had been severely trau-matized. … I encouraged the family to seek family counselling as the children were also targets of racial vilification, [and]threats of violence. The counselling assisted the children in addressing their anger issues and general behaviour.

Here the student has described the event and explained why she took certain steps. However, she has notexplained the significance of the event because she had already done that in the previous Step 2.

In the fourth step, the student interpreted the event in terms of child protection issues and her personalhistory.

My main concern [was] the racism impacting on the children [which] caused a problem for me as I had gone through thesame thing at a young age … I was worried as a Koori worker (and personally) … the children had been exposed to some-thing so young that it could have a detrimental effect on [them] growing up … I had to submit a seven page investigationtype report that included my knowledge as a Koori person. I … had to put my own feelings on to paper which did bringabout some unresolved issues from my childhood.

This is an effective and powerful piece of reflective writing. The student has acknowledged the difference andpotential conflict between a personal and professional response to the situation. However, the order in whichthe student explained the context and described the event raises a question for how the online reflection activ-ity is organized in the future.

Along with these improvements in students’ reflective writing, the development and implementation of theactivity has also raised a number of challenges and involved a level of risk. For lecturers, these challenges haveincluded the time required for planning, implementing and evaluating the change in pedagogy, as well as thestaff development necessary for skills in online technology and educational design. There are major adjust-ments that academics must make to transfer their education activities into an online context, includingteaching and assessing using a new medium, managing the changed work demands associated with teachingonline and becoming skilled in using the technology. For Indigenous students, challenges have includedaccessing and using the technology off campus, where support of the lecturers is limited and learning in newways. Nevertheless, the online activity design has provided students with a transparent structure that hasincreased their control of their own learning and equipped them to reflect more deeply on their professionalpractice (Brockbank and McGill, 1998).

Conclusion

As a result of the scaffolding provided in each step of the online reflective activity and between successive activ-ities, coupled with lecturer feedback, there is a demonstrable improvement in most students’ reflective writing.Whereas most students previously wrote descriptive records in their reflective journals, all but a few are nowexplaining and interpreting their experiences as exemplified by the two students here. The four step activityfocuses student attention on significant issues and enables the lecturer to support them to explain and inter-pret. Significant unpredicted outcomes were the extent to which students were able to express their personalresponses to issues and events prompted by asking them what these events meant to them personally. Critically,

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this enabled students to identify themselves with the issues as a member of the Koori community as well as aprofessional health/community worker.

On the other hand, the outcomes have drawn attention to the need for further development of the onlineactivity in two ways. First, students with the weakest literacy skills still have difficulty moving beyond simpledescriptive accounts, so the explanation and interpretation steps need to be better scaffolded for thesestudents. Secondly, more experienced students have reversed the steps of ‘describing’ and ‘explaining’. Thisactually produced a more coherent text in that they first explained the context and then described the events.We realized that the genre of reflective writing that we were looking for consisted of three stages: orientation,incident and interpretation. According to Martin and Plum (1997), these are the stages of an ‘exemplum’genre whose function is to interpret an incident. This indicates that we must adjust the activity to prompt forfour key issues, secondly to explain the context of each issues, thirdly to recount the events and fourthly tointerpret the events in relation to both Aboriginal health in general and the students personal experience.

Finally, the distributed learning environment described here provided us with the opportunity to re-concep-tualize the teaching of reflection. This involved unpacking and scaffolding the reflection process, makingthe expectations of the activity explicit and supporting students’ to develop reflective skills. The online activ-ity embedded within the DLE has made it possible to provide timely and targeted feedback, which studentsare then able to use for their next reflection. At the same time, the activity is an opportunity for studentsand staff to develop confidence using information and communication technologies. Importantly, thedistributed learning environment has enhanced the professional practice curriculum and provided a meansto overcome some of the barriers faced by Indigenous students undertaking university study in block modeprogrammes.

References

Billet, S (1999) Guided learning at work. In Boud, D and Garrick, J (eds)

Understanding learning at work,

Rout-ledge, New York, pp. 151–164.

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November, Gold Coast, Queensland, Australia, pp. 26–28.Crawford, CM (2001) Developing webs of significance through communications: appropriate interactive

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Biographical notes

Miranda Rose is the co-ordinator of the Professional Practice Curriculum within the Bachelor of Health Science(Aboriginal Health and Community Development) at Yooroang Garang, School of Indigenous Studies, The

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University of Sydney. Her main research interests are the professionalization of Indigenous Health WorkerPractice and Indigenous Health Worker education.

Elizabeth Devonshire works at the Faculty of Medicine, The University of Sydney. Prior to this, she was the co-ordinator of a post-graduate coursework Masters programme in Indigenous Community Health. Her researchinterests include the changing nature of academic work and the design and implementation of flexiblelearning.

Address for correspondence

Miranda Rose, Yooroang Garang: School of Indigenous Health Studies, The University of Sydney. PO Box 170,Lidcombe, NSW 1825, Australia; e-mail: m.rose@fhs.usyd.edu.au

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