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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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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.
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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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