Abstract
A dominant focus of clinical education for health professional students is experiential learning through an apprentice model where students are exposed to a range of clinical scenarios and conditions through observation initially, and then through supervised clinical practice. However experiential learning may not be enough to meet the need for health professionals to be flexible, self-aware and understanding of alternative perspectives or ‘where other people are coming from.’ Critical reflection skills are recognised as a way of thinking and a process for analysing practice, that enables learning from, and redeveloping professional practice in an ongoing way. This paper describes and examines the effect of a three hour per week, six week critical reflection program, grounded in knowledge paradigms of postmodernism, reflexivity and critical theory, on third year undergraduate physiotherapy students’ experience of their first clinical placements. The theoretical basis of the program provides a potential bridge with which to link and broaden the established framework of clinical reasoning theories. Within the program, students’ critical reflection discourse focused on notions of power, hierarchies, connecting with others and relationships. Their feedback about the effects of the program highlighted themes of validation and sharing; a break in clinical performance and a broadening of their spheres of knowledge. These themes resonated with students’ overall experiences of learning in clinical placements and provide some evidence for the inclusion of critical reflection as a valid and worthwhile component of early clinical education.
Similar content being viewed by others
References
Baird, M., & Winter, J. (2005). Reflection, practice and clinical education. In M. Rose & D. Best (Eds.), Transforming practice through clinical education, professional supervision and mentoring (p. 156). Edinburgh: Elsevier.
Barry, C., Britten, N., Barber, N., Bradley, C., & Stevenson, F. (1999). Using reflexivity to optimise teamwork in qualitative research. Qualitative Health Research, 9, 26–44. doi:10.1177/104973299129121677.
Bleakley, A. (1999). From reflective practice to holistic reflexivity. Studies in Higher Education, 24, 315–330. doi:10.1080/03075079912331379925.
Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from teamworking. Medical Education, 40, 150–157. doi:10.1111/j.1365-2929.2005.02371.x.
Boenink, A., Oderwald, A., De Jonge, P., Van Tilberg, W., & Smal, J. (2004). Assessing student reflection in medical practice. The development of an observer-rated instrument: Reliability, validity and initial experiences. Medical Education, 38, 368–377. doi:10.1046/j.1365-2923.2004.01787.x.
Boud, D., Keogh, R., & Walker, D. (1985). Reflection: Turning experience into learning. London: Kogan Page.
Boud, D., Cressey, P., & Docherty, P. (2006). Setting the scene for productive reflection. In D. Boud, P. Cressey, & P. Docherty (Eds.), Productive reflection at work. London: Routledge.
Charmaz, K. (2000). Grounded theory Objectivist and constructivist methods. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (pp. 509–537). Thousand Oaks, CA: Sage Publications.
Clouder, L. (2000). Reflective prctice: Realising its potential. Physiotherapy, 86, 517–522. doi:10.1016/S0031-9406(05)60985-6.
Cole, K., Barker, R., Kolodner, K., Williamson, P., Wright, S., & Kern, D. (2004). Faculty development in teaching skills: An intensive longitudinal model. Academic Medicine, 5, 469–480. doi:10.1097/00001888-200405000-00019.
Cross, V. (1997). The professional development diary: A case study of one cohort of physiotherapy students. Physiotherapy Research Report, 83, 375–383.
Delany, C. (2007). Critical reflection program for third year physiotherapy students, Victorian Government Department of Human Resources; Clinical Placement Innovation Projects. http://www.health.vic.gov.au/workforce/placements.htm. Accessed May 2008
Donaghy, M., & Morss, K. (2000). Guided reflection: A framework to facilitate and assess reflective practice within the discipline of physiotherapy. Physiotherapy Theory and Practice, 16, 3–14. doi:10.1080/095939800307566.
Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking processes and outcomes of medical students’ workplace learning. Medical Education, 41, 84–91. doi:10.1111/j.1365-2929.2006.02652.x.
Dye, D. (2005). Enhancing critical reflection of students during a clinical internship using the s.O.A.P. Note. The Internet Journal of Allied Health Sciences and Practice, 3.
Edwards, I., Jones, M., Carr, J., Braunack-Mayer, A., & Jensen, G. (2004). Clinical reasoning strategies in physical therapy. Physical Therapy, 84, 312–330.
Eraut, M. (1994). Developing professional knowledge and competence. London: Falmer Press.
Fish, D., & Twinn, S. (1997). Quality clinical supervision in the health care professions. Oxford: Reed Educational and Professional Publishing.
Fook, J. (2002). Theorising from practice. Towards an inclusive approach for social work. Qualitative Social Work, 1, 79–95. doi:10.1177/1473325002001001746.
Fook, J. (2004). Critical reflection and transformative possibilities. In L. Davies & P. Leonard (Eds.), Social work in a corporate era: Practices of power and resistance. Ashgate: Aldershot.
Francis, D. (1995). The reflective journal: A window to preservice teeachers’ practical knowledge. Teaching and Teacher Education, 11, 229–241. doi:10.1016/0742-051X(94)00031-Z.
Gard, G. (2000). Stress prevention in an organisational context. A challenge for the physiotherapist. Nordisk Fysioterapi, 4, 1–5.
Gardner, F. (2003). Critical reflection in community-based evaluation. Qualitative Social Work, 2, 197–212. doi:10.1177/1473325003002002005.
Grace, A. (1997). Where critcal postmodern theory meets practice: Working in the intersection of instrumental, social and cultural education. Studies in Continuing Education, 19, 51–70. doi:10.1080/0158037970190102.
Habermas, J. (1990). Moral consciousness and communicative action. Cambridge: MIT Press.
Hansen, E. (2006). Successful qualitative health research. Sydney: Allen and Unwin.
Henderson, P., & Johnson, M. (2002). An innovative approach to developing the reflective skills of medical students. BMC Medical Education, 2.
Higgs, J. (2001). Charting standpoints in qualitative research. In H. Byrne-Armstrong, J. Higgs, & D. Horsfall (Eds.), Critical moments in qualitative research (pp. 44–67). Oxford: Butterworth Heinemann.
Higgs, J., & Titchen, A. (2001). Rethinking the practice-knowledge interface in an uncertain world: A model for practice development. British Journal of Occupational Therapy, 64, 526–533.
Higgs, J., Jones, M., Loftus, S., & Christensen, N. (Eds.). (2008). Clinical reasoning in the health professions. Amsterdam: Elsevier Butterworth Heinemann.
Howell, J. (1989). The reflective practitioner in nursing. Journal of Advanced Nursing, 14, 824–832. doi:10.1111/j.1365-2648.1989.tb01467.x.
Hughes, J., & Sharrock, W. (2007). Theory and methods in sociology. An introduction to sociological thinking and practice. New York: Palgrave Macmillan.
Iedema, R., Degeling, P., Braithwaite, J. & Chan, D. (2004). Medical education and curriculum reform: Putting reform proposals in context Medical Education Online (p. 9).
Jensen, G. (2005). Mindfulness: Applications for teaching and learning in ethics education. In R. Purtilo, G. Jensen, & C. Brasic Royeen (Eds.), Educating for moral action. Philadelphia: F.A. Davis Company.
Jensen, G., Shepard, K., & Hack, L. (1990). The novice versus the experienced clinician: Insights into the work of the physical therapist. Physical Therapy, 70, 314–323.
Jensen, G. M., Gwyer, J., Shepard, K. F., & Hack, L. M. (2000). Expert practice in physical therapy. Physical Therapy, 80, 28–43.
Johns, C. (1995). Framing learning through reflection within carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22, 226–234. doi:10.1046/j.1365-2648.1995.22020226.x.
Johnson, R., & Waterfield, J. (2004). Making words count: The value of qualitative research. Physiotherapy Research International, 9, 121–131. doi:10.1002/pri.312.
Kember, D. (2001). Reflective teaching and learning in the health professions. Oxford: Blackwell Science.
Kennedy, T., & Lingard, L. (2006). Making sense of grounded theory in medical education. Medical Education, 40, 101–108. doi:10.1111/j.1365-2929.2005.02378.x.
King, P., & Kitchener, K. (1994). Developing reflective judgment. San Francisco: Jossey-Bass.
Larin, H., Wessel, J., & Al-Shamlan, A. (2005). Reflections of physiotherapy students in the united arab emirates during their clinical placements: A qualitative study. BMC Medical Education, 5.
Lave, J., & Wenger, E. (1990). Situated learning: Legitimate peripheral participation. Cambridge, UK: Cambridge University Press.
Loftus, S., & Smith, M. (2008). A history of clinical reasoning research. In J. Higgs, M. Jones, S. Loftus, & N. Christensen (Eds.), Clinical reasoning in the health professions. Amsterdam: Elsevier Butterworth Heinemann.
Maudsley, G., & Strivens, J. (2000). Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical Education, 34, 535–544. doi:10.1046/j.1365-2923.2000.00632.x.
McLeod, S., Romanini, J., Cohn, E., & Higgs, J. (1997). Models and roles in clinical education. In L. McAllister, M. Lincoln, S. Mcleod, & D. Maloney (Eds.), Facilitating learning in clinical settings. Cheltenham: Stanley Thornes.
Mellion, L., & Tovin, M. (2002). Grounded theory: A qualitative research methodology for physical therapy. Physiotherapy Theory and Practice, 18, 109–120. doi:10.1080/09593980290058490.
Patton, M. (2002). Qualitative research and evaluation methods. California: Sage Publications.
Pease, R., & Fook, J. (1999). Postmodern critical theory and emancipatory social work practice. In R. Pease & J. Fook (Eds.), Transforming social work practice (pp. 1–22). London: Routledge.
Pee, B., Wodman, T., Fry, H., & Davenport, E. (2002). Appraising and assessing reflection in students’ writing on a structured worksheet. Medical Education, 36, 575–585. doi:10.1046/j.1365-2923.2002.01227.x.
Rees, C. (2004). The problem with outcomes-based curricula in medical education: Insights from educational theory. Medical Education, 38, 593–598. doi:10.1046/j.1365-2923.2004.01793.x.
Rice, P., & Ezzy, D. (1999). Qualitative research methods. A health focus. Oxford: Oxford University Press.
Richardson, G., & Maltby, H. (1995). Reflection-on-practice: Enhancing student learning. Journal of Advanced Nursing, 22, 235–242. doi:10.1046/j.1365-2648.1995.22020235.x.
Routledge, J., Willson, M., McArthur, M., Richardson, B., & Stephenson, R. (1997). Reflection on the development of a refective assessment. Medical Teacher, 19, 122–128.
Ryan, S., & Higgs, J. (2008). Teaching and learning clinical reasoning. In J. Higgs, M. Jones, S. Loftus, & N. Christensen (Eds.), Clinical reasoning in the health professions (pp. 379–389). Amsterdam: Elsevier Butterworth Heinemann.
Schwandt, T. (2000). Three epistemological stances for qualitative inquiry. In N. Denzin & Y. Lincoln (Eds.), Handbook of qualitative research (pp. 189–214). Thousand Oaks: Sage.
Shepard, K., Hack, L., Gwyer, J., & Jensen, G. (1999). Describing expert practice in physical therapy. Qualitative Health Research, 9, 746–758. doi:10.1177/104973299129122252.
Snadden, D., & Thomas, M. (1998). The use of portfolio learning in medical education. Medical Teacher, 20, 192–199. doi:10.1080/01421599880904.
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage.
Talbot, M. (2004). Monkey see, monkey do: A critique of the competency model in graduate medical education. Medical Education, 38, 587–592. doi:10.1046/j.1365-2923.2004.01794.x.
Taylor, C., & White, S. (2000). Practicing reflexivity in health and welfare. Buckingham: Philadelphia.
Trede, F., Higgs, J., Jones, M., & Edwards, I. (2003). Emancipatory practice: A model for physiotherapy practice. Focus on Health Professional Education: A Multidisciplinary Journal, 5, 1–13.
Wessel, J., & Larin, H. (2006). Change in reflections of physiotherapy students over time in clinical placements. Learning in Health and Social Care, 5, 119–132.
Williams, D. (2002). Reflective practice: Writing and professional development. Journal of Medical Ethics, 28, 56–57. doi:10.1136/jme.28.1.56.
Acknowledgments
We would like to thank the student and educator focus group participants for sharing their perspectives with us.
Funding
This project was funded by the Victorian Government, Department of Human Services Service and Workforce Planning: Clinical Placement Innovations Projects.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Delany, C., Watkin, D. A study of critical reflection in health professional education: ‘learning where others are coming from’. Adv in Health Sci Educ 14, 411–429 (2009). https://doi.org/10.1007/s10459-008-9128-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-008-9128-0