The Reflective Debrief: Using Students’ Placement Experiences to Enrich Understandings of Distinct Kinds of Nutrition and Dietetic Practice

Abstract

The practicum is one of the most important components in health professional education. It is also one of the most challenging. The hospital setting offers situations that may be physically, mentally and emotionally demanding on students. Under the pressure of being assessed, students may be reluctant to reflect on their challenges with placement supervisors, which may leave difficult experiences unprocessed.

A university-based reflection and debrief following hospital placement has the advantage of avoiding this student-supervisor dynamic and embedding the evaluation of placement clearly in the university curriculum. This format was chosen for a formal reflection and debrief session that formed part of a week-long post-placement workshop held upon return to the university for nutrition and dietetic students at Griffith University at the end of their credentialing programme. The aim of the reflective debrief was to provide a staff-facilitated opportunity for students to reflect formally and collectively on their hospital placement experiences and to explore the implications for future dietetic work. The development, implementation and evaluation of the reflective debrief session following hospital placement highlight the contributions of the critical incident approach to practicum-based learning.

The reflective debrief was underpinned by principles of effective reflection for health and social care students. It was person-oriented, delivered in face-to-face mode, used verbal reflection and was facilitated by trained dietitians. The reflective debrief used a two-stage process. In the first stage, critical incidents were reflected on by participants and discussed in small groups with trained facilitators. Following this, a large, facilitated group discussion synthesised themes arising from the small group discussions and linked them to future practice implications. The process and impact of the first implementation of the reflection and debrief were evaluated by an independent observer using a mixed methods approach.

The critical incidents described by students fell into four distinct themes: self-management, professional identity formation, the challenge of learning within a new environment and key features of performing dietetic work in the hospital environment. Underlying each theme was the notion that the hospital placement was a transformational experience for these students. The critical incident approach used appeared to be useful as a basis for a reflective debrief that assisted students in enhancing their placement-based learning, processing emotional experiences and providing a lens through which they can view their suitability for a hospital-based career.