Skip to main content

Reflection and reflective practice in health professions education: a systematic review

Advances in Health Sciences Education volume 14, Article number: 595 (2009) Cite this article

Abstract

The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  • Andrews, K. (2005). Evaluating professional development in the knowledge era. Sydney: TAFE NSW ICVET International Centre for VET Teaching and Learning.

    Google Scholar 

  • Argyris, C., & Schon, D. (1974). Theory into practice: Increasing professional effectiveness. San Francisco: Jossey Bass.

    Google Scholar 

  • Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

    Google Scholar 

  • Beecher, A., Lindemann, J., Morzinski, J., & Simpson, D. (1997). Use of the educator’s portfolio to stimulate reflective practice among medical educators. Teaching and Learning in Medicine, 9, 56–59.

    Article  Google Scholar 

  • Biggs, J., Kember, D., & Leung, D. (2001). The revised two factor study process questionnaire: R-SPQ-2F. British Journal of Educational Psychology, 71, 133–149.

    Article  Google Scholar 

  • Boenink, A.,Oderwald, A., de Jonge, P., van Tilburg, 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.

    Article  Google Scholar 

  • Boud, D. (1999). Avoiding the traps: Seeking good practice in the use of self assessment and reflection in professional courses. Social Work Education, 18, 121–132.

    Article  Google Scholar 

  • Boud, D., & Walker, D. (1998). Promoting reflection in professional courses: The challenge of context. Studies in Higher Education, 23(2), 191–206.

    Article  Google Scholar 

  • Boud, D., Keogh, R., & Walker, D. (1985). Reflection: Turning experience into learning. London: Kogan Page.

    Google Scholar 

  • Burnard, P. (1995). Nurse educators’ perceptions of refection and reflective practice: A report of a descriptive study. Journal of Advanced Nursing, 21, 1167–1174.

    Article  Google Scholar 

  • College of Family Physicians of Canada. (2007). Eligibility requirements and general information. Retrieved October 2, 2007, from College of Family Physicians of Canada Web site: http://www.cfpc.ca/English/cfpc/education/examinations/family%20medicine/default.asp?s=1

  • Catto, G. (2005). GMC and the future of revalidation: Building on the GMC’s achievements. British Medical Journal, 330, 1205–1207.

    Article  Google Scholar 

  • Clark, P. (2006). What would a theory of interprofessional education look like? Some suggestions for developing a theoretical framework for teamwork training. Journal of Interprofessional Care, 20, 577–589.

    Article  Google Scholar 

  • The Cochrane Collaboration. (2006). Retrieved September 17, 2007, from The Cochrane Collaboration Web site: http://www.cochrane.org/index.htm

  • Dewey, J. (1933). How we think, revised edition. Boston: D.C. Heath.

    Google Scholar 

  • Dornan, T., Carroll, C., & Parboosingh, J. (2002). An electronic learning portfolio for reflective continuing professional development. Medical Education, 36, 767–769.

    Article  Google Scholar 

  • Duke, S., & Appleton, J. (2000). The use of reflection in a palliative care programme: A qualitative study of the development of reflective skills over an academic year. Journal of Advanced Nursing, 32, 1557–1568.

    Article  Google Scholar 

  • Epstein, R., & Hundert, E. (2002). Defining and assessing professional competence. JAMA, 287, 226–235.

    Article  Google Scholar 

  • Epstein, R. (1999). Mindful practice. JAMA, 282, 833–839.

    Article  Google Scholar 

  • Eva, K., & Regehr, G. (2005). Self-assessment in the health professions: A reformulation and research agenda. Academic Medicine, 80, s46–s54.

    Article  Google Scholar 

  • Francis, D., Owens, J., & Tollefson, J. (1998). It comes together at the end: The impact of a one year subject in nursing inquiry on philosophies of nursing. Nursing Inquiry, 5, 268–278.

    Article  Google Scholar 

  • General Medical Council. (2005). Licensing and revalidation factsheet. Retrieved June 25, 2007, from General Medical Council Web site: http://www.gmc-uk.org/doctors/licensing/archive/factsheet_2005_08.asp

  • Glaze, J. (2001). Reflection as a transforming process: students advanced nurse practitioners’ experiences of developing reflective skills as part of an MSc programme. Journal of Advanced Nursing, 34(5), 639–647.

    Article  Google Scholar 

  • Gustafsson, C., & Fagerberg, I. (2004). Reflection, the way to professional development? Journal of Clinical Nursing, 13, 217–280

    Google Scholar 

  • Hallett, C. (1997). Learning through reflection in the community: The relevance of Schön’s theories of coaching to nursing education. International Journal of Nursing Studies, 34, 103–110.

    Article  Google Scholar 

  • Harden, R., Grant, J., Buckley, G., & Hart, I. (1999). BEME guide no. 1: Best evidence medical education. Medical Teacher, 21, 553–562.

    Article  Google Scholar 

  • Hatton, N., & Smith, D. (1995). Reflection in teacher education: Towards definition and implementation. Teaching and Teacher Education, 11, 33–49.

    Article  Google Scholar 

  • Johns, C. (1992). Nuances of reflection. Journal of Clinical Nursing, 3, 71–75.

    Article  Google Scholar 

  • Kember, D., Leung, D., Jones, A., Loke, A., McKay, J., Sinclair, K., Tse, H., Webb, C., Wong, F., Wong, M., & Yeung, E. (2000). Development of a questionnaire to measure the level of reflective thinking. Assessment and Evaluation in Higher Education, 25, 381–395.

    Article  Google Scholar 

  • Klemola, U., & Norros, L. (1997). Analysis of the clinical behaviour of anaesthetists: Recognition of uncertainty as a basis for practice. Medical Education, 31, 449–456.

    Article  Google Scholar 

  • Klemola, U., & Norros, L. (2001). Practice-based criteria for assessing anaesthetists habits of action: Outline for a reflexive turn in practice. Medical Education, 35, 455–464.

    Article  Google Scholar 

  • Kolb, D. (1984). Experiential learning. Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  • Leung, D., & Kember, D. (2003). The relationship between approaches to learning and reflection upon practice. Educational Psychology, 23, 61–71.

    Article  Google Scholar 

  • Mamede, S., & Schmidt, H. (2005). Correlates of reflective practice in medicine. Advances in Health Sciences Education, Theory and Practice, 10, 327–337.

    Article  Google Scholar 

  • Mamede, S., & Schmidt, H. (2004). The structure of reflective practice in medicine. Medical Education, 38, 1302–1306.

    Article  Google Scholar 

  • Mantzoukas, S. & Jasper, M. (2004). Reflective practice and daily ward reality: A covert power game. Journal of Clinical Nursing, 13, 925–933.

    Article  Google Scholar 

  • Mezirow, J. (1981). A critical theory of adult learning and education. Adult Education, 32, 3–24.

    Article  Google Scholar 

  • Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.

    Google Scholar 

  • Moon, J. (1999). A handbook of reflective and experiential learning. London: Routledge.

    Google Scholar 

  • Moon, J. (2004). A handbook of reflective and experiential learning: Theory and practice. London: Routledge Farmer.

    Google Scholar 

  • Nehari, M., & Bender, H. (1978). Meaningfulness of a learning experience: A measure for educational outcomes in higher education. Higher Education, 7(1), 1–11.

    Article  Google Scholar 

  • Niemi, P. (1997). Medical students’ professional identity: Self-reflection during the pre-clinical years. Medical Education, 31, 408–415.

    Article  Google Scholar 

  • Pearson, D., & Heywood, P. (2004). Portfolio use in general practice vocational training: A survey of GP registrars. Medical Education, 38, 87–95.

    Article  Google Scholar 

  • Pee, B., Woodman, T., Fry, H., & Davenport, E. (2002). Appraising and assessing reflection in students’ writing on a structure worksheet. Medical Education, 36, 575–585.

    Article  Google Scholar 

  • Pinsky, L., & Irby, D. (1997). If at first you don’t succeed: Using failure to improve teaching. Academic Medicine, 72(11), 973–976.

    Article  Google Scholar 

  • Pinsky, L., Monson, D., & Irby, D. (1998). How excellent teachers are made: Reflecting on success to improve teaching. Advances in Health Sciences Education, 3, 207–215.

    Article  Google Scholar 

  • Platzer, H., Blake, D., & Ashford, D. (2000). Barriers to learning from reflection: A study of the use of group work with post-registration nurses. Journal of Advanced Nursing, 31, 1001–1008.

    Article  Google Scholar 

  • Richardson, J. (1990). Reliability and replicability of the approaches to studying questionnaire. Studies in Higher Education, 15, 155–168.

    Article  Google Scholar 

  • Schön, D. (1983). The reflective practitioner. San Francisco: Jossey-Bass.

    Google Scholar 

  • Schön, D. (1987). Educating the reflective practitioner. San Francisco: Jossey-Bass.

    Google Scholar 

  • Sobral, D. (2000). An appraisal of medical students’ reflection-in-learning. Medical Education, 34, 182–187.

    Article  Google Scholar 

  • Sobral, D. (2001). Medical students’ reflection-in-learning in relation to approaches to study and academic achievement. Medical Teacher, 23, 508–513.

    Article  Google Scholar 

  • Sobral, D. (2005). Mindset for reflective learning: A revalidation of the reflection in learning scale. Advances in Health Sciences Education, 10, 303–314.

    Article  Google Scholar 

  • Strawson, G. (2004). Against Narrativity. Ratio, 17, 428–452.

    Article  Google Scholar 

  • Teekman, B. (2000). Exploring reflective thinking in nursing practice. Journal of Advanced Nursing, 31, 1125–1135.

    Article  Google Scholar 

  • von Klitzing, W. (1999). Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients. Journal of Advanced Nursing, 30, 1213–1221.

    Article  Google Scholar 

  • Williams, R., & Wessel, J. (2004). Reflective journal writing to obtain student feedback about their learning during the study of chronic musculoskeletal conditions. Journal of Allied Health, 33, 17–23.

    Google Scholar 

  • Williams, R., Sundelin, O., Foster-Seargeant, E., & Norman, G. (2000). Assessing the reliability of grading reflective journal writing. Journal of Physical Therapy Education, 14, 23–26.

    Google Scholar 

  • Wong, K., Kember, D., Chung, L., & Yan, L. (1995). Assessing the level of student reflection from reflective journals. Journal of Advanced Nursing, 22, 48–57.

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge with thanks the contribution to the conduct of this study by the Society of Directors of Research in Medical Education. Thanks also to Drs. Kevin Eva and Joan Sargeant for their helpful feedback.

Author information

Authors and Affiliations

  1. Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada, B3H4H7

    Karen Mann

  2. University of Sydney, Sydney, NSW, Australia

    Jill Gordon

  3. University of South Australia, Adelaide, SA, Australia

    Anna MacLeod

Authors
  1. Karen Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jill Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna MacLeod
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen Mann.

Appendix

Appendix

Appendix 1 Studies included with abstract
Full size table

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mann, K., Gordon, J. & MacLeod, A. Reflection and reflective practice in health professions education: a systematic review. Adv in Health Sci Educ 14, 595 (2009). https://doi.org/10.1007/s10459-007-9090-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10459-007-9090-2

Keywords

  • Health professional education
  • Practicing health professionals
  • Health professional students
  • Reflection
  • Reflective practice
  • Systematic literature review