Introduction to Critical Reflection

Louise Aronson, MD MFA Marieke Kruidering, PhD Patricia O’Sullivan, PhD

University of California, San Francisco

Learning Objectives

Distinguish critical reflection from reflection

Identify the role of critical reflection in professional development

List the contextual elements that support reflection

Discuss the components of successful reflection

Critical reflection…

• What is it?

• Why should you care?

• How do you do it well?

Reflection v. Critical Reflection

Reflection

A word with many meanings and uses

Reflection

The bending or folding back of a part upon itself

Reflection

The return of light after striking a surface

Reflection

A thought occurring in consideration or meditation

Definitions of Reflection

“Active persistent and careful consideration of any belief or supposed

form of knowledge in the light of grounds that support it and further the

conclusion to which it tends.” (Dewey ‘93)

“A form of mental processing with a purpose and/or anticipated

outcome that is applied to complex or unstructured ideas for which

there is no obvious solution.” (Moon ‘99)

“A generic term for those intellectual and affective activities in which

individuals engage to explore their experiences in order to lead to a

new understanding and appreciation. (Boud ‘95)

“The reflective practitioner is one who uses the tool of reflection to

revisit an experience both to learn from it and to frame murky complex

problems in professional practice.” (Shon ‘83)

Critical Reflection is different

Goes beyond “consideration or meditation”

A skill developed over time

In medicine, a tool for learning and life-long professional development

Critical Reflection

Not just what happened (anecdote)

More than personal opinion of events

Requires

Data gathering and analysis

Integration of past, present and future

Contextualizing and reframing

Learning!

Critical Reflection: UCSF definition

The analysis of personal experience to enhance learning and improve future professional behavior and

outcomes.

Quiz

=

Reflection

Critical Reflection

Bottom line:

Not an expert today, but…

you can become a surgeon

with training, practice &

feedback

Critical Reflection

Not an expert today, but…

you can become good at CR

with training, practice &

feedback

Critical Reflection

What is it?

Why should you care?

How do you do it well?

Why critically reflect?

Improves performance Pre-clinical learning

Patient care

Better professionalism

Lifelong learning

Increasingly required Portfolios

Courses and clerkships

Recertification (coming soon…)

Outcomes Data

Sobral: ↑ student exam performance

Blatt: ↑ student clinical performance with Standardized Patients

Mamede: ↓ resident diagnostic errors

Toy: ↑ residents achieving rotation goals

Sobral 2001, Blatt 2007, Mamede 2008, Toy 2009

Critical Reflection and Professionalism

Critical Reflection is

a core component of professionalism

a tool useful in addressing traditionally overlooked aspects of professional development

professionalism

the informal curriculum

clinical uncertainty/behavioral gray areas

context/conflicts/reasons for behaviors

AAMC 2010, Branch 2002, Hafferty 2010, LCME 2010

The Reflective Practitioner

… is able to identify essential professional problems, to

challenge self-evident ‘truths’, to seek feedback and to use it for

personal professional development.

Schön, 1983

Critical Reflection

What is it?

Why should you care?

How do you do it well?

UCSF LEaP

LEaP = Learning from your Experiences as a Professional

Guidelines to foster Critical Reflection

Included in the handout

Effective Critical Reflection

4 part format based on clinical note structure

4 parts = S.O.A.P. Subjective

Objective

Assessment

Plan

Subjective

Discusses the experience

What happened? (content)

How did it happen? (process)

Why did it happen? (premise/

assumptions)

Considers emotion as well as intellect

Objective

Includes data

Feedback, multiple perspectives

Peer, patient, other professional, faculty

Scholarly/journal articles

Expert consultation

Open-minded, open-ended queries to others involved about their interpretations of events

Web-based resources

Assessment

Draws parallels to past experience

Go beyond the particular experience

How is this a larger challenge or opportunity for you?

Explicitly identifies learning issues

Those selected must stem clearly from the information in S and O

Plan

Should be SMART

Specific

Measurable

Attainable

Relevant

Timely

Note when and how you will assess the plan’s effectiveness

Keys to success

Focus on the analysis, not the story

Devote most of your time to O, A and P

Remember the LEaP offers guidelines, not a cookbook

Demonstrate learning from the critical reflection beyond the experience

Informative data, integration, reframing

Start with the right sort of experience

Choosing the right experience

Read the prompt carefully

Choose a personal experience

where you didn’t have the necessary knowledge or skills

that went well but you’re not sure why

which was complex, surprising, uncomfortable or uncertain

in which you felt personally or professionally challenged

Lessons we learned

Parameters for learner acceptance

Required exercise

Relevant to current learning & priorities

Faculty champions/ culture of reflection

Structured guidelines more effective than prompt alone

Feedback signals importance and supports learning

Summing up

Critical reflection is a skill that can be developed

Doing it well will take effort, practice, feedback, mentoring and time

Exercise 2: Start a Critical Reflection

Read the LEaP Guide to Critical Reflection before beginning your reflection

Use the LEaP SOAP note format to guide your writing

Use as much space as you need. Worskheet provided in packet