Teaching ReflectionCatherine Noonan, PT, DPT, PCS, CEIM

Frank Tudini, PT, DSc

Assistant Professor, Department of Physical Therapy, Campbell University

Objectives

Learners will:

• Understand the role of reflection in teaching and clinical practice

• Learn practical tools for student and self-reflection

• Engage in reflection on their teaching and clinical practice

• Identify reflection tools best suited to learning styles

What is Reflection?

• “To integrate or explore the experience to develop a new application, solution or understanding” (Schon, 1987)

•A process regarding thinking about and exploring an issue of concern, which is triggered by an experience (Boyd & Fales, 1983)

Why Reflect?

• Skill

• ArtLearning

• Narrative

• Clarify future actionsCoping

• Cultural competence

• Emotional IntelligenceEmpathy

The Reflective Practitioner

“one who, given particular circumstances, is able to distance herself from the world in which she is an everyday participant and open herself to influence by others, believing that this distancing is an essential first step toward improvement.”(Day, 2001)

Tools for Reflection

• Clinical journal writing

• Video analysis – OSCE

• 1-minute paper

• Virtual Discussion board

• Peer Feedback

• Patient Feedback

• Collage/Drawing

• List

• Mind mapping

• Clinical Performance Instrument (CPI)

• Reflection papers

• Generic Abilities

• The Scale of Reflection in Learning

• Clinical conversations

Reflection Tools: A ComparisonJournal Entry vs. Written Paper

Student Reflections: A Comparison

Patient or experience that moved you

(s/p 6 mos; in-class assignment; ungraded)

• I had a patient who was very complex…

Student Reflections: A Comparison

Self-assess performance on recent OSCE/practical

(s/p 24 hrs, out-of-class assignment; reflection on practical exam; graded)

•Overall, I thought my performance…

Reflection ToolsThe Clinical Conversation

Clinical Conversations

Help Us:

• 1) Make decisions

• 2) Exchange Knowledge

• 3) Aid understanding

• 4) Frame and reframe a problem (Taylor, 2010 [#1-3] & Schon, 1987 [#4])

The Reflective Clinical Conversation

Has “a focus on caring values: the ends we have in mind and the means we might choose to achieve them” (Taylor, 2010)

Reflection Activity #1Clinical Conversation: Reflection Recipe Image from Radiusonline

Meaningful Reflection: A Recipe• Choice

• Significance

• Timing

• Method

• Perspective

• Feedback

• Feasible

Reflection ToolsCollage

The Art of Healing

With the use of any material, construct a collage that represents you as you know yourself at this moment. Your collage may comprise pictures and colors as in a traditional collage, or you may wish to use other materials such as digital images or 3-D objects to construct a less traditional montage. Do not choose representations of your persona only. Search your heart for symbols of your true self, the part of you that you hold dear but that you do not readily reveal. Also, choose representatives of your ego and your shadow as well. You may w ant to use video or digital pictures to represent yourself. If you do decide to do that, be comprehensive. For example, the exercise would not be complete if you simply brought in one song on an iPod and played it and declared, “This is who I am,” without going into more detail.” (Davis & Musolino, 2016)

“Physician, heal thyself”Reflecting as a Teacher

Formal Feedback Processes

•Teaching Evaluations

•Peer Review

•CPI

•Other?

Reflection ToolsThe 5 Microskills & Peer Review

Frank Tudini, PT, DSc

Reflection ToolsThe 1-Minute Paper

Reflection Activity: The 1-Min. Paper

What are your values as a teacher/clinician?

Reflection ToolsThe Pros & Cons List

Reflection Activity: Pros & Cons List

• Describe a teaching experience that either lived up to (pro) or challenged (con) your values.

• What would you change in the future to better match your values?

Value: Good Care is Relationship-basedStudent Exp: Student interrupts with questions

Models Values

• Modeled building rapport with patients and families

• Modeled patient-centered care

Challenges Values

• Building rapport while also teaching student diverts attention from family & Pt; disrupts relationship building

• Questioning can feel attacking, as though student questions my abilities undermines family’s confidence

Solutions…?

Reflection ToolsThe Work Journal

The Work Journal(Stilley, 2018)

• What events stand out in my mind from the work day? How did it affect my inner work life?

• What progress did I make today? How did it affect my inner work life?

• What supported me in my work today? How can I sustain this tomorrow?

• What one thing can I do to make progress on my important work tomorrow?

• What setbacks did I have today? How did they affect me? How can I learn from them?

• What toxins and inhibitors impacted me and my work today? How can I weaken or avoid them tomorrow?

• Did I affect my colleagues work lives positively today? How might I do so tomorrow?

Reflection Activities by Learning Style

Learning Style Reflection Activity

Visual Collage, Video, Mind Mapping, Pros & Cons List

Verbal Journal, Written Reflection, Clinical Conversation, 5 Microskills, 1-min Paper

Logical Pros & Cons list, Written Paper, CPI, Scale of Reflection in Learning

Auditory Video, Clinical Conversation, Dictation of Journal

(Chibana N, 2018)

Reflection Activities by Learning Style

Learning Style Reflection Activity

Social Peer Feedback/Peer Review, Pt Feedback, Clinical Conversation, Virtual Discussion Board

Intrapersonal Generic Abilities, CPI, Journal, Mind Mapping

Kinesthetic OSCE/Video, Mind Mapping, Collage, 5 Microskills (w/ physical practice), Clinical Conversation (with movement)

Naturalistic Informal Clinical Conversation, OSCE Video, Observing Others (giving peer review)

(Chibana N, 2018)

Resources• Boyd EM, Fales AW. Reflective learning key to learning from experience. Journal of

Humanistic Psychology 1983;23(2):99-117.

• Chibana N. Blog post: The 8 learning styles: Which one works for you? Visme.co. Accessed on January 31, 2018 from http://blog.visme.co/8-learning-styles/.

• Chuan-Yuan C, Ying-Tai W, Ming-Hsia H, Jia-Te L. Reflective learning in physical therapy students: Related factors and facilitative effects of a short introduction. Procedia - Social and Behavioral Sciences. 2013;93:1362-1367.

• Davis CA, Musolino GM. Patient Practitioner Interaction: An Experiential Manual for Developing the Art of Health Care, Sixth Edition. Thorofare, NJ: SLACK Incorporated; 2016.

• Day L, Pringle P, Healy K. Reflective Enquiry into Therapeutic Institutions. London: KarnacBooks; 2001.

• Leaver-Dunn D, Harrelson GL, Martin M, Wyatt T. Critical-thinking predisposition among undergraduate athletic training students. Journal of Athletic Training. 2002;37:S-147-S-151.

Resources• Sobral DT. Medical Students’ Mindset for Reflective Learning: A Revalidation Study of the

Reflection-In-Learning Scale. Advances in Health Sciences Education. 2005;10:303-314

• Stilley M. The benefits of keeping a work journal. Levo Leage.com. Accessed January 31, 2018 from https://www.levo.com/posts/the-benefits-of-keeping-a-work-journal.

• Schön DA. Educating the reflective practitioner: Toward a new design for teaching and learning in the professions. 1st ed. San Francisco: Jossey-Bass; 1987.

• Taylor BJ, ebrary I. Reflective practice for healthcare professionals: A practical guide. 3rd;3; ed. Berkshire, England: Open University Press; 2010.

• Ward A, Gracey J. Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators. Medical Teacher. 2006;28:32-39.

• Walker SE. Journal writing as a teaching technique to promote reflection. Journal of Athletic Training. 2006;41:216-221

• Williams RM, Wessel J. Reflective journal writing to obtain student feedback about their learning during the study of chronic musculoskeletal conditions. Journal of Allied Health. 2004;33:17-23.