Critically reflective practice and its sources: A qualitative exploration

Abstract

Context Critical reflection may improve health professionals’ performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value‐conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches. Methods The study context was the interface between health care and education for children with chronic conditions or disabilities necessitating health‐related recommendations and supports (eg accommodations or equipment) at school. We conducted a secondary analysis of 42 interview transcripts from an institutional ethnographic study involving health professionals, school‐based educators and parents of children with chronic conditions or disabilities. We coded all transcripts for instances of critical reflection, moments that seemed to lack but could benefit from critical reflection, and participant‐attributed sources of critically reflective insights. Results Critically reflective practice involved getting to know the other, valuing and leveraging different forms and sources of knowledge, identifying and communicating workarounds (ie strategies to circumvent imperfect systems), seeing inequities, and advocating as collaborators, not adversaries. Participants invariably attributed critically reflective insights to personal experiences such as former careers or close personal relationships. Conclusions This study shows that personal experiences and connections inspire critically reflective views, and that being critically reflective is not a binary trait possessed (or not) by individuals. It is learnable through personally meaningful experiences. Health professions education could aim to preserve philosophical space for personal experience as a source of learning and integrate evidence‐informed approaches to foster critically reflective practice.

Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis

“…The category "Accomplishing learning potential"confirms what many authors highlight: putting thoughts into words not only permits a deeper understanding of events [6], enhances professionalism [52] but also improves personal [16], communication, and empathy skills [4,17]. In this context, RW fulfills its mandate by letting human sciences [53] and evidence-based health disciplines affect clinical practice. As noted [54], students and health professionals'RW training allowed integrating scientific knowledge with behavioral and sociological sciences to supporttheir learning [55].…”

Critical reflection in medical training and the biomedical world view

“…As Ng et al suggest, students' own clinical experiences need to be recognised by faculty members as valid sources of information and as triggers for reflective learning. 1 In-depth reflection may enable students to gain useful insights into their expectations about how patients should behave, the nature of illness and the roles and responses of health professionals. Through critical reflection, students may also identify gaps between their expectations and the observed reality of clinical practice.…”

“…In a research report in this issue of Medical Education , Ng et al explore critical reflection by practitioners who work in the interface between health care and education, an ‘indeterminate’ context of practice requiring high levels of cooperation and personal initiative. They present analysis of interview data from a range of social actors, such as health professionals, school‐based educators and parents of special needs children who have disabilities or medical conditions.…”

“…‘Thinking critically involves recognizing the assumptions underlying our beliefs and behaviours. It means we can give justifications for our ideas and actions … it means we try to judge the rationality of these justifications.’ In other words, the adjective ‘critical’ implies a process of review that ‘specifically challenge[s]/question[s] assumptions, power relations, and structural or systemic effects and constraints on practice.’ As a current illustration, Ng et al identify how practitioners at the interface of health care and education are able to identify and respond to existing constraints and power relations …”

“…How may medical students be encouraged to develop the necessary skills for critical reflection in this regard, with mediation through individual reflection such as writing or through carefully structured group discussion? As Ng et al suggest, students’ own clinical experiences need to be recognised by faculty members as valid sources of information and as triggers for reflective learning . In‐depth reflection may enable students to gain useful insights into their expectations about how patients should behave, the nature of illness and the roles and responses of health professionals.…”