Enhancing Clinical Reasoning Skills through Structured Reflection Models

Abstract

Background:Clinical reasoning is an essential skill to all health care practitioners. McGlynn et al, 2015 mention that lower level of clinical reasoning skills are associated with higher rates of medical and diagnostic errors.. To enhance the clinical reasoning through reflection Hamad Medical Corporation (HMC) – Qatar established a new educational initiative under the title of reflective learning conversation and debriefing.Method:A prospective cross sectional exploratory of mixed methodology research conducted at Qatar- Hamad Medical Corporation (HMC) – In the critical care and trauma units. Anonymous self-reported questionnaires were collected from 236 critical care and trauma nurses who attended the reflective learning conversation and debriefing activities. Semi structured Interviews conducted for 10 nurses who facilitated the reflective learning conversation and debriefing activities. Content analysis and thematic analysis were applied.Results:Attending the reflective learning conversations and debriefing educational activities have a significant positive impact on the clinical reasoning skills of the critical care and trauma nurses. Moreover, attending the group level reflection, feeling threatened, are limitations and barriers for the reflective learning conversation and debriefing. Additionally, reflective practice can be encouraged and enhanced through; having reflective conversation and debriefing models and guidelines, and reflecting on both good and bad experiences.Conclusion:There is a positive correlation between the clinical reasoning and the structured reflections in the format of reflective learning conversation and debriefing. Reflective practice can be enhanced through attending the reflective learning conversation and debriefing activities. There are some limitations and challenges to the reflective learning conversation and debriefing method.

The effect of reflective learning in nursing and health students: a literature review

“…The effectiveness of reflective learning, such as improving clinical reasoning and critical care, is influenced by the application of a structured reflection model, students participating in thoughtful conversations and debriefing education learning activities, where a reflection guide must support this, the reflection process must reflect good and bad experiences, have sessions reflection is less than one hour, has enough reflection, and has a reflective REVIEW session moderator or preceptor with good knowledge and the presence of a supervisor or teacher who has more skills or expertise in the field of reflection. 4 The results of this study are in line with research in China by Zhang et al The results of reflective training can encourage nursing students in China to explore more, enhance thinking, and do problemsolving activities during practice. 3 In a systematic reflection training program, the supervisor will provide feedback by writing or making a diary containing experiences during the clinical trial, and students create an evidence-based portfolio.…”

“…The results showed that participants who took part in reflective conversations and debriefing education had a meaningful effect on critical care's clinical reasoning decision skills. 4 Another research that discusses the application of reflective learning is conducted by Ruitan et al with quantitative descriptive design and a research sample of 100 active students from the 2016 Medical Education in Sam Ratulangi University. They were using the Reflection-in-Learning questionnaire, that study aims to determine the students' learning reflection ability.…”

“…11, 12 In addition to barriers in guidelines and portfolios, there are also obstacles in conducting reflection training, such as time constraints, feelings of shame or insecurity. 3,4 The limitation of this literature was the number of data based, there was only three data based where it may cause some related articles not included in the search. In addition, further study is needed to describe more about the application of reflection learning in health institution.…”

Impact of Reflective Thinking Intervention on Improving Pediatric Nursing Care

“…However, we will place a high value on the notion of reflection in this study, and given the abundance of evidence demonstrating its benefits, nurses should engage in more reflection-based activities and sessions to enhance and improve practice. 10,11,12,13…”