Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review

Winkel, Abigail Ford; Yingling, Sandra; Jones, Aubrie-Ann; Nicholson, Joey

doi:10.4300/jgme-d-16-00500.1

Cited by 114 publications

(91 citation statements)

References 26 publications

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“…39 Similarly, while the impact of the dashboard was not formally evaluated, the focus group comments suggest that it enhanced resident reflection and helped them create learning goals, thus supporting self-assessment. Such reflection is essential for resident development 16 and thought to support selfregulated learning . 15,17 While there are numerous overlapping elements between our competence committee and resident dashboard, it is important to note that they did identify different needs.…”

Section: Discussionmentioning

confidence: 99%

“…The senior author (BT) reviewed the literature on reflective practice and self-regulated learning, [15][16][17] learning analytics, 18,32 and data visualization 11,20,23,32 to generate ideas for the initial iteration of the resident dashboard. In November 2018, our resident investigators (RC and GW) facilitated simultaneous focus groups lasting 64 minutes.…”

Section: Phase 1 Analysis and Explorationmentioning

confidence: 99%

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Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

et al. 2020

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Background: Canadian specialty programs are implementing Competence By Design, a competency-based medical education (CBME) program which requires frequent assessments of entrustable professional activities. To be used for learning, the large amount of assessment data needs to be interpreted by residents, but little work has been done to determine how visualizing and interacting with this data can be supported. Within the University of Saskatchewan emergency medicine residency program, we sought to determine how our residents’ CBME assessment data should be presented to support their learning and to develop a dashboard that meets our residents’ needs. Methods: We utilized a design-based research process to identify and address resident needs surrounding the presentation of their assessment data. Data was collected within the emergency medicine residency program at the University of Saskatchewan via four resident focus groups held over 10 months. Focus group discussions were analyzed using a grounded theory approach to identify resident needs. This guided the development of a dashboard which contained elements (data, analytics, and visualizations) that support their interpretation of the data. The identified needs are described using quotes from the focus groups as well as visualizations of the dashboard elements. Results: Resident needs were classified under three themes: (1) Provide guidance through the assessment program, (2) Present workplace-based assessment data, and (3) Present other assessment data. Seventeen dashboard elements were designed to address these needs. Conclusions: Our design-based research process identified resident needs and developed dashboard elements to meet them. This work will inform the creation and evolution of CBME assessment dashboards designed to support resident learning.

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Section: Discussionmentioning

confidence: 99%

Section: Phase 1 Analysis and Explorationmentioning

confidence: 99%

Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

et al. 2020

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“…The Nursing & Midwifery Council require five written reflections over 3 years by nurses for revalidation. 60 However, despite the widespread promotion of reflection as a tool for self-improvement, evidence that it actually improves performance is weak, [61][62][63] as is the evidence that feedback from patient experience surveys promotes effective reflection. 64 We are biased towards favourable events and judgements 65,66 and tend to reject adverse patient feedback, 67 thereby missing the opportunity to learn from either through critical analysis.…”

Section: How Does Reflection Stimulate Learning?mentioning

confidence: 99%

A framework and toolkit of interventions to enhance reflective learning among health-care professionals: the PEARL mixed-methods study

Bion

Brookes

Brown

et al. 2020

Health Serv Deliv Res

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Background Although most health care is high quality, many patients and members of staff can recall episodes of a lack of empathy, respect or effective communication from health-care staff. In extreme form, this contributes to high-profile organisational failures. Reflective learning is a universally promoted technique for stimulating insight, constructive self-appraisal and empathy; however, its efficacy tends to be assumed rather than proven. The Patient Experience And Reflective Learning (PEARL) project has used patient and staff experience to co-design a novel reflective learning framework that is based on theories of behaviour and learning. Objective To create a toolkit to help health-care staff obtain meaningful feedback to stimulate effective reflective learning that will promote optimal patient-, family- and colleague-focused behaviours. Design A 3-year developmental mixed-methods study with four interlinked workstreams and 12 facilitated co-design meetings. The Capability, Opportunity, Motivation – Behaviour framework was used to describe factors influencing the behaviour of reflection. Setting This took place at five acute medical units and three intensive care units in three urban acute hospital trusts in England. Participants Patients and relatives, medical and nursing staff, managers and researchers took part. Data sources Two anonymous surveys, one for patients and one for staff, were developed from existing UK-validated instruments, administered locally and analysed centrally. Ethnographers undertook interviews and observed clinical care and reflective learning activities in the workplace, as well as in the co-design meetings, and fed back their observations in plenary workshops. Main outcome measures Preliminary instruments were rated by participants for effectiveness and feasibility to derive a final set of tools. These are presented in an attractively designed toolbox with multiple sections, including the theoretical background of reflection, mini guides for obtaining meaningful feedback and for reflecting effectively, guides for reflecting ‘in-action’ during daily activities, and a set of resources. Results Local project teams (physicians, nurses, patients, relatives and managers) chaired by a non-executive director found the quarterly reports of feedback from the patient and staff surveys insightful and impactful. Patient satisfaction with care was higher for intensive care units than for acute medical units, which reflects contextual differences, but in both settings quality of communication was the main driver of satisfaction. Ethnographers identified many additional forms of experiential feedback. Those that generated an emotional response were particularly effective as a stimulus for reflection. These sources of data were used to supplement individual participant experiences in the nine local co-design meetings and four workshops to identify barriers to and facilitators of effective reflection, focusing on capability, opportunity and motivation. A logic model was developed combining the Capability, Opportunity, Motivation – Behaviour framework for reflection and theories of learning to link patient and staff experience to changes in downstream behaviours. Participants proposed practical tools and activities to enhance reflection ‘in-action’ and ‘on-action’. These tools were developed iteratively by the local and central project teams. Limitations Paper-based surveys were burdensome to administer and analyse. Conclusions Patients and health-care staff collaborated to produce a novel reflective learning toolkit. Future work The toolkit requires evaluating in a cluster randomised controlled trial. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 32. See the NIHR Journals Library website for further project information.

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“…Given the presumed link between reflection and medical error, this is a growing area of research. When used appropriately, reflection can contribute to learning . Yet we are only beginning to carefully evaluate and assess the effects of different approaches to reflective practice .…”

Section: Functional Linguistics and Hpe: Future Directionsmentioning

confidence: 99%

“…When used appropriately, reflection can contribute to learning. 40,[42][43][44] Yet we are only beginning to carefully evaluate and assess the effects of different approaches to reflective practice. 41,45,46 As reflection is usually a relatively open-ended process, it can be difficult to capture the distinctions among reflections and to determine which of those distinctions may be indicative of some kind of important cognitive, affective or social change.…”

Section: Reflectionmentioning

confidence: 99%

Why health professions education needs functional linguistics: the power of ‘stealth words’

et al. 2019

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Context Language is one of the primary modalities for teaching and learning in the health professions in contexts ranging from the more formal teaching relationships of medical school to the guided practice of trainees through continuing education and the deliberate practice of lifelong learning. Yet linguistic analysis, with the possible exception of discourse analysis, has not become a core methodological tool in the field of health professions education (HPE). The purpose of this paper is to argue for the more widespread adoption of one particular approach to linguistics, one that examines less of what learners and instructors say and looks more at how they say it: functional linguistics. Functional linguistics: the power of ‘stealth words’ This approach theorises and structures the functions of language, regularly focusing attention on ‘stealth words’ such as I, but and was. Drawing on a rich body of literature in linguistics, psychology, the learning sciences and some early work in HPE, we demonstrate how functional linguistic tools can be applied to better understand learners’ and instructors’ beliefs, reasoning processes, values and emotions. Functional linguistics and reflection: an application of stealth words A brief qualitative analysis of one tool – analysis of the generic use of ‘you’ to mean ‘one’ or ‘anyone’ – demonstrates how functional linguistics can offer insight into physicians’ bids for credibility and alignment as they think aloud about their clinical reasoning. Functional linguistics and hpe: future directions Finally, we offer suggestions for how functional linguistic tools might address questions and gaps in four active research areas in HPE: reflection; emotion and reasoning; learning in simulated contexts, and self‐regulated learning. Conclusions We argue that the words used by learners, instructors and practitioners in the health professions as they move through undergraduate and graduate training into practice can offer clues that will help researchers, instructors and colleagues to better support them.

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Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review

Abstract: Critical reflection is a tool that can amplify learning in residents and fellows. Added research is needed to understand how reflection can influence growth in professional capacities and patient-level outcomes in ways that can be measured.

Cited by 114 publications

References 26 publications

Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

A framework and toolkit of interventions to enhance reflective learning among health-care professionals: the PEARL mixed-methods study

Why health professions education needs functional linguistics: the power of ‘stealth words’

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