The reflective zombie: Problematizing the conceptual framework of reflection in medical education

Abstract

Reflection is an ambiguous and profoundly complex human activity. We celebrate the developments in teaching and researching reflection in education, yet have identified flaws in the way reflection has been operationalized: medical education has translated the age-old concept into a teachable and measureable construct. We fear that in this process of operationalization, the philosophical underpinnings of reflection have been discarded. We illustrate this with a thought experiment about a ‘reflective zombie’: students who have been conditioned to follow prescribed thought steps rather than engaging in truly reflective behaviour. In research and assessment of reflection, measuring tools might be unable to distinguish reflective zombies from students who authentically reflect. We argue that the instrumental approach lies at the root of this problem as it limits the rich concept of reflection and illustrate our point by describing problems related to paradigm (we are looking at reflection in the wrong way), methods (we are using the wrong tools), and epistemics (can we even know what we want to know?). We offer three suggestions for implementing reflection into the curriculum and for research into reflection. First, acknowledge the diversity of reflection and let go of the ‘checklist approach’. Second, embrace the personal nature of reflection by stimulating awareness of one’s personal reflection styles as part of the reflective process. Third, shift the focus of research to the practice of reflection. We believe that a strong vision on reflection can lead to a balanced curriculum, setting students up for a lifelong learning as a reflective practitioner.

Using text mining to analyze reflective essays from Japanese medical students after rural community placement

“…Clarifying this relationship may be especially important for student reflections on patient relationships. For example, patient appears often in community-based service learning program evaluation rubrics and questionnaires [27][28][29]; however, these formats presuppose types of student experiences with patients and may present a false homogeneity of these experiences [10].…”

“…Some general practitioners view reflection in writing as an ill-defined task that takes time from more important duties [8,9]. Another argument against these writings is that they have been used invalidly for assessing achievement --such as attainment of "professionalism" --removed from their primary function as a tool for cultivating reflection [3,4,10]. The current consensus may be that writing is instructive, but what it instructs is still not clear [11,12].…”

Knowledge, skills and beetles: respecting the privacy of private experiences in medical education

“…When empathy becomes a skill or a performance, it ceases to be empathy. The moment reflection becomes a tick-box exercise, it ceases to be authentic reflection [19]. This paper explores the problems we encounter in dealing with beetles in medical education, and how to move forward.…”

Critical reflection in medical training and the biomedical world view

“…There is a strong theoretical foundation for reflection in medical training. 2 Although there is ongoing debate about how best to 'operationalise' such theory, 3 medical students are now required to demonstrate their capacity for reflection through reflective essays, critical incident reports and portfolios. 4 A current definition is: 'Reflection is the process of engaging the self in attentive, critical, exploratory and iterative interactions with one's thoughts and actions, and their underlying conceptual frame, with a view to changing them and with a view on the change itself.'…”