Moan and Groan No More: Making It Meaningful - Learning from Reflective Practice to Transform the Teaching of Reflection

Problem

Reflection is an essential attribute of competent medical practitioners and a formal part of licencing and revalidation. Consequently, teaching reflective practice is an important part of medical training (GMC 2018). Despite different definitions, theories and understandings of reflection, Aronson (2012) suggests little is known as to the best ways of teaching it. Driessen (2017) describes that structured reflection is often met with resistance from students and tutors alike, and highlights concerns that the transformational potential of reflection risks being lost. This study aims to explore GP lecturers’ experiences of teaching reflection, drawing on their own experience of reflecting within professional practice, in order to inform how we teach reflection to students.

Approach

This was a qualitative study consisting of semi-structured interviews with lecturers in primary care from two London medical schools, which were audio recorded, transcribed and analysed using a thematic analysis approach to identify themes. An interpretivist stance was used to explore the behaviour, perspectives and experiences of GP lecturers’ reflective practice and teaching.Illeris' (2009) theory of learning was used as a framework through which to consider reflective learning. The educational principles of threshold concepts, social constructivist theory and transformative learning provided the lenses through which to understand the teaching of reflection.

Findings

Lecturers reported that both they and their students have negative perceptions of structured reflection, identifying it as a box-ticking exercise detached from meaningful reflective practice. However, the data suggests that lecturers operate from a transformed perspective where reflection within clinical practice is seen as innate and recognised as valuable, whereas lecturers perceive that students are yet to develop that same transformed perspective and struggle to recognise its value. For reflection to be meaningful lecturers felt it needs to be linked to relevant clinical experiences and facilitated through timely, integrated discussions.

Consequences

Identifying reflection as a threshold concept can help us see it as a process that occurs over time and to recognise the transformative learning journey the students are on. In order to support students through the liminal state of learning to becoming reflective practitioners, we need to bring reflective practice back into view. To do this, clinicians need to recognise reflection in their daily practice and role model it in an integrated, meaningful way that is evidenced for students to see. We need to differentiate between documentation of learning and reflection, in order to remove the negative associations with structured reflection. Instead reflection needs to be tutor facilitated rather than portfolio driven, through relevant, timely, clinically integrated discussions. By changing the focus of how we teach reflection, we have the potential to change student perceptions of reflective learning, thereby supporting them as they master the necessary skills for becoming competent reflective practitioners.