Reflective Practice -- guidance for trainees and students

Reflective Practice - How to write a reflective piece - guidance for trainees and students


As part of any learning experience, you may be asked to or to choose to keep a reflective practice log . This can be done in electronic form or on paper, as you see fit.

Many learners are often advised to include pieces of reflective writing in their portfolio or record of learning during a course. These will maximise your potential for learning from practice, record your thoughts, beliefs and actions and build upon the learning activities you undertake both in class, in a peer group setting, on line and with your mentor as well as at organised study events and in your everyday practice. Reflective practice acts as the cement which holds together the building bricks of formal learning activities and everyday practical work.

You can complete a reflective piece whenever you like but a useful way to engage in reflection on practice is to be incident led. As a time consuming exercise, reflective writing is not something you can formally do every day. It is however, something that can be carried out following an event of note. This may be:

Ÿ a particularly difficult event or procedure,
Ÿ an emotional patient or client encounter,
Ÿ a successful personal intervention,
Ÿ a challenging case or situation
Ÿ A difficult part of the course you are following
Ÿ A particularly useful encounter with a colleague or mentor

Reflection on practice does not have to focus only on practical or clinical events; remember that many learning programmes are made up of Knowledge, Skills, and Reflection. All aspects of learning should be reflected upon.

So what is reflective practice?

Reflective practice is not new; as a concept it has been used to underpin adult and professional learning for over two decades. The cultivation of the capacity to reflect on, and in action has become an important feature of courses and professional training programmes in many disciplines.

You need to ensure that you understand what you are learning and in understanding, that you develop the skills to retain and develop your understanding, to transfer it to different contexts, pass it on to others and take control of your own professional development in order to gain the most you can from all of your practical and learning experiences.

Reflective practice is related to Experiential Learning. That is to say that having an experience is an important part of learning but that having an experience is not the same as understanding its meaning. We know that repeated practice is the best way to improve technical and vocational proficiency but if we do not understand the theory behind the practice we will take much longer to reach the level of competence required, if at all. We may need to go beyond that to achieve excellence. We also need to remember that practice may not make perfect - it may make permanent but if it is not correct practice it will become dangerous in its permanence.

There are two different uses of Reflective Practice:

Ÿ Reflection on Practice
Ÿ Reflection in Practice

Reflection on practice is a retrospective activity, free from the urgency and the pressures of the immediate situation. It can be maximised by feedback and ideas from others and is usually the first stage of our development of reflection as a habit. Engaging in formal reflection from time to time not only deepens understanding and learning but also develops an internal ability to reflect in practice.

Reflection in practice is a hands on approach to thinking on your feet. It can take place during the action with a “where do we go from here?” question. This can be very useful in the full range of professional practices encountered in a career in dentistry. Reflection in practice develops over time after considerable experience of reflecting on practice.

Reflective practice is not then, a bolt on extra to a learning programme. It is an integral and vital part of the learning process. Reflective practice is a way for us all to make sense of the different elements of learning and how they fit into training and good practice.

How do we write a reflective piece?

There are many ways to structure reflection on practice and learners will find preferred ways of doing this. However, to help you, here is our recommended approach for any situation.

Event - what happened? Go through the basics of the incident on which you wish to refelct, pulling out the facts as you saw them
Debrief - try to list the good elements of the event and the bad. Work out what you would do again and what you would wish to change. Isolate any emotions that may stand in the way of you revisiting the event again, and deal with them at this point.
Actions - set actions to intervene and amened the elements you were not so happy with and plan for those interventions
Review - look at the interventions and follow up actions and see how they made a difference to your practice.

This is similar to the original Reflective Practice cycle developed by Kolb (1984) in that it takes as its starting point an action or an event. This approach is unique in that it encourages us to examine our practice from three different perspectives - factual, emotional and theoretical before making changes for future use.

HOW DO I INCLUDE MY REFLECTIVE PIECES WITHOUT MAKING ME SOUND LIKE A TOTAL IDIOT?

Some of you have expressed concern about the “bearing my soul” aspect of reflective practice and it is true that there is a fine line between sharing experiences honestly and laying oneself open to criticism for doing so.

What we would suggest is that you do the whole reflective process for your own benefit, because it is only by being totally honest and open about it that you can learn properly from it. But when it comes to including that reflective piece in your portfolio, it may be an idea to edit it thus:

HEADLINE: What you have learned from this event
EVENT: 1-3 sentences about the event itself with some idea of the area you targeted from reflection
LEARNED: now you can spend longer on this area, discussing what it was you learned from the event and expressing this in developmental but positive terms
ACTION: This is where you identify the actions resulting from the reflection. They may be short, medium or long term and you can revisit them after you have implemented them to comment on their efficacy once used in practice.
Remember to always follow up with a review of your amended practice after you have implemented your actions. This completes the cycle of learning initiated from the original piece of reflection.

Good luck!