CE  Vol.6 No.4 , March 2015
Best Practice for Teaching and Learning Strategies to Facilitate Student Reflection in Pre-Registration Health Professional Education: An Integrative Review
ABSTRACT
There is a growing expectation from registering authorities and the public for health professionals to enter their respective professions armed with the necessary skills, attitudes and behaviours to be reflective practitioners. However, there is limited and inconsistent evidence of the effectiveness of pedagogic strategies used for teaching reflective practice in health practitioner courses. We therefore conducted an integrative literature review of recent original studies (2004-2014) to gain an understanding of current initiatives for teaching reflective practice. A key finding from the review is the shift from the reliance on written reflective activities to more dialogic and social based reflection. Studies that use reflective dialogue suggest that facilitated dialogue with peers and clinical educators is the most effective approach to foster deeper reflection, critical thinking and clinical reasoning. Also the consensus evident from the review is that for reflection to be meaningful it needs to be intentionally connected to clinical programs. Although we find compelling evidence of the usefulness of embedding reflective learning strategies in health curricula, repeated reference to a lack of adequate training to prepare health educators to teach reflective practice suggests that there is an urgent need for research into how this can be achieved.

Cite this paper
McLeod, G. , Barr, J. and Welch, A. (2015) Best Practice for Teaching and Learning Strategies to Facilitate Student Reflection in Pre-Registration Health Professional Education: An Integrative Review. Creative Education, 6, 440-454. doi: 10.4236/ce.2015.64044.
References
[1]   Abrahams, K. (2012). Evaluation of a Reflective Learning Programme for Radiation Therapy Graduates. Radiographer: The Official Journal of the Australian Institute of Radiography, 59, 40-45.

[2]   Australian Physiotherapy Council (2006). Australian Standards for Physiotherapy. In Safe and Effective Physiotherapy (pp. 1-82). Canberra: Australian.
http://www.physiocouncil.com.au/files/the-australian
-standards-for-physiotherapy


[3]   Blake, T. (2005). Journaling: An Active Learning Technique. International Journal of Nursing Education Scholarship, 2.
http://dx.doi.org/10.2202/1548-923X.1116

[4]   Boud, D. (2001). Using Journal Writing to Enhance Reflective Practice. New Directions for Adult and Continuing Education, 2001, 9-18.
http://dx.doi.org/10.1002/ace.16

[5]   Boud, D. (2010). Relocating Reflection in the Context of Practice. In H. Bradbury, N. Frost, & S. Kilminster (Eds.), Beyond Reflective Practice (pp. 25-36). New York: Routledge.

[6]   Boud, D., & Walker, D. (1998). Promoting Reflection in Professional Courses: The Challenge of Context. Studies in Higher Education, 23, 191-206.
http://dx.doi.org/10.1080/03075079812331380384

[7]   Boud, D., Cressey, P., & Docherty, P. (2006). Productive Reflection at Work. Learning for Changing Organisations. New York: Routledge.

[8]   Boud, D., Keogh, R., & Walker, D. (1985). Promoting Reflection in Learning: A Model. Reflection: Turning Reflection into Learning. London: Routledge.

[9]   Brockbank, A., & McGill, I. (2007). Facilitating Reflective Learning in Higher Education (2nd ed.). Maidenhead: Open University Press McGraw-Hill.

[10]   Brookfield, S. (1995). Becoming a Critically Reflective Teacher. San Francisco: Jossey-Bass.

[11]   Burns, N., Grove, S., & Gray, J. (2011). Understanding Nursing Research: Building an Evidence-Based Practice (5th ed.). St Louis, MO: Elsevier Saunders.

[12]   Canniford, L. J., & Fox-Young, S. (2014). Learning and Assessing Competence in Reflective Practice: Student Evaluation of the Relative Value of Aspects of an Integrated, Interactive Reflective Practice Syllabus. Collegian, in Press.
http://dx.doi.org/10.1016/j.colegn.2014.04.003

[13]   Cooper, C., Taft, L., & Thelen, M. (2005). Preparing for Practice: Students’ Reflections on Their Final Clinical Experience. Journal of Professional Nursing, 21, 293-302.
http://dx.doi.org/10.1016/j.profnurs.2005.07.002

[14]   Critical Appraisal Skills Programme (CASP) (2014). CASP Checklists.
http://www.casp-uk.net/#!casp-tools-checklists/c18f8

[15]   Delany, C., & Watkin, D. (2009). A Study of Critical Reflection in Health Professional Education: “Learning Where Others Are Coming from”. Advances in Health Sciences Education, 14, 411-429.
http://dx.doi.org/10.1007/s10459-008-9128-0

[16]   Dewey, J. (1933). How We Think: A Restatement of the Relation of Reflective Thinking to the Educative Process. Boston, MA: D.C. Heath & Co Publishers.

[17]   Dirkx, J., & Mezirow, J. (2006). Musings and Reflections on the Meaning, Context, and Process of Transformative Learning: A Dialogue between John M. Dirkx and Jack Mezirow. Journal of Transformative Education, 4, 123-139.
http://dx.doi.org/10.1177/1541344606287503

[18]   Donaghy, M., & Morss, K. (2000). Guided Reflection: A Framework to Facilitate and Assess Reflective Practice within the Discipline of Physiotherapy. Physiotherapy Theory and Practice, 16, 3-14.
http://dx.doi.org/10.1080/095939800307566

[19]   Donaghy, M., & Morss, K. (2007). An Evaluation of a Framework for Facilitating and Assessing Physiotherapy Students’ Reflection on Practice. Physiotherapy Theory and Practice, 32, 83-94.
http://dx.doi.org/10.1080/09593980701211952

[20]   Dyment, J. E., & O’Connell, T. S. (2011). Assessing the Quality of Reflection in Student Journals: A Review of the Research. Teaching in Higher Education, 16, 81-97.
http://dx.doi.org/10.1080/13562517.2010.507308

[21]   Fisher, K. (2003). Demystifying Critical Reflection: Defining Criteria for Assessment. Higher Education Research & Development, 22, 313-325.
http://dx.doi.org/10.1080/0729436032000145167

[22]   Howe, A., Barrett, A., & Leinster, S. (2009). How Medical Students Demonstrate Their Professionalism When Reflecting on Experience. Medical Education, 43, 942-951.
http://dx.doi.org/10.1111/j.1365-2923.2009.03456.x

[23]   Hubbs, D., & Brand, C. F. (2010). Learning from the Inside Out: A Method for Analyzing Reflective Journals in the College Classroom. The Journal of Experiential Education, 33, 56-71.
http://dx.doi.org/10.5193/JEE33.1.56

[24]   Johns, C. (1995). Framing Learning through Reflection within Carper’s Fundamental Ways of Knowing in Nursing. Journal of Advanced Nursing, 22, 226-234.
http://dx.doi.org/10.1046/j.1365-2648.1995.22020226.x

[25]   Kok, J., & Chabeli, M. (2002). Reflective Journal Writing: How It Promotes Reflective Thinking in Clinical Nursing Education: A Students’ Perspective. Curationis, 25, 35-42.

[26]   Leech, N., & Onwuegbuzie, A. (2007). An Array of Qualitative Analysis Tools: A Call for Data Analysis Triangulation. School Psychology Quarterly, 22, 557-584.
http://dx.doi.org/10.1037/1045-3830.22.4.557

[27]   Lutz, G., Scheffer, C., Edelhaeuser, F., Tauschel, D., & Neumann, M. (2013). A Reflective Practice Intervention for Professional Development, Reduced Stress and Improved Patient Care—A Qualitative Developmental Evaluation. Patient Education and Counseling, 92, 337-345.
http://dx.doi.org/10.1016/j.pec.2013.03.020

[28]   Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and Reflective Practice in Health Professions Education: A Systematic Review. Advances in Health Sciences Education, 14, 595-621.
http://dx.doi.org/10.1007/s10459-007-9090-2

[29]   Medical Board of Australia (2014). Good Medical Practice.
http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx

[30]   Medical Radiation Practice Board of Australia (2014). Code of Conduct: Professional Values and Qualities.

[31]   Mezirow, J. (1990). How Critical Reflection Foster Transformative Learning. In J. Mezirow (Ed.), Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning (pp. 1-20). San Francisco, CA: Jossy-Bass.

[32]   Mezirow, J. (1991). Transformative Dimensions of Adult Learning. San Francisco, CA: Jossey-Bass Inc.

[33]   Mezirow, J. (1995). Transformation Theory of Adult Learning. In M. Welton (Ed.), In Defense of the Lifeworld: Critical Perspectives on Adult Learning (pp. 37-90). New York: State University of New York Press.

[34]   Mezirow, J. (1997). Transformative Learning: Theory to Practice. New Directions for Adult and Continuing Education, 1997, 5-12.
http://dx.doi.org/10.1002/ace.7401

[35]   Mezirow, J., & Associates (1990). Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco, CA: Jossey-Bass.

[36]   Mezirow, J., & Associates (2000). Learning as Transformation. San Francisco, CA: Jossey-Bass.

[37]   Moon, J. (2003). Learning Journals and Logs, Reflective Diaries. Good Practice in Teaching and Learning, Dublin: University College Dublin.

[38]   Moriarty, H., & McKinlay, E. (2008). Reflective Journals Reveal the Transformative Nature of Early Community-Based Experience. Focus on Health Professional Education: A Multi-Disciplinary Journal, 10, 59-70.

[39]   Nicholl, H., & Higgins, A. (2004). Reflection in Preregistration Nursing Curricula. Journal of Advanced Nursing, 46, 578- 585.
http://dx.doi.org/10.1111/j.1365-2648.2004.03048.x

[40]   Nielsen, A., Stragnell, S., & Jester, P. (2007). Guide for Reflection Using the Clinical Judgment Model. Journal of Nursing Education, 46, 513-516.

[41]   Norrie, C., Hammond, J., D’Avray, L., Collington, V., & Fook, J. (2012). Doing It Differently? A Review of Literature on Teaching Reflective Practice across Health and Social Care Professions. Reflective Practice, 13, 565-578.
http://dx.doi.org/10.1080/14623943.2012.670628

[42]   Nursing and Midwifery Board of Australia (2010). National Competency Standards for the Midwife. Melbourne: APHRA. www.nursingmidwiferyboard.gov.au/documents/default.aspx

[43]   Owings Swan, K., & Hoffer, M. (2008). Technology and Social Studies: Self-Report. In L. Levstik, & C. Tyson (Eds.), Handbook of Research in Social Studies Education (pp. 307-328). Oxford: e-Library Taylor and Francis.

[44]   Pitkälä, K., & Mäntyranta, T. (2004). Feelings Related to First Patient Experiences in Medical School: A Qualitative Study on Students’ Personal Portfolios. Patient Education and Counseling, 54, 171-177.
http://dx.doi.org/10.1016/S0738-3991(03)00209-X

[45]   Polit, D., & Beck, C. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice (9 ed.). Philadelphia, CA: Lippincott Williams and Wilkins.

[46]   Ramli, A., Joseph, L., & Lee, S. (2013). Learning Pathways during Clinical Placement of Physiotherapy Students: A Malaysian Experience of Using Learning Contracts and Reflective Diaries. Journal of Educational Evaluation for Health Professions, 10, 6.
http://dx.doi.org/10.3352/jeehp.2013.10.6

[47]   Rosenthal, S., Howard, B., Schlussel, Y. R., Herrigel, D., Smolarz, B. G., Gable, B. et al. (2011). Humanism at Heart: Preserving Empathy in Third Year Medical Students. Academic Medicine, 86, 350-358.
http://dx.doi.org/10.1097/ACM.0b013e318209897f

[48]   Sandelowski, M., Barroso, J., & Voils, C. I. (2007). Using Qualitative Metasummary to Synthesize Qualitative and Quantitative Descriptive Findings. Research in Nursing & Health, 30, 99-111.
http://dx.doi.org/10.1002/nur.20176

[49]   Sch?n, D. (1983). The Reflective Practitioner: How Professionals Think in Action. London: Temple Smith.

[50]   Smith, M., & Trede, F. (2013). Reflective Practice in the Transition Phase from University Student to Novice Graduate: Implications for Teaching Reflective Practice. Higher Education Research & Development, 32, 632-645.
http://dx.doi.org/10.1080/07294360.2012.709226

[51]   Sobral, D. T. (2005). Medical Students’ Mindset for Reflective Learning: A Revalidation Study of the Reflection-in-Learning Scale. Advances in Health Sciences Education, 10, 303-314.
http://dx.doi.org/10.1007/s10459-005-8239-0

[52]   Stockhausen, L. (2005). Learning to Become a Nurse: Students’ Reflections on Their Clinical Experience. Australian Journal of Advanced Nursing, 22, 8-14.

[53]   Tanner, C. A. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing Education, 45, 204-211.

[54]   The Balint Society (2012). The Balint Society.
http://balint.co.uk/

[55]   Wessel, J., & Larin, H. (2006). Change in Reflections of Physiotherapy Students over Time in Clinical Placements. Learning in Health & Social Care, 5, 119-132.
http://dx.doi.org/10.1111/j.1473-6861.2006.00124.x

[56]   Williams, R. M., Wesse, J., Gemus, M., & Foster-Seargean, E. (2002). Journal Writing to Promote Reflection by Physical Therapy Students during Clinical Placements. Physiotherapy Theory & Practice., 18, 5-15.
http://dx.doi.org/10.1080/095939802753570657

 
 
Top