MRTs participate in reflective practice with the direct goal of understanding and improving their practice and knowledge
Importance of reflective practice
- Reflective practice refers to the ability of examining one’s actions and experience during practice with the direct goal of understanding and improving practice and knowledge, especially within unique and unanticipated situations.
- Most individuals use reflection to review aspects of their life. However, reflective practice requires the professional to apply a metacognitive process of critical reflection.1 This process involves the deliberate and explicit analysis of the impact of one’s perspective on thinking and decision-making.2,3
- Critical reflection within practice should involve the analysis of all facets of professional life (e.g., reflection on clinical experiences, evaluating current competencies and developing career paths).2
- Reflective practice skills can be taught, learned, replicated, and measured.4,5
- MRTs are ethically responsible for upholding their duty to provide the best possible patient care by committing to the principles of evidence-based and reflective practice.6
- This includes, but is not limited to, adopting an open attitude and lifelong commitment to assessing and continuously improving their work.6,7
- An MRT may benefit from reflective practice by:
- increased learning from an experience or situation (e.g., critical incidents);
- improved wellness and job satisfaction8;
- promotion of deep learning;
- identification of personal and professional strengths and areas for improvement;
- identification of educational needs;
- acquisition of new knowledge and skills;
- further understanding of own beliefs, attitudes, and values;
- encouragement of self-motivation and self-directed learning;
- increased personal and clinical confidence9;
- deepened professionals values.10
- Reflective practice is generally seen as a cognitive, individual and internalized activity. However, such practice should also be considered as highly social, and benefiting from interactions and feedback models.
- Critical reflection may improve a practitioner’s performance within interdisciplinary collaboration, especially when roles are ambiguous, unique, unstable or conflicted.5
- Reflective practice can facilitate the improvement of patient care and may help prevent error and bias.8
- Some techniques can be used to improve one’s ability to self-reflect. These activities include building professional networks, taking part in continuing education, soliciting feedback from patients and colleagues, participating in case conferences, engaging in expressive writing, and learning mindfulness skills.11–13
- MRTs can increase the effectiveness of these activities by incorporating other people, expanding their knowledge on the topic being reflected upon, and completing the activities with an openness to new experiences.11
- Critics of reflective practice caution users that:
- practitioners must be ready to confront their own behaviours and emotions, which can cause emotional distress:
- confusion can arise when trying to determine what to reflect on;
- superficial reflection will not result in the necessary deep learning required;
- there are potential dangers in promoting private thoughts in public (e.g., misinterpretation of intended message, harmful non-constructive criticism, identification of unfavourable biases); and
- cultural barriers may arise in collaborative reflection activities.14,15
- practitioners must be ready to confront their own behaviours and emotions, which can cause emotional distress:
- Provided with sufficient education and mentorship, reflective practice can overcome such obstacles. MRTs should seek out the advice of those with reflective practice skills to support their own reflective practice skill acquisition.
Critical reflection in practice
- Reflective practice is based on the fundamental principle of continuous learning through a process of self-assessment and integration of knowledge with experience.7 As such, critical reflection by practitioners should be considered an inherent and consistent part of their practice,6 requiring MRTs to identify frameworks, strategies, and expertise to support this.
- There are a number of models and frameworks from which MRTs can draw upon to facilitate reflection in their professional practice, such as those created by Gibbs (1998),16 Schon (1983),17 Atkins and Murphy (1994),18 Kolb (1984)19 and Johns (1996).20
- Studies have identified common building blocks among reflective practice frameworks, that MRTs can replicate:
- using a cognitive, emotional, and experiential process of examining assumptions embedded in actions or experience;
- Identifying the relationship between assumptions and their origins (personal, emotional, social, cultural, historical, and/or political);
- review and evaluation of the above according to relevant criteria (context, purpose, etc.);
- reworking of concepts and practice based on this evaluation.4
- Studies have identified common building blocks among reflective practice frameworks, that MRTs can replicate:
- MRTs can use a reflective practice framework and apply it to various practice activities:
- self-directed activities: reflective journals, essays, questionnaires, portfolios, personal statements, log, blog, questionnaire, video, diary, and brief thought of the day21; and
- group activities: group discussions, interdisciplinary case conferences, rounds, and feedback models from patients and mentors.
- Within these activities, there are iterative critical questions MRTs can ask themselves, or obtain feedback on, to guide their practice22:
- What, where, and who? Define the situation.
- How did it make you feel? Define your emotional state.
- Why did it happen? Describe the core reasons that influence the situation occurring.
- Could you have done anything differently? Conduct a critical review of your actions and develop insight.
- What will you do differently in the future? Define how this situation and reflection will change your practice.
- What happens when you put this into practice? Evaluate any change that occurs and determine how to sustain positive change.
- There are different types of evidence within critical reflections MRTs can utilize:
- Technical reflection – utilizes scientific method, is deductive, and generates and validates knowledge through rigorous means (e.g., seeking information from peer-reviewed literature, subject matter experts, case conferences).
- Practical reflection – leads to interpretation through description and explanation of human interaction (e.g., understanding ways to improve communication by deconstructing a conversation and identifying biased language, unclear messages, and moments of excellence).
- Emancipatory reflection – leads to transformative action through evaluation of one’s own assumption or oppression forces that limit practice (e.g., identification of the core problem to activate change through fishbone analysis or other deductive thinking strategies).22
- MRTs can identify a reflective template to assess reflection levels and can guide their personal and peer reflection.21
- Repeated exposure to reflective practice skills appears to be necessary to deepen learning.9 Therefore, a practitioner should be provided adequate time for reflection in clinical learning.23
- Feedback in the context of reflection refers to a positive communication between two or more colleagues with a mutual respect and a mutual goal of developing personally and professionally.24
- Feedback can be an important tool to strengthen the insight gained through personal reflection, promoting shared reflection and reciprocal learning through a professional partnership.25 For evidence-based suggestions to optimize feedback, see Brehaut et al. Practice feedback interventions, 2016.26
References
- Mamede S, Schmidt HG. The structure of reflective practice in medicine. Med Educ. 2004;38(12):1302-1308. doi:10.1111/j.1365-2929.2004.01917.x
- Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: A systematic review. Adv Health Sci Educ. 2007;14(4):595. doi:10.1007/s10459-007-9090-2
- Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: A critical narrative review. Med Educ. 2015;49(5):461-475. doi:10.1111/medu.12680
- Nguyen QD, Fernandez N, Karsenti T, Charlin B. What is reflection? A conceptual analysis of major definitions and a proposal of a five-component model. Med Educ. 2014;48(12):1176-1189. doi:10.1111/medu.12583
- Ng SL, Mylopoulos M, Kangasjarvi E, et al. Critically reflective practice and its sources: A qualitative exploration. Med Educ. 2020;54(4):312-319. doi:10.1111/medu.14032
- Canadian Association of Medical Radiation Technologists. Member code of ethics and professional conduct. CAMRT. Published November 2015. Accessed June 23, 2020. https://www.camrt.ca/mrt-profession/professional-resources/code-of-ethics/
- Horton-Deutsch S, Sherwood GD. Reflective Practice: Transforming Education and Improving Outcomes. 2nd ed. Sigma Theta Tau; 2017.
- McIntyre C, Lathlean J, Esteves JE. Reflective practice enhances osteopathic clinical reasoning. Int J Osteopath Med. 2019;33-34:8-15. doi:10.1016/j.ijosm.2019.07.002
- Davies S. Embracing reflective practice. Educ Prim Care. 2012;23(1):9-12. doi:10.1080/14739879.2012.11494064
- Winkel AF, Yingling S, Jones A-A, Nicholson J. Reflection as a learning tool in graduate medical education: A systematic review. J Grad Med Educ. 2017;9(4):430-439. doi:10.4300/JGME-D-16-00500.1
- Knapp S, Gottlieb MC, Handelsman MM. Enhancing professionalism through self-reflection. Prof Psychol Res Pract. 2017;48(3):167-174. doi:10.1037/pro0000135
- Chelliah KK, Arumugam Z. Does reflective practice enhance clinical competency in medical imaging undergraduates? Procedia – Soc Behav Sci. 2012;60:73-77. doi:10.1016/j.sbspro.2012.09.349
- Fernandez SC, Chelliah KK, Halim L. A peek into oneself: Reflective writing amongst undergraduate medical imaging students. Reflective Pract. 2015;16(1):109-122. doi:10.1080/14623943.2014.982524
- Beverley T. Reflective practice for healthcare professionals: A practical guide. McGraw-Hill Education (UK); 2010.
- Price A. Encouraging reflection and critical thinking in practice. doi:10.7748/ns2004.08.18.47.46.c3664
- Gibbs G. Learning by doing: A guide to teaching and learning methods. FEU; 1988.
- Schön DA. The reflective practitioner: How professionals think in action. Routledge; 2017.
- Atkins S. Reflective practice. Nurs Stand R Coll Nurs G B 1987. 1994;8(39):48-56. doi:10.7748/ns.8.39.48.s64
- Kolb DA. Experiential learning: Experience as the source of learning and development. FT Press; 2014.
- Johns C. Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. J Adv Nurs. 1995;22(2):226-234. doi:10.1046/j.1365-2648.1995.22020226.x
- Tsingos C, Bosnic-Anticevich S, Lonie JM, Smith L. A model for assessing reflective practices in pharmacy education. Am J Pharm Educ. 2015;79(8). doi:10.5688/ajpe798124
- Koshy K, Limb C, Gundogan B, Whitehurst K, Jafree DJ. Reflective practice in health care and how to reflect effectively. Int J Surg Oncol. 2017;2(6):e20. doi:10.1097/IJ9.0000000000000020
- McLeod GA, Vaughan B, Carey I, Shannon T, Winn E. Pre-professional reflective practice: Strategies, perspectives and experiences. Int J Osteopath Med. 2020;35:50-56. doi:10.1016/j.ijosm.2019.11.005
- Eisen MJ. Peer-based professional development viewed through the lens of transformative learning. Holist Nurs Pract. 2001;16(1):30-42. doi:10.1097/00004650-200110000-00008
- Hunter LA. Debriefing and feedback in the current healthcare environment. J Perinat Neonatal Nurs. 2016;30(3):174-178. doi:10.1097/JPN.0000000000000173
- Brehaut JC, Colquhoun HL, Eva KW, et al. Practice feedback interventions: 15 suggestions for optimizing effectiveness. Ann Intern Med. 2016;164(6):435-441. doi:10.7326/M15-2248
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