Reflection and Practice

Dr. Maria Christodoulou

MBChB (Stell)/DipHom (CEDH)/DIPC
What is Reflection?
Reflection is the process of examining personal values,
beliefs, styles of communication, experiences and
application of knowledge. This process develops:

i. A deeper awareness and understanding of one’s

self, experiences, relationships, personal and cultural
biases, (incl. the culture of the medical profession)

ii. Assessment of knowledge and related practices

that may influence learning and future action.
Reflection
• A metacognitive process that creates greater
understanding of self and situations to
inform future action.
(Sandars, J. 2009)

• Reflection is a process of thinking about and

exploring an experience, with the
intention of conceptualising new
understanding or insight and defining a
different way of responding to the
same experience in the future.
Why should you reflect?

•Consider various options in a specific situation and

play out scenarios in different ways
•Articulate new concepts/ ideas/ discoveries/ ways of
doing things/ intentions or a plan of action.
•Consider what you have learnt about yourself or
about others
•Define what you need to know more about and what
you need to be more conscious of
•Articulate what you need to change and what you
need to do differently
Transformative Learning
• Learning that is based on reflection and on the
interpretation of the experiences, ideas and
assumptions gained through prior learning.
(Mezirow, 2007)
•The goal of transformative learning is to understand
what has helped us to form our way of seeing
the world (our worldview) and to free ourselves of
the constraints of limiting perspectives. In order
for the questioning of personal assumptions and
self-reflection to occur, the environment must
provide the support and the ability to dialogue
and critically reflect on the material presented, as
well as on the course itself.
(Cranton, 2007)
What should you reflect on?

•Clinical experiences and patient interactions – past and

present
•Concepts and theories and knowledge you are learning,
researching, reading about.
•Things you are finding difficult to understand or interpret
or that might offer new insight, perspective and ideas
•Observations and interactions during discussion groups or
conversations with colleagues or students
•Experiences that trigger or evoke strong emotional
reactions for you
•Personal goals, experiences, challenges, dilemmas and
questions
•Anything else that feels relevant to your personal growth
and development
Kolb’s Learning Styles

Take action Experience

Conceptualise Reflect
The Integral Model

INTERIOR EXTERIOR
Subjective Objective
INDIVIDUAL

• Thoughts • Action
• Feelings • Behaviour
• Beliefs • Physiology
• Attitude • Skills
• Developmental Stage • Competencies
• Values and Morals • Self-care
COLLECTIVE

• Sociology • Systems
• History • Policies
• Culture • Process
• Worldview • Procedures
• Religion • Structures

Intersubjective Interobjective
The Progression of Learning
Fig. 1 The Span of Reflection (Johns 2005, p. 69)

Reflecting on a situation or
experience after the event with the
Doing reflection
Reflection-on-experience intention of drawing insights that
may inform my future practice in
positive ways
Pausing within a particular situation
or experience in order to make sense
Reflection-on-action
and reframe the situation in order to
proceed towards desired outcomes
Dialoguing with self whilst in
The internal supervisor conversation with another in order to
make sense
Being aware of the way I am thinking,
feeling and responding within the
unfolding moment and dialoguing
with self to ensure that I am
interpreting and responding
Reflection-within-the-moment
congruently to whatever is unfolding.
It is having some space in your mind
to change your ideas in the moment
rather than being fixed to certain
ideas
Being aware of self within the
unfolding moment with the intention Reflection as a way of being
Mindful practice of realising desirable practice within
that specific moment (however
desirable is defined)
The Process
1. DATA i.e. the facts devoid of emotion or interpretation
2. FEELING (mad, sad, glad, afraid, bad, surprised, defensive,
confused, bored, etc. )

3. SENSATION (tightness, pressure, tension, knot in stomach,

shivering etc.)

4. The MEANING/STORY/ INTERPRETATION / JUDGMENT

I MAKE i.e. My interpretation of what happened. PERSONAL vs
THEORETICAL conclusions, assumptions, inference.

5. THE IMPACT of my thoughts, feelings, sensations, meaning

6. WHAT I NEED to know, understand, learn, change, ask for,

research

7. WHAT I HAVE LEARNT

8. WHAT I WILL DO DIFFERENTLY IN FUTURE

Useful Reflection Questions
• Why do I do what I do?

• How do I do what I do?

• How do I know what I know?

• What am I assuming about this person, event, situation, my

abilities etc.

• What belief or fear or assumption or judgement underlies my

thoughts/ feelings/ behaviour?

• How does my belief/ fear/ assumption enable and/or disable

me/my patient?

• What can I do differently next time/ in the future?

• What will support me to think/feel/do things differently?

Change your Mind, Change your Heart
“For family physicians, being well-
informed and up-to-date is necessary but
not sufficient. Good family practice
depends on healthy relationships, and
the maturing of a family physician is a
matter of educating the emotions as well
as the intellect. Learning in this sense is
often a matter of going through some
personal change. Practicing patient-
centred medicine is a different way of
being a physician, and unless this change
has taken place, no technique will be
effective. True and lasting change in
medical practice and medical education
has to come first in the hearts and minds
of physicians themselves.”

(McWhinney, 2009)