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Using Reflection to Teach Professionalism

Using Reflection to Teach Professionalism. Karen V. Mann, BN, MSc, PhD Professor Emeritus, Dalhousie University. Objectives . Describe approaches to defining professionalism Describe approaches to understanding reflection

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Using Reflection to Teach Professionalism

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  1. Using Reflection to Teach Professionalism Karen V. Mann, BN, MSc, PhD Professor Emeritus, Dalhousie University

  2. Objectives • Describe approaches to defining professionalism • Describe approaches to understanding reflection • Identify and discuss methods to teach professionalism using reflection • Discuss approaches to assessing professionalism

  3. What is professionalism?

  4. What is professionalism? • Competence and mastery of appropriate knowledge skills and attitudes • Capability to adapt to change, generate new knowledge, and continue to improve • Self-awareness and self-regulation

  5. Different Paradigms for Understanding Professionalism generalizable across cultural contexts Adapted from Hodges et al. (2011) p 356

  6. Reflection : a definition • ‘reflection is a meaning-making process that moves learners from one experience into the next, each time with a deeper understanding of its relationships with and connections to other experiences and ideas. It is the thread that makes continuity of learning possible.’ (Dewey as cited in Wear et al, 2012)

  7. Approaches to reflection Knowing-in-action Surprise Reflection-on-action Reflection-in-action Experimentation (Schön, 1987)

  8. Approaches to reflection • Returning to experience • Utilizing positive feelings • Removing obstructing feelings • Re-evaluating experience Newperspectives on experience Change in behaviour Readiness for application Commitment to action Behaviour Ideas Feelings Experience(s) Reflective processes Outcomes The reflection process in context (Boud, Keogh & Walker, 1985)

  9. Approaches to reflection Concrete experience Observations and reflections Testing implications of concepts in new situations Formation of abstract concepts and generalizations (Kolb, 1984)

  10. Approaches to Reflection Optimal level of functioning King and Kitchener (1994)

  11. Characteristics: What models of reflection share • A return to experience • Reflection and reframing • Lessons- capacity to inform future practice • Iterative process • Levels of reflection

  12. The elements of reflection • Reflection on experience involves elaborating on or interrogating the experience. • Reflection has a purpose: to ‘work out’ an issue or felt difficulty. • Reflection involves complicated mental processing of issues for which there is no obvious solution. • Reflection provokes transformative thinking, leading to transformative action. • Reflection is a social rather than a solitary act. Wearet al, 2012)

  13. What would be our goals in using reflection as a teaching strategy?

  14. What would be our goals in using reflection as a teaching strategy? To help the learner to: • Articulate their own reasoning, including tacit understandings • Construct and make meaning of experience- to develop new knowledge • Understand the broader context of their practice • Connect theory and practice- move outside their comfort zone • Monitor their developing professionalism and professional identity-to develop agency • Increase self-awareness • In telling stories, learners are constructing their professional identity

  15. Reflection in Professional Development • Experiential learning as part of becoming a physician • Reflection transforms the experience into learning • Offers opportunity for ‘deep learning’

  16. Sources of Stimuli for Reflection • Formal learning experiences • Personal experiences • Interactions with patients • Learning gains and needs • Seminal events • Personal beliefs and values • Interactions with colleagues • Observations

  17. Sources of Stimuli for Reflection • Overall impressions • What went well • What they were thinking • Any new goals that emerged • Any assumptions or biases • What they were feeling • What others were feeling (Westberg & Jason, 2001)

  18. How Can Reflection Help Learners in Understanding Professionalism? • What choice did the learner make? • What did the learner do? • Why did the learner choose that action? • How did they justify their actions?

  19. Reflection on Professional Dilemmas • A reflective approach to the self-assessment of professionalism • Reflection may require a socially interactive process • Emphasizes both behaviours and internal and external context Bernabeo et al., 2013

  20. The Role of Reflection on Lapses in Professionalism • Focusing on action • Illuminate professional and non-professional behaviour • Helps to reveal the broader context • Can reveal competing values

  21. What is the Teacher’s Role? Modeling Reflection • Ask reflective questions • Reflect on events with students • Create a safe environment • Provide debrief opportunities (Sutkin et al., 2008; Weissmann et al., 2006)

  22. What vehicles for reflection? • Informal ,impromptu approaches • Structured approaches • Individual approaches • Collective approaches

  23. Portfolios as a Vehicle for Reflection • A file of achievements vs. a tool for reflection • Identification of learning needs • Details of learning experiences • Demonstration of what has been learned • Formative and summative assessment – teaching value

  24. Sample Portfolio Items for Medical Education p. 216, of Stern (2006)

  25. Elements of Successful Portfolio Programs • Self-reflection from evaluated portfolios • Promote a supportive climate for learning and feedback • Advance development of self-assessment and mentoring skills • Chart progress over time: observation and interactive goal-setting • Support learning development p. 222, of Stern (2006)

  26. Methods to Assess Professionalism • Portfolios • Direct observation • Multisource feedback • Self-assessment and feedback • Critical incidents

  27. Factors that Enhance Reflection • At the level of: • Institution • Teaching environment • Individual • What does this mean for teaching?

  28. Factors that Promote or Hinder Reflective Practice as Teachers Personal factors Contextual factors Environment Culture Other Pressures Colleagues Administrative Support 28

  29. Challenges of Teaching Reflection in the Professional Context Barriers and enablers Free expression of opinion Perceived usefulness of the activity Prior experience Organizational climate Time for reflection Non-reflective professionalism Boud and Walker, 2002 30

  30. Review Recommendations from Systematic Review • Use reflection as a learning strategy and ensure that you are a guide for learners to this process • Model reflection for the learners • Include learners in your own reflective practice • Provide feedback on both the content and process of the learners own reflective practice • Provide an environment that encourages reflective practice (Mann, Gordon & MacLeod, 2009)

  31. Tips for Implementing a Program • Define reflection for the learner • Decide on goals for reflective practice. • Choose the right method to teach reflection • Decide whether you will use a structure or unstructured approach to prompt reflection Aronson (2011)

  32. Tips for Implementing a Program • Make a plan for dealing with concerns • Follow up with the learner • Create a learning environment that fosters reflection Aronson (2011)

  33. Tips for Implementing a Program • Teach learners how to reflect before asking them to do it • Provide feedback and follow-up • Make reflection part of a larger curriculum • Reflect on your own teaching of reflection Aronson (2011)

  34. Preparing and Supporting Faculty Faculty can benefit from experiencing reflection as well, both in personal growth and in developing skills in promoting learners’ reflection. Longitudinal faculty development, where groups can reflect on their own practices, as well as learn new skills, in a safe, trusting environment, lead to changes in teaching Opportunity to reflect on teaching practices can lead to sustained change in teaching approaches. (Mann, in press)

  35. The Iceberg of Professional Practice Fish & Coles, 1998

  36. Summary • Professionalism is more than a set of behaviors. • Learners construct their identity throughout their education. • Reflecting on experience can provide learners a means to integrate learning and to construct an understanding of their own professionalism. • To be effective, reflection must be more than superficial or ritualistic. • Feedback and guidance on reflection, and modeling reflection are important roles for Faculty.

  37. References Aronson, L. (2011). Twelve tips for teaching reflection at all levels of medical education. Medical Teacher, 33 (p. 200-205) Bernabeo, E.C., Holmboe, E.S., Ross, K., Chesluk, B., Ginsburg, S. (2013). The utility of Vignettes to stimulate reflection and professionalism: Theory and Practice. Adv in Health Sci Edu, 18: 463-484 Boud D, Keogh R, Walker D. Reflection: turning experience into learning. Kogan Page London, 1985 (eds). Boud D. and Walker D. (2002). Promoting reflection in professional courses: the challenge of context. In R. Harrison , F. Reeve, A. Hanson and J. Clarke. (eds.) Supporting Lifelong Learning. Vol. 1. Perspectives on learning. London UK: Rutledge Farmer. (pp. 91-110) Coles, C. (2002). Developing Professional Judgment. J. Cont. Educ. Health Prof. 22, 3-10.

  38. References Ginsburg, S. & Lingard, L. (2006). Using reflection and Rhetoric to Understand Professional Behaviours. In Stern, DT. (ed) (2006). Measuring Medical Professionalism. New York, NY. Oxford University Press (pp. 195-212). Fryer-Edwards, K., Pinsky, L.E., Bobins., L. (2006). The Use of Portfolios to Assess Professionalism. In Stern, DT. (ed) (2006). Measuring Medical Professionalism. New York, NY. Oxford University Press (pp. 213-233). Hodges et al. (2011). Assessment and Professionalism: Recommendations from Ottawa 2010 Conference. Medical Teacher, 33: 354-363. King, P.M. (1994). Developing Reflective Judgment. San Francisco: Jossey-Bass. Mann KV, Gordon JJ, MacLeod AM. Reflection and Reflective Practice in Health Professions Education: A Systematic Review of the literature in the Health Professions. Advances in Health Sciences Education. 2009;14:595-621

  39. References Mann K. ( 2013 In press) Faculty development for reflection and role-modeling. In Steinert Y. Faculty development for the Health Professions. Springer In press Moon J. (1999). Reflection in Learning and Professional Development. London UK: Kogan Page Murdock-Eaton D, Sandars J. (2013) Reflection: moving from mandatory ritual to meaningful professional development. Archives of Disease in Childhood.doi:10.1136/archdischild-2-13-303948 Schön D. (1987) Educating the Reflective Practitioner: toward a new design for teaching and learning in the professions. Jossey-Bass, San Francisco, CA Wear D, Zarconi J, Garden R, Jones T. (2012) Reflection in/and writing: Pedagogy and Practice in medical Education. Academic Medicine 87:603-609

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