How to reflect
When asked to reflect on an experience, what questions do you ask yourself?
In the book, Make it Stick [6], neurosurgeon Mike Ebersold comments:
I’d go home that night thinking about what happened and what could I do, for example, to improve the way a suturing went. How can I take a bigger bite with my needle, or a smaller bite, or should the stitches be closer together? What if I modified it this way or that way?
The above quote demonstrates how reflection can be used in a physician’s career, but how does one accurately self-reflect and have it become a habit? Reflection is not always intuitive; like any skill it takes practice. [7] Rubrics can be an excellent way to facilitate what questions you want students to ask themselves. Defining reflection and providing tools to guide students on how to achieve the desired reflection levels can help your learners attain them. With practice, learners will adapt to perform reflection-in-practice [8] (developed by Donald Schon as part of his reflective model [9]), demonstrating deep reflection characteristics using tacit knowledge to adjust to changing circumstances.
Now, how can educators integrate strategies to minimize confusion in these three areas?
Explain the Why
Actively monitoring your learning experience to include reflection as a deliberate and guided process can provide multiple benefits to learners. Self-awareness leads to self-monitoring, which improves individual performance. In addition, reflection leads to self-assessment, which can lead to individuals incorporating self-directed learning to their work (Merriam & Bierema, 2014). Encouraging the mindfulness that is needed to notice [10] the “disorienting dilemma” (Mezirow, 1978) or experience the “surprise” (Schon, 1984) begins the cycle of being a lifelong learner. Processing new information, reflecting on it, and adjusting future behavior is an increasingly important skill to possess to keep up with the constant changes in medical knowledge.
While Transformative Learning is typically about individual change, it can serve as the basis for cultivating organizational change. Individuals who transform can assist others as mentors and help influence others to experience that “aha” moment that is paramount in Transformational Learning. [11]
Transformational Learning frames an experience leading to changing perceptions about a topic. Critical reflection is paramount to effectively question prior beliefs to restructure our thought processes when engaging with new information.
For physicians, this means adjusting to new data that comes out about treatment options and adjusting a patient’s plan for care. This type of self-reflection needs to be cultivated from the beginning of a physician’s education. It will also help students consolidate their knowledge throughout medical school for long-term processing, serving as a form of retrieval practice. Lastly, it will also give them the skills to continuously receive new information, internalize it, and act on it to improve patient care.
Putting it into action
In designing learning activities to foster a Transformational Learning experience and guide toward deep reflective practice, consider the following:
