+ using reflection to teach professionalism karen v. mann, bn, msc, phd professor emeritus,...
TRANSCRIPT
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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
Identify and discuss methods to teach professionalism using reflection
Discuss approaches to assessing professionalism
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+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
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+Different Paradigms for Understanding Professionalism
Individual Interpersonal Societal/Institutional
Positivist (objective,definable)
•Characteristic/trait•Behaviour/cognitive process• Generalizable across contexts•Stable
•In interactions •In interactions
Subjectivist - constructivist
Subjectively constructed within individuals arising from cultural contexts
•Interpersonally constructed: •not generalizable across contexts
•Socially constructed
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generalizable across cultural contexts
Adapted from Hodges et al. (2011) p 356
+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)
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+Approaches to reflection
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Knowing-in-action
Surprise
Reflection-in-actionExperimentation
Reflection-on-action
(Schön, 1987)
+Approaches to reflection
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Behaviour
Ideas
Feelings
Returning to experience• Utilizing positive feelings
• Removing obstructing feelings
Re-evaluating experience
Newperspectives on
experience
Change in behaviour
Readiness for application
Commitment to action
Experience(s) Reflective processes Outcomes
(Boud, Keogh & Walker, 1985)
The reflection process in context
+Approaches to reflection
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Concrete experience
Formation of abstractconcepts and generalizations
Testing implications
of concepts in new situations
Observations and
reflections
(Kolb, 1984)
+Approaches to Reflection
•Right/wrong answers
•Recognize uncertainties
•Defensible conclusions about complex problems
•Pre-reflective thinking
•Quasi-reflective thinking
•Reflective thinking
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Optimal level of functioning
King and Kitchener (1994)
+Characteristics: What models of reflection share
A return to experience
Reflection and reframing
Lessons- capacity to inform future practice
Iterative process
Levels of reflection
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+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.
Wear et al, 2012)
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+ 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
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+Reflection in Professional Development
Experiential learning as part of becoming a physician
Reflection transforms the experience into learning
Offers opportunity for ‘deep learning’
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+Sources of Stimuli for Reflection
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Formal learning experiences
Personal experiencesInteractions with
patientsLearning gains and
needs
Seminal eventsPersonal beliefs and
valuesInteractions with
colleaguesObservations
+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
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(Westberg & Jason, 2001)
+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?
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+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
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Bernabeo et al., 2013
+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
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+What is the Teacher’s Role? Modeling Reflection
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Ask reflective questions
Reflect on events with students
Create a safe environment
Provide debrief opportunities
(Sutkin et al., 2008; Weissmann et al., 2006)
+What vehicles for reflection?
Informal ,impromptu approaches
Structured approaches
Individual approaches
Collective approaches
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+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
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+Sample Portfolio Items for Medical Education
•Professionalism goals
•Learning plan
•Standardized and real patient
evaluations
•Videotape segments
•Self-evaluation forms
•Peer feedback
•Reflective exercises
•Formative faculty feedback from
small groups or mentoring
•Faculty evaluation forms
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p. 216, of Stern (2006)
+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
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p. 222, of Stern (2006)
+Methods to Assess Professionalism
Portfolios
Direct observation
Multisource feedback
Self-assessment and feedback
Critical incidents
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+Factors that Enhance Reflection
At the level of:
Institution
Teaching environment
Individual
What does this mean for teaching?
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Factors that Promote or Hinder Reflective Practice as Teachers Personal factors
Contextual factors
Environment
Culture
Other Pressures
Colleagues
Administrative Support
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Boud and Walker, 2002
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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
+ 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
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(Mann, Gordon & MacLeod, 2009)
+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
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Aronson (2011)
+Tips for Implementing a Program
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Make a plan for dealing with concerns
Follow up with the learner
Create a learning environment that fosters reflection
Aronson (2011)
+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
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Aronson (2011)
+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)
+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.
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+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.
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+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
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+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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