Moving from awkward to “aha!”: Strategies for building reflective capacity among health science students and faculty.

Tara Hatch1, Renate Kahlke1, Sharla King1, Barbara Gitzel2 and Hedy S. Wald3

1 Health Sciences Education and Research Commons, University of Alberta, Edmonton, AB2 Dental Hygiene Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB3 Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI

The Health Sciences Education and Research Commons collaborates to develop and deliver interprofessional education (IPE) for students from eight health science faculties. Curriculum is based on four interprofessional (IP) competencies: communication, collaboration, role clarification and reflection.

Students struggled with reflection assignments in IPE courses. • Expectedtobestruckbyanelusive“aha”

moment• Failedtoseethevalueinreflectionasa

process to facilitate their learning

Course facilitators felt ill-prepared to support struggling students. Variation in assignmentexpectationsandgradingwasobserved across course sections.

Facilitators and studentsoftenlackedclearunderstanding of the purpose and/or process of reflection. In response, we developed and implemented• Reflectionguide• Threeapproachestofacultydevelopment

Table excerpted from Reflection GuideComponents of Reflection

Description Questions to consider

Description Describe the “event,issueorsituation”(Williams&Wessel, 2004)

What happened?Who was involved?What was your role in the event?What role or roles did other team members play, including the patient and/or family?

Personal Analysis Analyze the event “inrelationtopriorknowledge,feelingsofattitudes”(Williams&Wessel, 2004)

How do you interpret the event?What was your emotional response to the event?What factors may have affected the event?What are the broader implications of the event?

ContextAnalysis Analyze the event in thecontextofexternalsources of information

What evidence supports or refutes your interpretation?Whatfeedbackdidyoureceivefrompatients,communitymembers,facilitators, team members or other peers? How does your interpretation fit within the literature?How does the event relate to your profession’s standards of practice or code of ethics?How does the event relate to your personal ethics or values?What organizational, historical or sociological implications does the event have?What were your personal or professional strengths and limitations in relation to the event?

Practice Implications

Use your analysis to identify learning needs or changes to practice

Whatknowledgeorexpertisewillyouseektosupportyourpractice?Howwillyouacquirethatknowledgeoraccessexpertise?How will you approach a similar event in the future?What other implications does the event have for your future practice?

Students • Structured guide provides support for early learnersFaculty • Diverse delivery approaches with practical, relevant tools build capacity• Experiential workshops facilitate relationship

building • Walk the talk: presenters from different

disciplines provide robust exploration of reflection

Selected ReferencesMann,K.,Gordon,J.,&MacLeod,A.(2009).Reflectionandreflectivepracticein

health professions education: A systematic review. Advances in Health Sciences Education: A Theory and Practice, 14,595-621.doi:10.1007/s10459-007-9090-2

Reis,S.P.,Wald,H.S.,Monroe,A.D.,Borkan,J.M.(2010).BegintheBEGAN(TheBrownEducationalGuidetotheAnalysisofNarrative)-aframeworkforenhancingeducationalimpactoffacultyfeedbacktostudents’reflectivewriting. Patient Education and Counseling, 80(2):253-9.Epub2010Jan6.

Sandars,J.(2009).Theuseofreflectioninmedicaleducation:AMEEguideno.44.Medical Teacher, 31(8),685-695.doi:10.1080/01421590903050374

Schön,D.A.(1983).The reflective practitioner: How professionals think in action.New

York:BasicBooks.

Wald,H.S.,Borkan,J.M.,Taylor,J.S.,Anthony,D.,Reis,S.P.(2011).FosteringandEvaluatingReflectiveCapacityinMedicalEducation:DevelopingtheREFLECTRubric for Assessing Reflective Writing. Academic Medicine, in press.

Reflection GuideThis tool was made available to students enrolled in two IPE courses and on-linetoallstudentsandfaculty.Itwasdevelopedtoexplaintherationaleforreflectionandsupportdevelopmentofreflectionskills.

Observations: • Improvedqualityofreflection• Fewernegativecommentsfromstudentsincourseevaluations• Instructorsreportedincreasedconfidenceinintegratingreflection

Faculty DevelopmentThreeinteractiveworkshopsfocusedonliteratureonreflection,frameworksforfeedback,andassessment.Eachwastailoredtoauniqueaudience.

Course specifictrainingdeliveredbyfourdisciplinesto63facilitatorsofarequired IPE course and covered:• Purposeofreflection• Practiceapplyingreflectionrubric• Practiceprovidingfeedbackwithstudentteam

Observations:• Moreconsistencyingrading,fewernegativecommentsfromstudents• Facilitatorsreportedincreasedconfidenceinintegratingreflection

Inter-institutional IP approach developed to build instructor capacity in inte-grating reflection across degree, diploma and certificate health science programs. Participants represented 15 disciplines from academic and practice setting.

Visiting scholar and clinical psychologist from Alpert Medical School (AMS) of Brown University delivered:1. Foundational seminar with didactic and interactive learning2. Skillspracticeworkshop• Sharedlocalinitiativesonreflectivelearning• AppliedtoolsdevelopedatAMSofBrownUniversitytoanalyzestudent

reflections

Observations:• Stepforwardinbuildingcommunityofreflectivepractice• Learningintegratedintocoursecurriculumandclinicalpractice

Program specificworkshopforDentalHygieneinstructorsdeliveredby2disciplines:• Focusedonverbalandwrittenreflection• Appliedtoolsforconstructingverbal/writtenfeedback• Appliedadvocacyinquirydebriefingmethod

Observations:• Teambuildingfacilitatedbyinteractivepresentation• Instructorsengagedthroughexamplesrelevanttoteachingcontext• Futureintegrationsupportedbypracticaltools

Next Steps:Move beyond review of process; formally evaluate impact of reflection guide.