Helping learners become reflective practitioners.

Abstract

CONTEXT: In too many schools in the health professions, students are given little or no opportunities to reflect systematically on their simulated or real experiences practicing the skills they need as clinicians (e.g. eliciting information and solving problems). In addition, they are given little or no help in learning the skills that are central to being reflective practitioners. RATIONALE: Reflecting alone or with the help of educators or others, students and residents can learn to identify and build on their existing knowledge, identify their biases and assumptions, integrate new understandings, and formulate generalizations that will enable them to make positive changes in what they do in future situations. Put another way, they can derive lessons from their experiences that will enhance their skills and enable them to provide better patient care. When learners reflect aloud on their insights and their strengths and deficiencies before their teachers give them advice or feedback, learners can make their own discoveries and have the dignity of identifying what they need to work on. The learners' self-disclosures provide educators with "diagnostic" information that can enable them to tailor their teaching to the learners' interests and needs. SUGGESTIONS: Educators can help learners become reflective practitioners by taking such steps as ensuring learners have worthy experiences on which to reflect; observing learners in action; scheduling times and places for reflection; building trust; determining the learners' prior experiences, comfort with, and attitudes toward reflection; ensuring learners understand the rationale and strategies for reflection; modeling reflection; clarifying the learning goals; encouraging learners to have questions to ask themselves; helping learners reflect on their thoughts, feelings, biases, and assumptions; helping learners consider other approaches; inviting learners to identify the lessons they've learned; and asking them to discuss how they intend to use these new understandings.