Critical thinking and reflection
Learning to support practice development is influenced by critical thinking and the application of an evidence-based approach. The processes of clinical reasoning and critical analysis are crucial if practice is to be understood and developed. Ideally, practitioners should draw on the best evidence, combining research findings, clinical expertise and patient preference.
The skills of reflection and critical thinking combine to inform practice by development of cognitive skills (See Figure):
Figure: Challenging practice and the application of cognitive skills (Price 2004)
Purpose of Reflection
Reflection informs practice. A number of purposes are known:
- to understand yourself, your motives, perceptions, attitudes and values associated with the delivery of care
- to see practice afresh and challenge the assumptions about delivery of care
- to discuss with others how the episode might be approached differently (and encourage a learning community of practice)
Using reflection to inform practice development
The reflective practitioner begins to examine practice with an event or critical incident and follows a sequence of analysis resulting in actions to inform better practice or professional behaviour. A number of models of reflection capture the learning process; the following cycle indicates the main landmarks of the process of reflection.
Figure: The reflective cycle (Gibbs 1988)
- Description: What happened?
- Feelings: What were you thinking and feeling?
- Evaluation: What was good and bad about the experience(s)?
- Analysis: What sense can you make of the situation?
- Conclusion: What else could have been done?
- Action plan: If the experience arose again, what would you do next time?
Using reflection and critical thinking in practice
The process of reflection and the development of critical thinking are transferable skills that the practitioner is encouraged to develop. Practitioners are able to transform practice through insight and critical reasoning. Reflective practice is an approach to learning and practice development that is patient-centred. Critical thinking is the ability to deconstruct events and to reason the origins and steps of situations. Like reflection, it considers what has gone on before and what may yet happen. In both approaches, there is a retrospective and prospective or creative dimension. Creative thinking involves consideration of the relationship between events. To reflect, or think critically invokes investigating and imagining alternative scenarios.
There a number of ways to engage with learning associated with reflection. Reflection is a dynamic process and thoughts best captured when fresh in the learner’s mind. Reflective approaches include using:
- a reflective notebook: jot down questions, thought or observations as they occur
- a framework: this helps the learner to adopt the discipline of reflection and so capture learning opportunities (see Gibbs model)
- a sounding board: a learner may be encouraged to reflect by a mentor, ‘professional friend’ or learning partner, and should open up different perspectives
Reflective journal and diaries
It is contingent on practitioners to demonstrate reflection as part of evidence in the development of continuing fitness for purpose. It is hence useful to capture the process of reflection regularly so that it will serve as documentation supporting learning through reflection for the purposes of both improving practice and recording critical and creative thinking. Reflective practice and its associated learning is usually allied to forms of writing such as journals or diaries. Descriptive incidents from practice may be logged into journals together with critical, reflective writing applied to these events. The process and practice of critical writing helps to clarify initial thoughts by:
- recording new ideas and understanding
- empowering the practitioner by increasing ownership and confidence
- developing a questioning, problem-solving approach
- applying critical thinking
- clarifying achievements, professional goals and career aspirations
- identifying new learning associated with the practice area
Hi there, in this lesson we're going to discuss the idea of reflective writing.
First, we'll define what it is, and then explore the idea of critical
reflective writing at university using an example.
In order to discuss what reflective writing is,
it's useful to first define what we mean by reflection.
Mezirow suggests that reflection is a turning back on experience.
That is, we engage in reflection whenever we think back on or about an event or
an experience, or even when we engage with the simple awareness of an object.
That means actively thinking about what we've learned and the process of learning.
When we engage in this kind of reflection,
we're doing what Flavel would classify as metacognition.
We're gaining an awareness and
understanding of our own process of learning.
Another way to think of this is that it is, in part, critical self reflection.
We think about how we think.
So how, when, and why do we use reflection at university?
Firstly, reflection can be a study habit for individual students.
In fact, Mezirow suggests that critical reflection is a cornerstone of
adult learning, and key to being able to think independently.
This means that you, as a student,
critically reflect both on what you've learned and how you're learning.
You could reflect on anything, from your study habits, to the way your ideas and
attitudes are changing, or the gaps in your knowledge or
skills that you need to fill.
This kind of reflection, or
metacognition, encourages learner autonomy and will make you a better learner.
Boyd and Fales suggest that reflection occurs
when you think about an experience or event that revealed an area of concern.
For example, for a medical student, the experience might a clinical error
that might have revealed a lack of knowledge about a disease.
Or it might have uncovered a personal assumption or
bias that a student had towards a patient.
It might even highlight a personal tendency,
such as being too quick to jump to conclusions.
Reflecting on the experience and
area of concern thus enables you to better understand yourself and
your own gaps in knowledge, assumptions, and biases or thought processes.
Next, in the significance stage, you analyze why it happened.
You might draw on or question prior learning or relevant theory and
research in order to contextualize the concern.
If, for example, it was revealed that the medical student made an error due to
a lack of knowledge about a particular disease, they would then need to discuss
how they would overcome this difficulty in the future.
Simply looking up and
learning more about the particular disease doesn't solve the core problem.
It is impractical to assume that medical professions
will know everything about every disease and medication.
So, a good perfection would also discuss this issue, and
then consult theory and research into how medical professionals overcome it.
Of course, this is usually a difficult process.
You need to be honest about your failings,
to admit faults, or things you find particularly difficult.
As Brookfield suggests,
becoming aware of the implicit assumptions that frame how we think and act
is one of the most puzzling intellectual challenges we face in our lives.
In this way, reflective writing is both subjective and objective.
It's subjective because you're talking about your personal experiences,
thoughts, beliefs, and opinions, and you often use I.
On the other hand, it's objective because you need to treat those experiences,
thoughts, beliefs and opinions like any other argument.
Something that can be analyzed and deconstructed to reveal new truths.
And finally, while the written aspect to a reflection is probably more particular to
universities, critical reflection is definitely not.
Some of the most common interview questions for jobs are focused on
identifying personal strengths and weaknesses, successes and failures.
In fact, look at any advice page for interviews, and
you'll find people stressing the need to find examples of specific instances.
How you dealt with them, and what you've learned about
dealing with those situations, about yourself or about the field.
While you may not need to draw on theory and
research to back up what you're saying, the principle is still the same.
You need to be critically reflective.
Of course, this is something that applies to all the skills we've been discussing on
Being a critical and reflective thinker is not just a hat you put on
when you walk into a tutorial or a lecture hall.
It's something that you are and do every time you engage with new information or
a new argument.
Whether it's published in an academic journal article,
a friend's social media post, or a tabloid magazine.
Using these skills is how we grow and learn throughout our whole lives.