Introduction to Critical Reflection

Louise Aronson, MD MFAMarieke Kruidering PhD

University of California, San Francisco

Learning Objectives

1. Distinguish critical reflection from reflection

2. Identify the role of critical reflection in MD professional development

3. Discuss the 5 key steps for successful critical reflection

Critical Reflection…

Reflection v. Critical Reflection

Reflection

A word with many meanings and uses

Reflection

The bending or folding back of a part upon itself

Reflection

The return of light after striking a surface

Reflection

A thought occurring in consideration or meditation

Critical Reflection Is Different

Goes beyond “consideration or meditation”

A skill developed over time

In medicine, a tool for learning and life-long professional development

Mezirow, 1998; Boud, 1998; Sandars 2009

Critical Reflection Not just what happened (anecdote)

More than personal opinion

Requires Data gathering and analysis Integration of past, present and future Contextualizing and reframing Learning!

Critical Reflection: UCSF Definition

The analysis of personal experience to enhance learning and improve future professional behavior and

outcomes.

Critical Reflection

What is it?

Why should you care?

How do you do it well?

Outcomes Data

Sobral: ↑ student exam performance

Blatt: ↑ student clinical performance with standardized patients

Mamede: ↓ resident diagnostic errors

Toy: ↑residents achieving rotation goals

Pelgrim: trainees who reflect make better use of feedback, i.e do better

Sobral 2001, Blatt 2007, Mamede 2008/2010, Toy 2009, Pelgrim 2013

The Reflective Practitioner

… is able to identify essential professional problems, to

challenge self-evident ‘truths’, to seek feedback and to use it for

personal professional development.

Schön, 1983

Critical Reflection

What is it?

Why should you care?

How do you (help your learners) do it well?

Successful Reflection

1. Structured guidelines more effective than prompt alone

2. Feedback=essential

3. Practice is the only way to achieve competence

Aronson et al., 2011, 2012; Sargeant 2009

UCSF Approach

LEaP Guidelines: Learning from your Experience as a Professional

5 key steps to critical reflection

SOAP note format

Aronson et al., MEP 2012 (1,2); Kruidering MEP 2013

Critical Reflection

Choosing the right experience

A situation where reflector didn't have the

necessary knowledge or skills that went well but reflector not sure why which was complex, surprising,

uncomfortable or uncertain in which reflector felt personally or

professionally challenged

Critical Reflection

“Subjective”

Detailed consideration of experience What, how, why Intellectual & emotional responses

Told so others can form own conclusions

Not just good storytelling/writing

Critical Reflection

“Objective” (Outside perspective)

Going beyond own impressions Outside input Feedback from others

o supervisors, other professionals, mentors, patients, families, peers

Relevant research or data

Should lead to a reframing of the experience

Critical Reflection

“Assessment”

Synthesis of “S” and “O”

Links current and past experience to identify an important, ongoing

professional development challenge

Explicitly identifies a learning issue

Critical Reflection

“Plan”

Strategy for learning/future behavior

Must be SMART Specific, Measurable, Attainable,

Relevant and Timely

Ideal if specifies follow up or check in

Successful Reflection

Not just transcription of past learning

Not self-aggrandizement

Shows new learning or plan for new approach

Summing up Critical reflection is a skill

Reflection and Critical Reflection are different both may be useful choice based on educational objectives

Doing CR well takes effort, practice, feedback, mentoring and time

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