One immediately thinks of exotic climes, the adventure of passing from one country to the next, of fantastic destinations and the thrill of exploration and discovery.

For Tara Hatch and Renate Kahlke of the Health Sciences Education and Research Commons (HSERC), border crossings are a way of life. While their journeys are only sometimes geographical in nature, they cross borders of all kinds as a means of connecting students with rich learning opportunities, both in and out of the classroom.

“It is so important to expose our students to interprofessional learning, which is a significant part of what we do at HSERC,” says Tara Hatch, interprofessional practice manager with HSERC. In this role, Tara coordinates IntD 411, Advanced Health Team Practice, an elective course that places students in health care teams in clinical settings, where they analyze real-world team work and reflect on their own contributions.

“A big part of my job is making connections for students for learning beyond the classroom,” Tara says. “I work for collaboration across faculties, in clinical settings, and even with other institutions. That’s crossing a lot of borders right there.”

But the most celebrated border crossing of the year came with an honorable mention for a research poster presented at the Collaborating Across Borders conference in Tucson, Arizona. The conference, now in its third year, is designed to build relationships between health care researchers and educators in Canada, the United States and worldwide. Tara, Renate and their team proved their collaborative skill on a number of different levels – by joining forces with faculty across the health disciplines at the University of Alberta, other local institutions as well as Brown University in Rhode Island.

“For the poster, we looked at the concept of reflection, and how it relates to interprofessional study.” Renate says. “Reflection is a key competency for interprofessional work, as it is the skill that allows students to critically analyze their own work, and the work of others, and to continually strive to make it better. But early learners, especially those who are fresh out of high school or who come from the pure sciences, often have difficulty mastering the skill of critical thinking.”

“The issue is really two-fold,” Tara says, in agreement. “Students need some structure to guide them in how to be reflective, and instructors also need guidance in order to encourage reflection in their students. So, we developed a reflection guide for students, and arranged a number of learning opportunities for our faculty to better apply reflection in their practice and their teaching.”

The pair also scored a coup in recruiting the help of Hedy Wald from Brown University. “Hedy is a leading expert on reflection,” Tara says, “and we were so thrilled that she came to the U of A to give a workshop to several of our faculty members, as well as faculty from MacEwan and NAIT. That was a significant learning experience for all of us, and she really inspired our faculty to apply reflection skills in our courses. She also gave a lecture about the importance of applying

BORDERcrossingscrossings

Renate KahlkeIntegration of

Interprofessional Education

Competencies Project Coordinator

Tara HatchInterprofessional Practice Manager,

HSERC

16 - INTERACTIONS: Health Sciences Council Annual Report 2011-2012

these skills in learning and in practice, and I know a lot of people came away with the understanding of the need to think deeper and more intentionally about the work we do.”

Tara and Renate teamed up with Barbara Gitzel of the University of Alberta dental hygiene program, and taught a workshop for their faculty on the value of reflection. “That was a wonderful experience because we were able to put the theory into action,” Tara says. “Their instructors came away feeling like they had some direction as to how to apply reflection which made them more confident in requiring that kind of critical thought from their students. Not to mention that it was also an excellent team-building exercise for them – reflecting on critical thinking together made their team even more cohesive.”

The award-winning poster, then, was a culmination of Tara and Renate’s thoughts and experiences working across faculties and institutions – not to mention across the Canadian/American border. “It was such a great opportunity to build relationships with other institutions, both here in Edmonton, and with Brown University in the States. And we really built capacity on reflection within the faculties in our own institution.”

Indeed, Tara and Renate reported on the poster that the reflection guide made students feel more supported in their critical analysis, and instructors noted an increase in reflection skill in their students. Instructors also felt more confident applying reflection in their work, and were able to build in greater consistency in their grading.

“All told, it was a great experience,” Tara says. “The conference was amazing, and it was great to connect the work we’re doing here with what’s being done across North America.”

And a little recognition for work well done is an added bonus. Just the sort to inspire the next adventure.

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.

The award-winning poster.

”It was such a great opportunity to build relationships with other institutions, both here in Edmonton, and with Brown University in the States.

Tara Hatch

INTERACTIONS: Health Sciences Council Annual Report 2011-2012 - 17