introduction to critical reflection louise aronson, md mfa marieke kruidering phd university of...
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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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