SOME ACTION ON REFLECTION

Abstract

The healthcare professional in our age needs to
PERFORM in complex and challenging healthcare
environments. The importance of reflection,
reflective practice and teaching and training to
develop a reflective practitioner is frequently
established in the literature. In fact, recent research
on pedagogy stresses the importance of establishing a
link between reflective learning and reflective
practice as a means to developing adult learning and
life long learning skills. Reflection and its three
categories of reflection-in-action, reflection-on-action
and reflection-on-the-future have been established as
the panacea of all things wrong in the health
education and health care delivery systems.
Activities, therefore, to promote reflection are now
being incorporated into undergraduate, postgraduate,
and continuing medical education, and across a
variety of health professions.
Many definitions of reflection can be found.
Dewey1 defined reflection as '˜active, persistent and
careful consideration of any belief or supposed form
of knowledge in the light of the grounds that support
it and the further conclusion to which it ends'. This
definition shares our understanding of critical
thinking. Brockbank and McGill2 identify reflection
as a '˜process or means by which an experience, in the
form of thought, feeling or action, is brought into
consideration, while it is happening or subsequently'.
Secondly, and deriving from the first, '˜the creation of
meaning and conceptualisation from experience and
the potentiality to look at things as other than they
are'.
Action can specifically occur before
reflection and thus something that requires reflexive
'˜action' and '˜practice', can occur during reflection
(and here on the continuum of action can change or
remain unchanged as a result of reflection-in-action)
or can be the consequence of reflection-afterprevious-action. The argument related to the balance
between action and reflection is not a simple one.
How much reflection follows as a result of action and
vice versa is largely context, action, and '˜reflector'
dependent. This context, action, reflection,
relationship is presented in Table-1.
The Upper Right square is the square that
represents maximum action with maximum
reflection. Again the balance between action and
reflection is very situation, subject, experience,
context, person and position dependent.
Table-1: Context, Action, Reflection, Relationship
(CARR)
Reflection
No Action
Reflection
Action
No Reflection
No Action
No Reflection
Action
Reflection, strangely enough, is an in-built
reflex mechanism. At least it should be thought of in
this way and not as something inhuman and
mechanical.
There would not be such a person who does
not value the part reflection plays in improving
professional practice. Schön introduced the concept
of a reflective practitioner. Schön states that
professional knowledge is limited because it does not
take into account the realities of professional life and
practice.3,4 In this time and age, professional
knowledge gained by students before entering the
profession itself, is made to be as realistic to
professional practice as possible.
Knowledge before practice does not give
the learner the true taste in entirety of the actuality
in principle, nevertheless, newer learning techniques
and practices like problem based learning, task
based learning, community oriented education, work
place education give a lot in terms of reality to
education before practice. Furthermore, even
practice, brings new challenges everyday, which
require, intuition, assertion, initiative, reflection and
notably action.
The addition of the word '˜critically' to
'˜reflective practice' brings a new dimension to the
force of nature that is reflection. It allows the person
involved in critical reflective practice, to critically
analyse experiences, events, occurrences and
knowledge based on the context, situation, relevance,
existing knowledge, and attitude (affect) in order to
improve his own understanding, action, and attitude
towards his practice.
Reflective practice is the foundation that
supports healthcare delivery systems anywhere in
the world. It is through critical reflective practice
that we improve our clinical practice, patient
encounters and health care delivery. Developing
reflective practice is an important component of the
training and education of the healthcare
professionals and it should form both part of the
taught as well as the hidden medical curriculum in
Pakistan's universities.