• Junaid Sarfraz Khan


The healthcare professional in our age needs toPERFORM in complex and challenging healthcareenvironments. The importance of reflection,reflective practice and teaching and training todevelop a reflective practitioner is frequentlyestablished in the literature. In fact, recent researchon pedagogy stresses the importance of establishing alink between reflective learning and reflectivepractice as a means to developing adult learning andlife long learning skills. Reflection and its threecategories of reflection-in-action, reflection-on-actionand reflection-on-the-future have been established asthe panacea of all things wrong in the healtheducation and health care delivery systems.Activities, therefore, to promote reflection are nowbeing incorporated into undergraduate, postgraduate,and continuing medical education, and across avariety of health professions.Many definitions of reflection can be found.Dewey1 defined reflection as ‘active, persistent andcareful consideration of any belief or supposed formof knowledge in the light of the grounds that supportit and the further conclusion to which it ends’. Thisdefinition shares our understanding of criticalthinking. Brockbank and McGill2 identify reflectionas a ‘process or means by which an experience, in theform of thought, feeling or action, is brought intoconsideration, while it is happening or subsequently’.Secondly, and deriving from the first, ‘the creation ofmeaning and conceptualisation from experience andthe potentiality to look at things as other than theyare’.Action can specifically occur beforereflection and thus something that requires reflexive‘action’ and ‘practice’, can occur during reflection(and here on the continuum of action can change orremain unchanged as a result of reflection-in-action)or can be the consequence of reflection-afterprevious-action. The argument related to the balancebetween action and reflection is not a simple one.How much reflection follows as a result of action andvice 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 thatrepresents maximum action with maximumreflection. Again the balance between action andreflection is very situation, subject, experience,context, person and position dependent.Table-1: Context, Action, Reflection, Relationship(CARR)ReflectionNo ActionReflectionActionNo ReflectionNo ActionNo ReflectionActionReflection, strangely enough, is an in-builtreflex mechanism. At least it should be thought of inthis way and not as something inhuman andmechanical.There would not be such a person who doesnot value the part reflection plays in improvingprofessional practice. Schön introduced the conceptof a reflective practitioner. Schön states thatprofessional knowledge is limited because it does nottake into account the realities of professional life andpractice.3,4 In this time and age, professionalknowledge gained by students before entering theprofession itself, is made to be as realistic toprofessional practice as possible.Knowledge before practice does not givethe learner the true taste in entirety of the actualityin principle, nevertheless, newer learning techniquesand practices like problem based learning, taskbased learning, community oriented education, workplace education give a lot in terms of reality toeducation before practice. Furthermore, evenpractice, brings new challenges everyday, whichrequire, intuition, assertion, initiative, reflection andnotably action.The addition of the word ‘critically’ to‘reflective practice’ brings a new dimension to theforce of nature that is reflection. It allows the personinvolved in critical reflective practice, to criticallyanalyse experiences, events, occurrences andknowledge based on the context, situation, relevance,existing knowledge, and attitude (affect) in order toimprove his own understanding, action, and attitudetowards his practice.Reflective practice is the foundation thatsupports healthcare delivery systems anywhere inthe world. It is through critical reflective practicethat we improve our clinical practice, patientencounters and health care delivery. Developingreflective practice is an important component of thetraining and education of the healthcareprofessionals and it should form both part of thetaught as well as the hidden medical curriculum inPakistan’s universities.


Dewey J. How we think. Revised Edn. Boston: D.C. Health;

Brockbank A, McGill I. Facilitating reflective learning in

higher education.2nd ed. Buckingham: SRHE and Open

University Press; 2007.

Schön DA. The Reflective Turn: Case Studies In and On

Educational Practice. New York: Teachers Press, Columbia

University; 1991.

Pakman M. Thematic Foreword: Reflective Practices: The

Legacy Of Donald Schön’. Cybernetics & Human





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