reflective practice in nursing education

Final thoughts

Being aware of ones' strengths, weaknesses and areas for improvement is essential for both our professional and personal lives, and one way of gaining greater self-insight is through reflective practice. However, while reflective practice has a clear contribution to make, it is also subject to much criticism. A growing body of literature speaks of, for example, overly structured approaches that restrict thinking ( Coward, 2011 ), reflective fatigue and apathy ( Timmins and Neill, 2013 ; McKinnon, 2016 ) and a lack of tools available to educators to actually enable them to facilitate reflective learning ( Donohoe, 2019 ). Indeed, as evidenced in the literature, when incorporating reflection in their teaching, many educators have implemented exercises that produce anecdotal and descriptive narratives instead of engaging with reflection in a truly critical, radical and meaningful manner ( Aronson, 2011 ; Rolfe, 2014 ). However, perhaps this suggests that the problem is not necessarily with reflective practice itself, but rather the problem is our practice of reflection. If we do want to really rediscover the radial origins of reflection ( Rolfe, 2014 ), then we need to go beyond the two-dimensional mirror image of surface self-reflection, and enter a cognitive rabbit hole where we are challenged to critically examine who it is that we really are. One way of doing this is through the elucidation of unconscious biases where, between the two positions of the ‘comforting lies we tell ourselves', and the ‘unpleasant truths we may prefer to ignore’, we will find the liminal space of accurate, but balanced, self-assessment. This is a space where we are neither overconfident nor driven to despair, and it is one that offers self-insight and growth potential. It is a safe space where we can begin to balance our biases, rather than berating ourselves for having them ( Karpen, 2018 ), and one where we can foster fresh approaches to learning in, and from, practice.

A good way to learn more about some of the concepts discussed here is to search for online videos. These concepts might seem complex and difficult, but there are many high-quality videos freely available where you can see and hear experts explain them in an understandable way. Start by using some of the search terms listed in Box 1 .

If we, the authors of this article, were to be biased in our thinking, we might suggest that this is probably one of the most important articles written relating to reflective practice since the seminal work of Schön (IKEA effect, egocentric bias). Our inflated self-assessment would lead us to propose that the eminence of this article is testament to our experience and expertise as nurse educators (self-serving bias, above average effect); that this is an article we always knew we would write (hindsight bias); and that a wealth of evidence supports our conclusions (cherry-picking fallacy). We are sure that you would agree (illusion of transparency), but would conclude that if you do not, it is probably because you are just jealous (social comparison bias). However, regardless of what you may think, or what evidence you may have to the contrary (belief perseverance), as we have invested a lot of time into writing this, we will continue to trust that we have made a novel contribution to nursing knowledge (sunk cost effect)!

If we were to be less biased and more critically reflective, we might conclude that while this article may provoke some thought, it has not been empirically researched in a traditional sense, did not involve a systematic review of the literature, and is written by those without a background in psychology. We might determine that we only highlight concepts and information that support our premise (choice supportive bias, confirmation bias), that we focus solely on some stereotypical traits of reflective practice (representative bias), or that our past experience of reflection has affected our judgement (confabulation bias). We might realise that we have not attempted to discuss underlying motivation for biases, or that, perhaps no relationship exists between bias and reflection whatsoever (illusory correlation). Indeed, it is probable, or at least possible, that unbeknown to us, other more knowledgeable persons have already examined this link (Kruger-Dunning effect), and have already drawn similar conclusions (misattribution effect). Either way, we will reflect on both our biases and our reflection, and hope that you, the reader, do so too.

• Reflective practice is seen as an important tool for learning in nursing
• A prerequisite of voluntary self-improvement is actually recognising the need for improvement in the first place
• The Kruger-Dunning effect, and other unconscious biases, may limit our self-insight and our ability to reflect
• It may be the case that those most likely to gain from reflecting on their practice are those least likely to be able to do so
• Raising awareness of unconscious bias and overconfidence in self-assessment is important in order to optimise learning from reflective practice

CPD reflective questions

• Why is the synergy between cognitive biases and reflection on practice important?
• If reflection were to be more sophisticated, then what would it look like?
• Can you identify and reflect on a bias from Table 2 that resonates with you?
• Is there a difference between reflection on practice and our practice of reflection?

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Nurturing Leadership: 4 Key Strategies for Reflective Practice in Nursing

5 min read • February, 21 2024

Nursing leaders play a pivotal role in guiding change to enhance patient care and improve professional practice environments. Reflective practice stands out as a cornerstone for effective leadership, allowing nursing professionals to evaluate their experiences critically and foster continuous improvement. This article delves into four key reflective practices that can empower nursing leaders to drive meaningful change.

The Power of Reflection in Nursing Change

Reflective practice is more than a method; it's a mindset that enables nursing leaders to learn from their actions, make informed decisions, and engage their teams in the journey towards excellence. By incorporating reflective practices into their leadership approach , nurses can better navigate the complexities of healthcare, adapt to challenges, and implement strategies that align with their goals and values.

Understanding Your Change Goals

Q: What did you say you were going to do? A: Begin by revisiting your initial objectives. Clear articulation of your goals lays the foundation for accountability and sets the stage for impactful change. Reflect on the scope of the changes you envisioned and the outcomes you aimed to achieve. This honest appraisal is your first step towards meaningful progress.

Assessing Your Actions

Q: What did you actually do? A: Reality often diverges from our plans. Assessing your actions with candor enables you to identify discrepancies between your intentions and your actual practices. Acknowledge both your achievements and the areas where you fell short. This recognition is crucial for realistic self-assessment and sets the groundwork for authentic growth.

Learning from Experience

Q: What did you learn? A: Every step in the change process offers valuable lessons. Reflect on the insights gained from your experiences and how they can inform future strategies. These lessons are the silver lining, providing clarity and direction for your next moves.

Planning Your Next Steps

Q: What do you need to do next? A: Armed with new knowledge, plan your forward strategy. Consider who needs to be involved, the resources required, and the timeline for implementation. This step is about translating insights into actionable plans that drive further change.

Incorporating Reflective Practice into Your Routine

Integrating reflective practice into your leadership routine doesn't have to be daunting. Start small with regular reflection sessions, encourage team discussions that foster collective learning, and set aside time for personal and professional development. Embracing reflection as a habit can transform your leadership approach and significantly impact your team's performance and well-being.

Reflective practice is an invaluable tool for nursing leaders seeking to navigate the complexities of healthcare and drive positive change. By focusing on these four essential aspects of reflection, you can enhance your leadership effectiveness, improve patient care , and foster a culture of continuous learning and improvement . Start today by taking a moment to reflect on your practice and empower yourself and your team for the challenges and opportunities ahead.

Images sourced from Getty Images

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‘The challenges facing nurse education must be tackled’

STEVE FORD, EDITOR

• You are here: Wellbeing for nurses

Reflective practice 3: making it meaningful and using it in practice

20 June, 2022

This article, the third in a series on reflective practice, explains why nurses need support to engage more deeply in reflection

Reflective practice should be embedded in nurses’ everyday practice. As the first two articles in this series explained, it is a cornerstone of revalidation and is promoted as essential to learning, improvement and wellbeing. However, some experts are concerned that the increased focus on reflective practice masks underlying problems, with reflection often poorly taught and reduced to a bureaucratic exercise. This third, and final, article in the series suggests reflection needs to be made more accessible and be more highly valued than at present, so it is no longer vulnerable to workload pressures. To engage fully with reflection, nurses need different opportunities to reflect that suit their roles and personal preferences.

Citation: Agnew T (2022) Reflective practice 3: making it meaningful and using it in practice. Nursing Times [online]; 118: 7.

Author: Thelma Agnew is a freelance health journalist.

• Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
• Click here to see other articles in this series

Introduction

You cannot be a nurse today and remain oblivious to reflective practice. Reflection’s place in nursing has become too obvious to miss; it is taught in every undergraduate nursing course and lauded by professional bodies and nursing leaders as an essential driver of lifelong learning and improvement. As the first two articles in this series discussed, it is a cornerstone of the revalidation process, which all nurses must complete to stay on the register, and is, increasingly, promoted as a support for nurses’ wellbeing and good mental health.

Reflective practice should be embedded in your everyday practice, but is it? There are concerns that, although reflection is well established in nursing and may have received a boost from the introduction of revalidation by the Nursing and Midwifery Council in 2016, nurses and midwives often lack the time and space they need to reflect. Questions are also being asked about how well reflection is taught in universities, why preceptorship programmes – where they exist – make little room for reflective practice, and how deeply reflection is valued, or even understood, in nursing.

Introducing reflective spaces

At the start of the Covid-19 pandemic, the Florence Nightingale Foundation (FNF) decided to provide reflective spaces to allow nurses and midwives to come together with their peers and “decompress” by sharing experiences, with the support of expert facilitators (Stacey, 2021). The aim was, not only to provide a restorative environment, where participants could be heard and have time to think, but to help them learn and develop leadership attributes.

Ongoing informal evaluations suggest these forums are “rare and valued” (Stacey, 2021). However, during the second surge of the pandemic, the FNF found that the protected time to attend the sessions became increasingly scarce, as nurses prioritised the demands of their services over their own need for reflection. In a piece for nursingtimes.net in July 2021, director of the FNF Academy Professor Gemma Stacey, noted: “This is a pattern we often see within our profession and is cited as the primary reason clinical supervision is rarely accessed or sustained. We do not see these same patterns in other health professionals who identify these learning opportunities as central to their ability to practise safely and effectively.” Reflective practice has moved up nursing’s agenda in recent years, but there is concern that it is still something that is beneficial but optional, rather than essential to professional identity and patient safety.

In another piece for nursingtimes.net , Professor Stacey and trade union Unison’s national officer Stuart Tuckwood highlighted the excessive focus on reassessing clinical competencies in preceptorship programmes, and the lack of protected time for reflective practice; it is the latter that supports staff with the “emotional and psychological tensions” associated with making the transition from student to autonomous practitioner (Stacey and Tuckwood, 2021). They called this a “critical oversight and a missed opportunity to embed regular clinical supervision as a [...] professional support [...] for every nurse and midwife throughout their career” (Stacey and Tuckwood, 2021).

The consequences of skimping on support for newly qualified practitioners are serious: 60% of those questioned in a recent survey by Unison said they were considering leaving their jobs because of work pressures; one respondent, a newly qualified nurse, said she had “never felt so lost, scared, stressed and underprepared” (Unison Health, 2021).

A recent position statement from four leading health and care organisations, including the FNF, demanded protected time for nurses and midwives to engage in reflective practice and emphasised that this will “require investment and a concerted whole-system effort” (FNF et al, 2022). Action is needed for safe practice, professional development and to fulfil employers’ ethical commitment to the wellbeing of their staff (FNF et al, 2022).

Making reflection a habit

The essential ingredients of reflection are listed in Box 1. Engaging in regular reflection is important for nurses because it enables them to:

• Make sense of situations that occur in the workplace;
• Manage the personal and professional impact of daily exposure to patients’ fundamental needs (Oelofsen, 2012a).

Box 1. Successful reflection: 10 essential ingredients

• Academic skills
• Attitudinal qualities
• Self-awareness
• Being person centred
• Being empathetic
• Communication
• Mindfulness
• Being process orientated
• Being strategic

Source: Clarke (2017)

However, as the second article in this series noted, “there is no one-size-fits-all model of reflection” (Agnew, 2022). Some individuals embrace group reflective practice as a safe space to share experiences, while others will find such a setting exposing and stressful, but thrive in one-to-one reflective discussions. Some people may feel most comfortable writing a private journal, in which they reflect on their own story. Personality, clinical area and level of seniority can all influence the style of reflection that works best for the individual.

At its heart, it has been suggested that reflective practice is about being curious (Oelofsen, 2012a). The theory behind it can be traced back to the work of educationist John Dewey in the 1930s; he described how reflective thought starts with curiosity about a difficult situation, is open to ambiguity and uncertainty, and concludes with a sense of clarity and understanding (Dewey, 1933).

Along with a “healthy curiosity”, effective reflection is characterised by a “questioning stance” in relation to accepted practices and assumptions (Oelofsen, 2012b). It should lead the practitioner to take a closer look at themselves, their organisation and their practices, which in turn generates “fresh approaches” that can change practice for the better (Oelofsen, 2012b). It is a transformational process, not something that can be done by rote.

The questioning, potentially disruptive, nature of reflection has led some experts to emphasise the need for reflective opportunities to be created outside of governance and supervision processes. The power imbalance between staff members and their supervisors, and the focus on the organisation’s priorities, may inhibit real reflection (Oelofsen, 2012b). Clinicians who deliver care to complex service users may particularly benefit from externally facilitated reflective groups in addition to clinical supervision. Other clinical teams may benefit from attending monthly reflective groups run by facilitators who do not manage them (Oelofsen, 2012b).

“Reflective practice has moved up nursing’s agenda in recent years, but there is concern that it is still something that is beneficial, but optional”

Origins of reflection

Reflective practice has been criticised for failing to live up to its radical origins, set out in the seminal work of John Dewey and Donald Schön (Schön, 1983; Dewey, 1933). The reflective thinking described by Dewey was genuinely transformative, enabling the thinker to “transform a situation in which there is obscurity, doubt, conflict and disturbance of some sort into a situation that is clear, coherent, settled and harmonious” (Rolfe, 2014).

Some modern supporters of reflective practice, keen to reconnect it with its origins, have emphasised that it should challenge practitioners and organisations, and drive change: “At both an individual and organisational level, the impact of reflective practice should be a process of continual questioning of assumptions and accepted ways of doing things, leading to transformation and improvement on an ongoing basis, the epitome of the ‘learning organisation’”(Oelofsen, 2012b).

Gary Rolfe, emeritus professor in the College of Human and Health Sciences at Swansea University, suggested the failure lay not with the idea of reflective practice but with the way in which it has been “misunderstood, misinterpreted and misapplied by managers, theorists, educators and practitioners” (Rolfe, 2014). He called on nurses to stop fixating on reflection on action (analysing past events and actions) and, instead, embrace Schön’s idea of reflection in action, in which the practitioner responds to a situation or event as it is happening through “on-the-spot experimentation” (Rolfe, 2014).

Reflection’s radical nature may have been blunted by being widely, but not deeply or accurately, taught. Nicola Clarke, a senior lecturer at Birmingham City University, whose research has focused on reflective practice and teaching academic skills, suggested – in Clarke (2021) – that the reflective models and frameworks students are required to use are, overall, incorrectly applied. Unfortunately, standard teaching practices “have reduced reflection to a means of meeting the bureaucratic requirement to reflect for placement, assignments and governing body purposes, which is therefore a disservice to both the practice and relationship of students and reflection” (Clarke, 2021).

“Personality, clinical area and level of seniority can all influence the style of reflection that works best for the individual”

Frameworks to support critical thinking

There may be particular problems, Clarke (2021) suggested, with reflective writing for academic purposes, with even Masters-level students with extensive clinical experience often finding it challenging. The familiar reflective models and frameworks – such as Gibbs (1988), Johns (2004) and Driscoll (2007) – were created to support a “cognitive immersion” in the reflective process (often with another person in the form of a “guided dialogue”) (Clarke, 2021); when “enforced” as structures for academic purpose, they can act as a barrier for the student, preventing them from owning their writing (Clarke, 2021).

Clarke (2021) suggested a framework that offers “non-prescriptive scaffolding” to support reflective writing for academic purposes and allow critical, analytical thinking to develop more naturally. The experience, deconstruction, implementation (EDI) framework is designed to help students take ownership of their writing, support creativity and exploration, and meet academic standards. It comprises:

• Experience – paint the picture of your experience (observe yourself in your experience/watch your own film), then tell this narrative to your marker/reader;
• Deconstruction – deconstruct the experience. Provide an introductory paragraph that tells the reader/marker that the deconstruction (analysis) of the experience will occur against the purpose of the brief;
• Implementation – this final section will tell the reader/marker how the reflective piece will inform your future self and explain its meaning/relationship to the assignment brief (Clarke, 2021).

Perception of reflection

Reflection is often viewed as a means to analyse significant events in practice, often when something has gone wrong, so the practitioner can improve their practice and do better next time. However, the association with negative events can act as a barrier to engagement. Nursing students need to know that they can reflect on “absolutely anything” (Clarke, 2021). Reflection makes “no assumptions that the person needs to improve in any way. Students, to engage willingly and enthusiastically, need to know that reflection only makes an assumption that the person reflecting wishes to understand themselves through the generation of new knowledge from analysis of any experience” (Clarke, 2021).

Nurses may also benefit from knowing that reflection is freer and kinder than is often thought to be the case: “When fully engaged in the reflective process, the experience can be humbling as we realise we are perhaps not what we assumed ourselves to be, yet also rewarding as we confirm that our best may have, at that time, been good enough” (Clarke, 2017).

As this series of articles has shown, to engage fully with reflection, nurses need different opportunities to reflect that suit their roles, level of seniority and personal preferences, and that do not automatically give way to service pressures. It is important to recognise that making reflection meaningful requires commitment, not just from individual practitioners, but also from employers, regulators and policy makers.

Given the enormous pressures on nurses and midwives, and the urgent need to support them to stay in the workforce, employers and other relevant organisations would be well advised to heed this message.

• Reflection is increasingly promoted as essential to nurses’ practice and wellbeing
• Many nurses prioritise service demands and lack the time they need to reflect
• The nursing profession still undervalues reflective practice
• There is concern that reflection is often poorly taught and misunderstood
• Work is under way to make reflective practice more accessible

Also in this series

• Reflective practice 1: aims, principles and role in revalidation
• Reflective practice 2: improving nurses’ mental health and wellbeing

Don't miss more great clinical content from Nursing Times NT Bitesize learning videos – helping you to organise learning to fit in with your schedule Clinical zones – keep up to date with articles in your clinical subject or nursing role/setting CPD zone – user-friendly online learning units on fundamental aspects of nursing Journal Club – clinical articles with discussion handouts for participatory CPD Practical Procedures – 'how to' guides and teaching materials for clinical procedures Self-assessment – clinical articles with linked online assessments for bitesize CPD Systems of Life – applied anatomy and physiology to support your practice

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Postgraduate Advanced Clinical Education (PACE) study support guide: 6.2 Reflective practice & writing

• 1. University jargon-buster
• 2. Library resources
• 3. Literature searching
• 4. Plagiarism
• 5.1 Using EndNote
• 6.1 Academic writing
• 6.2 Reflective practice & writing
• 6.3 Understanding feedback
• 6.4 Presentations
• 6.5 Preparing for exams and OSCEs

Reflective thinking is essential for success in unpredictable and complex situations such as working in healthcare.  Reflective thinking helps you to:

• Develop a questioning attitude and new perspectives
• Identify areas for change and improvement
• Respond effectively to new challenges
• Generalise and apply what you have learned from one situation to other situations

You will be asked to think reflectively when completing assignments that draw on your experience in the workplace, or when considering your own skills and experience and where you might need to develop.  Being able to think reflectively is an important transferrable skill that will help you to showcase your learning to the programme team, but also provide the skill of being a reflective healthcare practitioner.

Reflection will enable you to consider aspects of your practice in depth. By using a structured approach, you will be expected to describe and critically analyse an incident which is significant to your learning. Reflection is an important stage in effective learning and reflective practice is an integral part of continuing professional development (CPD) for health care professionals. Successful reflection enables self-awareness, personal and professional growth and it is important to develop these skills as a healthcare professional. A reflective account documents the way you have thought about and experienced a particular event or experience.

In all cases reflection is an active process that involves reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice. Reflective skills can include the ability to be:

• descriptive
• constructively evaluative

In a clinical working environment, this process should be continuous or cyclical, i.e. actions continually reviewed in light of most recent developments but may also be sparked by a particular event or experience.

You will also have access to resources from your regulator (GPhC, HCPC or NMC) on the role of reflection and revalidation which will help you link reflective practice to your registration.  If you are a member of your professional leadership body (e.g. RPS, RCN, CoP, CSP) they often have resources you can also access to support your development.

Developing reflective skills

• Developing your reflective insights
• Using theory & evidence
• Videos on reflection

Be prepared to:

• Stand back from the events and try to be objective
• Be critical of your own actions
• Think of alternative explanations of events
• Make use of evidence from a range of sources e.g. theories
• Recognise that your own point of view will change with time
• Discuss with others to deepen your insight and explore a range of perspectives

Reflective questions to ask yourself

• Why did I respond in this way?
• What was I thinking and feeling - did this influence me, and why?
• What was the client thinking and feeling, what is the evidence for this?
• What else could I have done?
• What would I do in a similar situation?

Consider the following

• How does my experience compare to what I have read? Are there any theories that would help explain what happened?
• What might be the results of doing things differently? What evidence is there to show things might change if done differently?
• How has the experience changed my understanding?

Keep comparing theory to practice and exploring the relationship between the two

Assignments involving reflective thinking often ask you to refer to both relevant  theories ,  evidence  and your  own experiences , but what does this mean? Academic theories and your professional observations are both evidence that you need to use to support your points, but they are different types of evidence:

Academic theories  provide a generalised model or framework to help you understand what might be happening in a situation - the reflective model discussed in this section are examples of theoretical models - they gives you a structure to compare your own experiences to and language to help you explain what is happening

Evidence  provides a means to compare your understanding of the situation to published evidence to analyse your real-life experiences.  These might be papers, journals, books, guidelines or good practice recommendations - evidence is something you can reference to critique your experience against.

Your own experiences  are what happens in practice; these may be more complex and richer than the evidence or theories, but it can be harder to see what is relevant. By analsying your experiences using a theory (i.e. a reflective model), you can develop some more insightful explanations for what happened. Also, use your own experiences to interrogate and question the evidence - does it fit what happened? If not, why? Does the evidence only explain part of the story? Does the evidence need to be adapted for different situations?

The Art of Reflection

This video was developed by Cardiff University to help their students develop reflective skills (5 min 19 sec).

Introduction to Reflective Practice

This short video (2 mins 42 sec) was produced by the Chartered Institute of Personnel and Development (CIPD) gives a brief introduction to reflective practice.

Reflective writing

• Assessed reflection
• Gibbs model
• Analytical not critical

What is reflective writing?

Reflective writing involves an exploration and explanation of an event. It may feel particularly difficult and more challenging than other forms of academic writing as it involves thinking and writing about anxieties and errors as well as successes in your interactions with an individual or when carrying out a practical task. Try to stand back from the situation and be as objective as possible. Although you are writing about your own experiences and feelings, you need to be as rigorous and thorough as you would be for any other assignment.

Reflective writing is a way of processing your practice-based experience to produce learning. It has two key features:

• It integrates theory and practice. Identify important aspects of your reflections and write these using the appropriate theories and academic context to explain and interpret your reflections. Use your experiences to evaluate the theories - can the theories be adapted or modified to be more helpful for your situation?
• It identifies the learning outcomes of your experience. So you might include a plan for next time identifying what you would do differently, your new understandings or values and unexpected things you have learnt about yourself.

Approaching reflective writing

It is a common misconception that reflective writing is describing an event, it requires much more depth and largely focusses on the analysis of the event/experience/learning/topic.  There are some tips in the box on the right about the questions you can ask yourself which encourage reflective thinking.  Being about to reflect on your own practice is a key skill as a competent healthcare professional - analysing how you react to situations and the impact they have had on your learning and development are the key aims.  When done well, reflective writing can help develop a better understanding of your strengths and weaknesses, challenge your own assumptions and biases to provide better patient care, deal with you own anxieties, support a learning plan and allow you to understand your own values and beliefs.

Topics for reflective writing

There are too many topics to list here, but almost any healthcare related experience can be used for reflective writing.  Common examples include:

• Analysis of experiences in your workplace with a patient and/or another healthcare professional
• Retrospective analysis of an incident in which you were involved
• Analysis of a past experience that relates to your current situation studying for this module
• Analysis of learning you have undertaken related to the module

Reflective writing will take many forms throughout the PACE modules and programmes.  You should refer to the assessment criteria for the piece of coursework to identify the expectations. Some coursework will be a specific reflective essay or you might need to reflect on a topic/event/experience as a much smaller part of a piece of coursework.  Do not forget in professional exams you will also be required to reflect verbally on your learning, experiences and/or performance.

Follow the guidelines for your module. There is likely to be a word limit: you cannot write about everything, so select what will illustrate your discussion best. Remember that most of the marks awarded for your work are likely to be for the reflective insights and not for the description of events, so keep your descriptions brief and to the point.

Gibbs' reflective cycle

This model was developed in the 1980's by Graham Gibbs and is widely used because of the clear framework and depth of reflection are well suited to coursework tasks.  It has six stages:

• Description - 
• Feelings - 
• Evaluation - 
• Analysis - 
• Conclusion - 
• Action plan -

However, this model has some disadvantages in that it is introspective and tends to focus on the writer. In some postgraduate study it it necessary to demonstrate critical analysis and reflexive skills in your reflective essay writing. You need to show how you are developing new perspectives and to do this you will need to refer to the available literature. So we have adapted Gibbs by using the work of Atkins and Murphy (1993) to ensure you take a robust academic approach: 

• Description - a simple description of the incident or case
• Feelings - use reflexivity to consider how you felt about the situation 
• Evaluation - use criticality to decide the main focus points and assign a value (good or bad) and then consider the wider concepts around these points. See examples in the 'Analytical not critical' tab in this box.
• Analysis - analyse each concept using the relevant literature.  (e.g. Why did the problem arise ? What wider systems were involved? What are the main concepts to be considered? What does the evidence tell us about the impact of such systems problems and concepts? 
• Conclusion - this is where new perspectives can be consolidated. 
• Action plan - what will need to happen now? This plan will need to specify your actions in the change process. .

Make sure that you read the assignment brief carefully and check with the course handbook to understand what is expected for each individual assignment. If you are unsure, please ask your tutor.

How to write reflectively

• This will be one of the only assessments in which you can use the  first person , critiquing your own practice cannot be done in the third person - this does not mean it should be written informally
• You may find that you write your account in a mixture of tenses, again this is unusual for coursework but describing the situation in the past tense and analysing it in the present tense will allow the writing to flow more structurally
• Where you describe future events think about how you use the words  could ,  would, might  and  will -  what is the tense and how does that affect your hypothetical arguments?
• If you are writing a fully reflective account, rather than part of a bigger piece of work, ensure your description is less than a third of the total length - you should concisely describe the situation for context but this is not a case study where each small detail is important
• Do not be judgemental - you must remain professional in how you describe and analyse events

Getting the language right

As a large proportion of your reflective account is based on your own experience, it is normally appropriate to use the first person ('I'). However, most assignments containing reflective writing will also include academic writing. You are therefore likely to need to write both in the first person ("I felt…") and in the third person ("Smith (2009) proposes that …"). Identify which parts of your experience you are being asked to reflect on and use this as a guide to when to use the first person.

You will produce a balance by weaving together sections of 'I thought… 'I felt,…' and the relevant evidence in the same section or paragraph. This is more effective than having a section which deals with the evidence and a separate section dealing with your experiences.

Try to avoid emotive or subjective terms. Even though you are drawing on your experiences (and they may well have been emotional), you are trying to communicate these to your reader in an academic style. This means using descriptions that everyone would understand in the same way. So rather than writing, "The patient was very unhappy at the start of the session", it might be better to write, "The patient was visibly distressed", or "The patient reported that he was very unhappy". This shows that you are aware that the patient's understanding of 'unhappiness' may be quite different from yours or your reader's.  

When writing about your reflections use the past tense as you are referring to a particular moment (I felt…). When referring to theory use the present tense as the ideas are still current (Smith proposes that...).

Try to move beyond being critical and think about being analytical - use your feelings to ask questions and challenge assumptions, where you can then draw in evidence from the module this will move towards excellence in reflection

Read the example statements below and  think about how they demonstrate moving from descriptive to analytical to self-reflective:

Example 1:  I identified a prescribing error and asked the doctor to re-prescribe it.  They stated I was wrong and the prescription was correct.  I checked the BNF and they were right as the BNF I had was out of date.  The literature states that 50% of these errors are due to incorrect resources (source).

Example 2:  I identified a prescribing error but when I asked the doctor to re-prescribe the medicine, it transpired I was wrong and the original prescription was correct.  I was embarrassed that I had not correctly reviewed the prescription and need to remember to use the most up to date reference sources in my practice.  I have looked at the literature on prescribing errors and was surprised that 50% of errors are due to incorrect resources (source)

Example 3 : I identified a prescribing error but when I asked the doctor to re-prescribe the medicine, it transpired I was wrong and the original prescription was correct.  I was embarrassed that I had made such an error and the doctor appeared frustrated that I had wasted their time.  It is important that all prescriptions are checked before administration and it is key in my role to do so thoroughly.  I have spent a lot of time building a relationship with the multi-disciplinary team to show my advancing knowledge and I feel this has set back their confidence in me.  It is my responsibility to ensure I have the correct resources to do my job well and on this occasion I felt under pressure to give a quick answer.  This made me reflect on how external factors can influence the quality of patient care.  In analysing prescribing errors I was surprised that 50% of errors were due to incorrect references but following this experience, I understand how they occur and I must safeguard my practice to prevent it recurring (source).

Example 4 : I identified a prescribing error but when I asked the doctor to re-prescribe the medicine, it transpired I was wrong and the original prescription was correct.  I was embarrassed that I had made such an error and the doctor appeared frustrated that I had wasted their time. It is important that all prescriptions are checked before administration and it is key in my role to do so thoroughly. I have spent a lot of time building a relationship with the multi-disciplinary team to show my advancing knowledge and I feel this has set back their confidence in me. This made me think about prescribing errors and how 50% of errors are due to incorrect or out of date information sources (source). However, although I recognise that it was part of my role responsibility to ensure I use up to date resources (source), I began to reflect on team relationships and how they impact team function and support. Author (source) explored the hierarchy of MDT membership and discovered that certain professions tend to regard their positions as more senior to others within any MDT. This impacted the ability of team members to questions the actions of other team members. This positional hierarchy seemed to be based on perceived value of qualification; medical qualification being most often seen as the most valuable. The concept of professional value is seen in the work of Author (source) who found that historical professional power had a significant impact on decision making within MDTs, with particular regard to accepting questions on clinical decisions from other team members. I realised that my own position within the team could be perceived, by some, as being less valuable in a prescribing setting. I have decided to speak to my manager and ask her to consider two things: firstly how we can make sure all the team have access to the most up to date information and secondly, how we offer and react to constructive criticism in the clinical setting (source). 

NB (source) would be an in-text citation for the relevant reference and a full reference would be given at the end in the Vancouver or Harvard style.

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Reflective practice: a critical analysis of data-based studies and implications for nursing education

Affiliation.

• 1 Lancaster Institute for Health Education, School of Nursing, Lancaster, Pennsylvania, USA. [email protected]
• PMID: 14626387
• DOI: 10.3928/0148-4834-20031101-07

Reflective practice has become part of the discourse of nursing education classrooms, conferences, and journals, and are popular features of nursing continuing education programs. Yet, the idea of reflective practice has become increasingly more disparate. This critical analysis examines data-based studies and provides an overview of reflective practice, discusses common themes that emerged from the studies, and identifies implications for reflective practice in the field of nursing education.

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Reflective practice of nurse residents in the teaching-learning process in teaching hospitals

Práctica reflexiva de residentes de enfermería en el proceso de enseñanza-aprendizaje en hospitales de enseñanza.

To analyze reflective practice in the teaching-learning process of nurses in residency programs in teaching hospitals in Minas Gerais, Brazil.

Case study, based on the reflective practice framework, conducted in two teaching hospitals. Observation and interviews were conducted with first and second-year residents, and five participants were included for in-depth analysis, with their data subjected to frequency distribution analysis and Critical Discourse Analysis.

In 519 observed activities, elements of reflection were identified in 22.2%, especially active listening and expression of doubts. Discourses indicated practice as the best moment for teaching-learning due to its potential to generate reflections. Learning by doing and case discussion were considered potential strategies for reflective learning.

Conclusion:

Know-in-action reflection was evidenced as the predominant formative aspect for residents, with few opportunities for reflection on reflection-in-action.

Descriptors: Learning; Nurses; Hospitals, Teaching; Professional Practice; Preceptorship

Analizar la práctica reflexiva en el proceso de enseñanza-aprendizaje de enfermeras en programas de residencia en hospitales de enseñanza en Minas Gerais, Brasil.

Estudio de caso, basado en el marco de la práctica reflexiva, realizado en dos hospitales de enseñanza. Se realizaron observaciones y entrevistas con residentes de primero y segundo año, y se incluyeron cinco participantes para un análisis en profundidad, cuyos datos fueron sometidos a análisis de distribución de frecuencia y Análisis Crítico del Discurso.

Resultados:

En 519 actividades observadas, se identificaron elementos de reflexión en un 22.2%, especialmente la escucha activa y la expresión de dudas. Los discursos indicaron que la práctica es el mejor momento para el aprendizaje debido a su potencial para generar reflexiones. Aprender haciendo y la discusión de casos fueron consideradas estrategias potenciales para el aprendizaje reflexivo.

Se evidenció que la reflexión sobre la acción es el aspecto formativo predominante para los residentes, con pocas oportunidades para reflexionar sobre la reflexión en la acción.

Descriptores: Aprendizaje; Enfermeras y Enfermeros; Hospitales de Enseñanza; Práctica Profesional; Preceptoría

Analisar a prática reflexiva no processo ensino-aprendizagem de enfermeiros em programas de residência em hospitais de ensino de Minas Gerais, Brasil.

Estudo de caso, baseado no referencial da prática reflexiva, desenvolvido em dois hospitais de ensino. Realizaram-se observação e entrevista de residentes do primeiro e segundo ano, e incluídos, para análise em profundidade, cinco participantes, cujos dados foram submetidos à análise de distribuição de frequência e à Análise do Discurso Crítica.

Em 519 atividades observadas, houve identificação de elementos de reflexão em 22,2%, especialmente escuta com atenção operativa e expressão de dúvidas. Os discursos indicaram a prática como o melhor momento para o ensino-aprendizagem pelo potencial de produzir reflexões. Aprender fazendo e discussão de casos foram consideradas estratégias potenciais para a aprendizagem reflexiva.

Considerações Finais:

Evidenciou-se a reflexão conhecer-na-ação como a predominante na formação dos residentes, com poucas oportunidades para reflexão sobre a reflexão-na-ação.

Descritores: Aprendizagem; Enfermeiras e Enfermeiros; Hospitais de Ensino; Prática Profissional; Preceptoria

INTRODUCTION

Professional Health Area Residency, established by Law No. 11,129 of 2005, is characterized as service education aimed at healthcare professionals, with the exception of the medical category( 1 1 Presidência da República (BR). Lei nº 11.129, de 30 de junho de 2005. Institui o Programa Nacional de Inclusão de Jovens - ProJovem; cria o Conselho Nacional da Juventude - CNJ e a Secretaria Nacional de Juventude; altera as Leis nº s 10.683, de 28 de maio de 2003, e 10.429, de 24 de abril de 2002; e dá outras providências [Internet]. Diário Oficial da União. 2005 [cited 2023 Dec 10]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/lei/l11129.htm https://www.planalto.gov.br/ccivil_03/_a... ). It plays a pivotal role in specialist training, aligned with the principles and guidelines of the Brazilian Unified Health System (SUS in Portuguese), and proposes the integration of theory and practice to foster critical reflection among residents regarding their experienced reality( 2 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 https://doi.org/10.1590/0034-7167-2022-0... , 3 3 Netto L, Silva KL, Rua MS. Reflective practice and vocational training: theoretical approaches in the field of Health and Nursing. Esc Anna Nery. 2018;22(1):e20170309. https://doi.org/10.1590/2177-9465-EAN-2017-0309 https://doi.org/10.1590/2177-9465-EAN-20... ).

The implementation of Professional Health Area Residency Programs (PHARPs) in Brazil dates back over 10 years. However, studies indicate challenges related to the residents’ training process that still need to be overcome. Among these challenges are the traditional teaching model, the centrality of medical knowledge, the lack of interaction among healthcare professionals, fragmented and disconnected practices from the patient’s social context, and the inadequacy of professionals for preceptorship and critical, reflective teaching on professional practice experiences( 2 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 https://doi.org/10.1590/0034-7167-2022-0... , 4 4 Blanco VM, Leonello VM, Souza CMS, Vasconcelos RO, Agreli HF. Health residency programs in a university hospital: a potent training setting for interprofessional collaborative practice. Interface (Botucatu). 2023;27: e220320. https://doi.org/10.1590/interface.230305 https://doi.org/10.1590/interface.230305... , 5 5 Maroja MCS, Almedia Júnior JJ, Noronha CA. Os desafios da formação problematizadora para profissionais de saúde em um programa de residência multiprofissional. Interface (Botucatu). 2020;24:e180616. https://doi.org/10.1590/Interface.180616 https://doi.org/10.1590/Interface.180616... ).

In this sense, evidence suggests that resident training is oriented towards a biologistic model, where the patient’s view is reductionist and fragmented, emphasizing technical skills over relational ones, thus placing the student in a passive role( 2 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 https://doi.org/10.1590/0034-7167-2022-0... , 4 4 Blanco VM, Leonello VM, Souza CMS, Vasconcelos RO, Agreli HF. Health residency programs in a university hospital: a potent training setting for interprofessional collaborative practice. Interface (Botucatu). 2023;27: e220320. https://doi.org/10.1590/interface.230305 https://doi.org/10.1590/interface.230305... , 5 5 Maroja MCS, Almedia Júnior JJ, Noronha CA. Os desafios da formação problematizadora para profissionais de saúde em um programa de residência multiprofissional. Interface (Botucatu). 2020;24:e180616. https://doi.org/10.1590/Interface.180616 https://doi.org/10.1590/Interface.180616... ). Consequently, reflective practice in the teaching-learning process of PHARPs is weakened, focusing on procedures, technique repetition, and knowledge transmission, with limited theoretical discussion and little interaction between preceptor-tutor and service-based teaching. Additionally, the presence of preceptors without pedagogical training who juggle multiple roles and sometimes do not identify with the role of healthcare educators is noted. This creates a cycle of task transfer to residents, impacting their learning.

In this context, the question arises: How does reflective practice occur in the teaching-learning process of nurses in residency programs? What elements of reflective practice are revealed in this process? Investigating reflective practice in the teaching-learning process of nurses in PHARPs is justified by the relevance of this formative process in shaping critical and creative professionals who reflect on and about their actions. There is recognition of the role of residencies as a defense and training strategy for SUS. Therefore, the study results can strengthen this teaching model and contribute to the reformulation of PHARP pedagogical projects.

The current research is grounded in Donald Schon’s theoretical framework concerning reflective practice within the teaching-learning process( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ). According to Schon, professional training still leans towards technical and scientific prowess, centered on the Cartesian model, where theory is detached from practice, with the latter viewed as a byproduct of theoretical education. This approach fails to cultivate creative professionals capable of meeting workforce demands( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ).

From this standpoint, an alignment between theory and practice is advocated for professional training in reflective teaching. This approach encourages reflective capacity through teacher-student interaction across various practical scenarios, emphasizing learning by doing. The framework of reflective practice posits that effective professional performance arises solely from reflecting on uncertain and conflicting situations encountered in daily practice( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ).

It’s noteworthy that literature on reflective practice, as proposed by Donald Schön, within the teaching-learning process of nursing residency programs, remains scant nationally( 2 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 https://doi.org/10.1590/0034-7167-2022-0... , 3 3 Netto L, Silva KL, Rua MS. Reflective practice and vocational training: theoretical approaches in the field of Health and Nursing. Esc Anna Nery. 2018;22(1):e20170309. https://doi.org/10.1590/2177-9465-EAN-2017-0309 https://doi.org/10.1590/2177-9465-EAN-20... , 7 7 Assad SGB, Valente GSC, Santos SCP, Cortez EA. Training and practice of nurses in Primary Care management: perspectives of Schön’s Theory. Rev Bras Enferm. 2021;74(3):e20200461. https://doi.org/10.1590/0034-7167-2020-0461 https://doi.org/10.1590/0034-7167-2020-0... , 8 8 Vieira ATG, Silva LB. Educação interprofissional na Atenção Básica: um estudo cartográfico da formação de residentes em Saúde. Interface (Botucatu). 2022;26: e210090 https://doi.org/10.1590/interface.210090 https://doi.org/10.1590/interface.210090... , 9 9 Lopes RE, Silva AC, Nóbrega-Therrien S. M. Formação reflexiva no ensino da enfermagem: discussão à luz de Schön. Cad Pesqui (São Luis). 2015;22(1):47-58. https://doi.org/10.18764/2178-2229.v22.n1.p.47-58 https://doi.org/10.18764/2178-2229.v22.n... , 10 10 Lima MM, Reibnitz KS, Kloh D, Silva KL, Ferraz F. Relação pedagógica no ensino prático-reflexivo: elementos característicos do ensino da integralidade na formação do enfermeiro. Texto Contexto Enferm. 2018;27(2):e1810016. https://doi.org/10.1590/0104-070720180001810016 https://doi.org/10.1590/0104-07072018000... , 11 11 Oliveira SN, Martini JG, Caravaca-Morera JA, Prado ML, Canever BP, Bortolato MC, et al. Debriefing, a dialogical space for the development of reflective thinking in nursing. Rev Gaúcha Enferm. 2024;45:e20230041. https://doi.org/10.1590/1983-1447.2024.20230041.pt https://doi.org/10.1590/1983-1447.2024.2... , 12 12 Souza VR, Marziale MH, Silva GT, Nascimento PL. Translation and validation into Brazilian Portuguese and assessment of the COREQ checklist. Acta Paul Enferm. 2021;34:eAPE02631. http://dx.doi.org/10.37689/acta-ape/2021ao02631 http://dx.doi.org/10.37689/acta-ape/2021... , 13 13 Polit DF, Beck CT. Fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática de enfermagem. 9a. ed. Porto Alegre: Artmed; 2019. ). Studies primarily focus on preceptor training, residents’ and preceptors’ perceptions of the teaching-learning process in PHARPs, alongside interprofessional and continuing education within PHARPs. Hence, there persists a necessity to scrutinize the teaching-learning process in PHARPs, underpinned by a theoretical framework that bolsters the residency’s intrinsic principles, particularly reflective practical experience.

To analyze reflective practice in the teaching-learning process of nurses in residency programs at teaching hospitals in Minas Gerais, Brazil.

Ethical aspects

This research was approved in 2021 by the Research Ethics Committee of the Federal University of Minas Gerais, in compliance with the ethical principles of Resolution 466/2012. Participants signed an Informed Consent Form and were coded to ensure confidentiality and anonymity.

Study design

This is a qualitative study, specifically a single-case study. Reflective practice in the teaching-learning process of nurses in residency programs was defined as the case. The criteria proposed by the Consolidated Criteria for Reporting Qualitative Research (COREQ)( 12 12 Souza VR, Marziale MH, Silva GT, Nascimento PL. Translation and validation into Brazilian Portuguese and assessment of the COREQ checklist. Acta Paul Enferm. 2021;34:eAPE02631. http://dx.doi.org/10.37689/acta-ape/2021ao02631 http://dx.doi.org/10.37689/acta-ape/2021... ) were adopted.

Methodological procedures

This study is part of a doctoral thesis conducted in three phases: document analysis, peripheral participant observation, and semi-structured interviews( 13 13 Polit DF, Beck CT. Fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática de enfermagem. 9a. ed. Porto Alegre: Artmed; 2019. ), forming a data triangulation approach for the case study. This article presents data from observation and interviews.

Study setting

The context of the case where reflective practice in the teaching-learning process occurs was the uniprofessional and multiprofessional PHARPs. The units of analysis were two teaching hospitals located in Minas Gerais, Brazil. One hospital, referred to as Unit of Analysis 1, is a general hospital specializing in trauma care, offering multiprofessional PHARPs in elderly health and uniprofessional PHARPs in Intensive Care, Emergency, and Trauma; the other, referred to as Unit of Analysis 2, specializes in women’s health with a uniprofessional PHARP in obstetric nursing.

Data source

The study population consisted of 47 nursing residents, out of the 53 enrolled in PHARPs at the scenario hospitals, after applying exclusion criteria. Three residents from the obstetric nursing PHARP were on medical leave during the data collection period; one first-year resident of the elderly health PHARP contributed to the pilot test; and two second-year residents of the elderly health PHARP withdrew from the specialization at the time of data collection.

For participant selection, a non-probabilistic method of proportional stratified random sampling was used to enhance sample representativeness( 13 13 Polit DF, Beck CT. Fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática de enfermagem. 9a. ed. Porto Alegre: Artmed; 2019. ). The population was divided into homogeneous groups: one stratum for first-year residents and another for second-year residents, considering that reflective practice progresses during professional training. Data collection was halted upon thematic saturation, confirmed by the identification of redundancy and recurrence of information. This saturation model observes the recurrence of codes or themes identified, as exemplified in the data( 14 14 Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-907. https://doi.org/10.1007/s11135-017-0574-8 https://doi.org/10.1007/s11135-017-0574-... ). This process was confirmed through the reading and pre-analysis of each collected material regarding the participants individually, after the inclusion of three first-year residents and two second-year residents.

Chart 1 presents the study population and the distribution of residents according to the units of analysis.

Data collection and organization

Data collection occurred from August 2022 to July 2023. Prior to this, a pilot study was conducted. A 2-hour observation was followed by a 10-minute and 36-second interview with a first-year resident of the Elderly Health PHARP. At the observation’s conclusion, the applicability of the proposed observation script was confirmed. Regarding the interview, adjustments were made to ensure the resident’s comprehension of the questions. After revision, the questions underwent testing in a new pilot interview, where their applicability was once again confirmed. Data from the pilot study were not included in the final research.

During observation, the focus was on reflective practice from the resident’s perspective. Residents were individually observed to identify teaching-learning scenarios. Upon identification, notes were recorded in a researcher’s digital diary, including: (1) a description of the observed activity; (2) elements of reflective practice expressed by the resident; (3) actors who enhanced this reflection; and (4) moments when these teaching-learning scenarios occurred, whether during a practical activity, theory, case study, or tutoring.

It is crucial to emphasize that students demonstrate reflection through their performances (6). Thus, while observing residents, the researcher identified some indicators of reflective performance in situations where the student: (1) was surprised by something; (2) paused during the execution of an activity, accompanied by silence; (3) commented or criticized something about the activity; (4) listened with focused attention; and (5) expressed doubts. These indicators were termed as elements of reflective practice in the research.

This stage resulted in the observation of five residents for a total of 156 hours and 10 minutes. Observations took place on weekdays and weekends, during morning and afternoon shifts. The average daily observation time was 6 hours, with each resident observed for approximately 31 hours.

After completing all observations of each resident, interviews with the respective students followed. The interviews were guided by a semi-structured script containing brief descriptions of the teaching-learning scenarios observed by the researcher during data collection. Based on these descriptions, residents were prompted to reflect on their perceptions of the scene, as well as on factors that facilitated or hindered reflexivity in that situation and in other teaching-learning moments. The interviews with the five observed residents were audio-recorded, with an average duration of 19 minutes and 25 seconds, totaling 1 hour, 37 minutes, and 5 seconds.

Data analysis

To ensure anonymity, each resident was assigned a code (R1, R2, R3, R4, and R5), which remained consistent across both observation and interview phases. Observation data were organized in an Excel spreadsheet, where the activities performed by the residents and observed by the researcher were described. Each activity was named and analyzed to identify elements of reflective practice expressed by the resident, actors that enhanced this reflection, and the stage of the teaching-learning process in which the activity occurred. Upon completing the description and analysis of activities performed by the five residents during the 156 hours and 10 minutes of observation, the researcher proceeded to compile and analyze the data using absolute and relative frequency distribution.

Interviews were transcribed using the InqScribe software, in its free version. To indicate speaker overlaps, pauses, silences, intonation, interruptions, and incomprehensible passages in the text, transcription conventions by Marcuschi( 15 15 Marcuschi LA. Análise da conversação. São Paulo: Ática; 1986. ) were adopted. These conventions not only express speech but also non-verbal elements capable of demonstrating reflection, such as pauses, silences, gestures typical of surprise, and attention.

Critical Discourse Analysis was conducted from Fairclough’s perspective( 16 16 Fairclough N. Discurso e mudança social. 2a. ed. Brasília: Editora UNB; 2016. ) to analyze empirical data based on the manifest content in the discourses, correlating them with the theoretical framework. Operationally, an analytical matrix was developed to extract data from each interview, which was meticulously examined, identifying discursive elements line by line, paragraph by paragraph. Following this step, vertical reading of each axis and transversal reading of the material were conducted, aiming to understand in-depth the corpus of analysis that would allow the reconstruction of knowledge about the phenomenon in question.

The residents participating in the study had an average undergraduate training period of 2.6 years and were all in their first specialization course. Only two of them had previous professional experience before joining the PHARPs.

During 156 hours and 10 minutes of observation, 519 activities performed by the residents throughout their respective PHARPs were analyzed. These activities were categorized into four teaching-learning moments: practical activity, theoretical activity, case study, and tutoring ( Table 1 ).

519 activities were categorized into 30 types, as shown in Table 2 , highlighting the number of activities in which at least one element of reflective practice was identified. Additionally, Table 2 presents the 13 categories of elements of reflective practice observed in the activities performed by the residents: a. attentive listening (43); b. expressing doubts (34); c. commenting or criticizing something about the activity (19); d. association (18); e. exchanging ideas/discussion (18); f. pausing during activity execution, accompanied by silence (9); g. detecting the need to change or do something different during or after the action (8); h. explaining the activity itself (7); i. insight (7); j. investigation (6); k. evaluating what was done (5); l. being surprised by something (5); m. comparison (4).

Through Table 2 , seven activities are highlighted in which residents, in 100% of the scenes, expressed at least one reflective element. Of the seven identified, two were categorized as case study teaching-learning moments (participation in presentations and discussion of case studies); two as theoretical activities (giving and attending presentations of works); and one as tutoring (group discussion). The remaining two activities were classified as practical activities, as they occurred within the designated time frame for such activities. However, it is important to note that the elaboration of the Residency Conclusion Work (TCR) and case study are activities associated with tutoring and case study moments, respectively. Therefore, none of the seven identified activities is directly related to practical activity.

Attentive listening was the most commonly expressed reflective element by residents, followed by the elements “expressing doubts” and “commenting or criticizing something about the activity.” Evaluation of what was done, being surprised by something, and comparison were the least expressed elements by residents.

Residents themselves, through self-reflection, were the ones who most enhanced reflection (42.9%), followed by preceptors (25.8%) and nursing resident colleagues (9.2%). Tutors (1.2%), patients (1.2%), and teachers (0.6%) were the actors who least enhanced residents’ reflection.

The activity with the highest observation frequency was patient assessment, with 91 observed scenes, of which, in 14 (15.4%), there was identification of nine types of reflective practice elements and six actors stimulating reflection. The element “expressing doubts” stood out, repeated on seven occasions, and residents engaged in “self-reflection” in nine situations.

The activity of nursing prescription or records was the second most observed, with 73 scenes, of which, in seven (9.6%), there was detection of seven types of reflection elements, with three actors enhancing reflection. The relationship between the highest frequency of activity execution and the low number of reflection element identification is consistent with R1’s discourse. In an interview, the participant characterized this process as “tiring” and “repetitive.” Using the argumentative operator “but,” R1 established an adversative relationship about the nursing record activity, stating that, in their journey as a resident, they initially enjoyed evolving patients, but now consider the activity repetitive:

[...] evolving is something I used to really enjoy doing before. But nowadays, it’s, it’s becoming tiresome for me, you know? Evolving. Because it’s very repetitive. That repetitive stuff. (R1)

This discourse differs from R2’s statement, who indicated nursing recording as the activity that most stimulates reflection. The resident perceived the activity as an opportunity to read the progress notes of the multidisciplinary team and understand the patient’s medical history.

I think it’s when I’m at, at the computer to UPDATE, and then, I always try to see what other professionals’ approach is to that patient too. So, I have my care. And then, I try to see, yeah, to really understand, like, the whole context of the patient, right? So, I think that, like, when I’m really (+). I’m going to... I assess my patient and I’m going to sit down to update, I try to understand his whole story, right? So, I think it’s more when I’m in front of the computer. (R2)

Furthermore, the residents mentioned learning by doing as a teaching and learning strategy:

[...] the teaching-learning technique is like this: “hum, I’ve never done this before. I’m going to do it”. So, I get my hands dirty and do it, you know? (R1)

And then, I see a lot that it’s like that. Sometimes, we’re there in assistance, we learn a lot from that, that doing. Solving that problem, right? And not always understanding what’s behind it. But we do learn, yes. (R2)

In the first excerpt, the teaching and learning strategy “learning by doing” was considered commonplace. The argumentative operator “but”, used by R2 in the last excerpt, illustrates that even without fully understanding “this doing,” he was still able to learn. Furthermore, R2 highlighted the discussion of clinical cases as a potential strategy for teaching and learning. This assertion is supported by the discursive elements “strategy (that) might be better, that would add more, fix the knowledge better.” Thus, the need for preceptor involvement in discussions is reaffirmed, aiming to take a more active role in the process.

And then, I think (+) a strategy [that] might be better, that would add more, would better solidify the knowledge, would be discussions in, um, within the department itself, you know? It’s, involving, um, actual discussion ABOUT the patient’s clinical situation, um, from both the resident’s perspective and the preceptor’s perspective, even. (R2)

R1 also emphasized the importance of case discussions beyond the moments of residents’ doubts, stressing the need to “deepen” and “better understand his (patient’s) case”.

Sometimes, I miss more of us sitting down and preceptor and, and resident, and discussing the cases more, you know? Not just, not just when we need to [...]. [...] sometimes there are patients that we can’t delve into, like, understand their case better, you know? [...] I miss this discussion, more like, working more on this issue of nursing diagnoses, interventions, not being kinda just that, the repetitive situation, you know? (R1)

In the interviews with R3 and R4, the expression of some reflection elements, such as expressing doubts, is noticeable.

I always go to a preceptor to clear up my doubts, always. (R3)

Usually, I feel quite comfortable, um, for example, if I have any doubts, to ask. (R4)

In this context, the term “doubt” was mentioned 11 times in R2’s discourse, correlated with the act of doing and operating as an ideological rationalization to justify the set of relationships; that is, from doubt, R2 refrains from acting and then seeks guidance from the preceptor.

I remember exactly that my doubt, actually, was whether I could try washing or if I had to aspirate. So I preferred not to do it. But that’s it. I think in... Generally, we find ourselves in situations, like, of doubt really... And then, we need the preceptor’s help. (R2)

In terms of actors, the residents themselves engaging in self-reflection (38%) were the ones who most enhanced reflective practice during the practical activity. Next were the preceptors (25.8%) and other nurses (8%) present in the residents’ daily routine. In the excerpts below, two actors are identified: the resident themselves and the preceptor. The resident engaging in self-reflection expresses: “I’m having difficulty” and “I thought passing the catheter would be super easy. When I got there, the woman was still on a stretcher, so I asked for help from Preceptor Y” moments where R1 analyzes the situation and reflects on their own difficulties.

Then, I have difficulty, I call Preceptor Y, “hey Preceptor Y, I’m having difficulty”. Then she guides me, you know? [...] when I was going to insert the catheter in her [patient], I thought she [the patient] was much younger than me, actually, so I thought it would be super easy to insert the [catheter]. I got there, the woman was still on a stretcher, a stretcher, that’s it, so I asked Preceptor Y for help, then Preceptor Y came over to... she went to the patient, it seems. She likes to teach. [...] It’s, executing the technique, that I learned. (R1)

The role of the preceptor in stimulating reflection is evidenced when the resident explains: “So she (the preceptor) guides me” and “then Preceptor Y came over... she went to the patient, it seems. She likes to teach... Yeah, by performing the technique, I learned”.

In R1’s discourse, doubt and the attempt to do are pointed out as triggering and mobilizing elements of learning. Through doubt, the participant presents the opportunity to learn on their own initiative, rather than being directed by the preceptor. However, even though the preceptor is one of the most present actors, R2’s discourse highlights the passive position of the preceptor at certain moments of the teaching-learning process:

But, well, most of the teaching-learning situations, I see that it’s me going after the preceptor, you know? (R2)

The observation of residents during theoretical teaching-learning activities lasted for four hours. During this time, three reflection elements (association; commenting or criticizing something about the activity; and exchanging ideas and discussion) were identified, with two actors (self-reflection and nursing resident colleague) enhancing this reflection.

During the case study moment, residents were observed for six hours. Within this period, four reflection elements (association; attentive listening; commenting or criticizing something about the activity; and explaining the activity) were identified, with three actors (nursing resident colleague, the residents themselves in self-reflection, and a nurse) enhancing this reflection.

Finally, the observation of residents during tutoring lasted for nine hours. Out of the five activities observed, three contained three reflection elements (association; commenting or criticizing something about the activity; and attentive listening), with four actors (the participants themselves in self-reflection, tutor, nursing resident colleague, and teacher) enhancing this reflection.

Regarding these teaching-learning moments, the participants expressed:

We lack this theoretical part of learning in residency. [...] But I think that, also, directing contents of specific axis, [...]. Oh, I, I think if they provided us, ah, contents, indeed, of theoretical deepening, it would be, um, interesting. Thus (+), it would help a lot in this process of integrating, right? Practice and theory. (R2)

I think the case studies, even. Taking a case and discussing the, the possible complications of it... Or possible positive outcomes. What exams we should pay more attention to, how to interpret. I think those things that will, will really stimulate, um, our reasoning. (R3)

Usually, the theoretical part we’re not having much of [...] Now we’ll only have the tutoring, sort of. Just lessons, but it’s not, um, not very focused on the practical part of nursing. We’re seeing more in a context, um, a general context. So, we’re seeing more about care management, like that. It’s not anything, like, directed TOWARDS the practical part of nursing. So, as we don’t have much of this practical part, I kind of try to make up for it at home, um, like, trying to study on weekends. (R4)

A solid and high-quality educational foundation, coupled with a variety of experiences in clinical practice, facilitate both the acquisition of knowledge and skills in a safer and faster manner and the progression of the professional to proficiency( 17 17 Escobar-Castellanos B, Jara-Concha P. Filosofia de Patrícia Benner, aplicacion em la formacion de enfermeria: propuestas de estrategias de aprendizaje. Educación. 2019;28(54):182-202. http://dx.doi.org/10.18800/educacion.201901.009 http://dx.doi.org/10.18800/educacion.201... ). Thus, it is important to emphasize that theoretical teaching activities are essential, but it is practical teaching activities that allow the application of this theory and the development of skills, teamwork, leadership, and self-confidence. Practical situations expose the student to experiencing different experiences necessary for reflection-in-action in situations of uncertainty, singularity, and conflict.

The research results revealed, through the residents’ observations, that activities in which 100% of the reflection elements were identified, in absolute numbers, were underdeveloped by the residents, as they are related to the theoretical educational strategies of the PHARP. The low provision of these types of activities is in accordance with regulations that define 20% of the total PHARP workload for theoretical activities and 80% in the form of practical and theoretical-practical educational strategies( 18 18 Ministério da Saúde (BR). Universidade Federal de Goiás. Manuais para o fortalecimento das residências em saúde: Manual 2: Abertura de Programa de Residência em Área Profissional da Saúde modalidades uni e multiprofissional suporte aos apoiadores técnicos loco-regionais [Internet]. Brasília: Ministério da Saúde, 2022 [cited 2023 Dec 10]. Available from: https://www.gov.br/saude/pt-br/composicao/sgtes/residencias-em-saude/publicacoes/2-abertura-de-programa-de-residencia-em-area-profissional-da-saude-web.pdf/@@download/file https://www.gov.br/saude/pt-br/composica... ).

It was found that the activities most performed by residents in the daily routine of PHARP were related to the moment of practical activity teaching-learning. In other words, activities such as patient assessment, nursing care documentation, and patient care are the most frequent in the learners’ daily lives, but they show a low percentage of reflection element identification.

By frequently repeating the execution of a certain task, the student develops tacit action, that is, knowing-in-action. This means that the learner may, at some point, discover that they have internalized the skilled performance( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ). Thus, the activity that started as an imitative construction now allows the student to experience something of their own, a new knowledge of their own repertoire, available for use( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 10 10 Lima MM, Reibnitz KS, Kloh D, Silva KL, Ferraz F. Relação pedagógica no ensino prático-reflexivo: elementos característicos do ensino da integralidade na formação do enfermeiro. Texto Contexto Enferm. 2018;27(2):e1810016. https://doi.org/10.1590/0104-070720180001810016 https://doi.org/10.1590/0104-07072018000... ).

In view of this, it is inferred that, in the daily lives of the observed residents, reflection of the knowing-in-action type prevailed, a spontaneous and automatic act in which the learner performs easy sequences of activities without having to think about it. It is a tacit process that occurs spontaneously, without conscious deliberation, and that works by providing the intended results as long as the situation remains within the limits of what is learned to be treated as normal( 3 3 Netto L, Silva KL, Rua MS. Reflective practice and vocational training: theoretical approaches in the field of Health and Nursing. Esc Anna Nery. 2018;22(1):e20170309. https://doi.org/10.1590/2177-9465-EAN-2017-0309 https://doi.org/10.1590/2177-9465-EAN-20... , 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 9 9 Lopes RE, Silva AC, Nóbrega-Therrien S. M. Formação reflexiva no ensino da enfermagem: discussão à luz de Schön. Cad Pesqui (São Luis). 2015;22(1):47-58. https://doi.org/10.18764/2178-2229.v22.n1.p.47-58 https://doi.org/10.18764/2178-2229.v22.n... ). This result aligns with a Canadian study, which states that the student uses technical rationality to solve linear situations, in which the same solutions can work in different cases. However, it highlights that, in the face of uncertainty, uniqueness, and not fully known, such as the experiences of nurses in the Covid-19 pandemic, technical rationality is not always sufficient to resolve the situation. On these occasions, reflective practice is necessary to achieve attempts at resolution( 19 19 Patel KM, Metersky K. Reflective practice in nursing: aconcept analysis. Int J Nurs Knowl. 2022;33(3):180-7. https://doi.org/10.1111/2047-3095.12350 https://doi.org/10.1111/2047-3095.12350... ).

In these circumstances, when the threshold of normality is exceeded, residents no longer act automatically and encounter unexpected situations, referred to as surprises, which can challenge the established categories of knowledge-in-action( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ). Thus, the occurrence of reflective practice in the daily teaching-learning processes in PHARP is identified.

In this context, residents are observed engaging in activities such as observing professionals perform tasks, clarifying doubts, and discussing clinical cases. That is, when residents can respond to unusual situations in professional practice, they mobilize not only tacit knowledge but also insights derived from observing other performances( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 7 7 Assad SGB, Valente GSC, Santos SCP, Cortez EA. Training and practice of nurses in Primary Care management: perspectives of Schön’s Theory. Rev Bras Enferm. 2021;74(3):e20200461. https://doi.org/10.1590/0034-7167-2020-0461 https://doi.org/10.1590/0034-7167-2020-0... ). On these occasions, the overcoming of knowing-in-action occurs, representing the most elementary level of reflection, and knowledge is demonstrated through intelligent actions, which are publicly observable physical performances.

This research captured the skilled performances of residents in attentive listening, expressing doubts, and exchanging ideas with other professionals. This finding is supported by Schön( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ), who suggests that during a student’s attempts to produce a design, the instructor’s instructions and receptiveness have significant potential for effectiveness, as the student listens with operative attention, ready to translate instructions into actions.

The occurrence of reflective practice and the subsequent expression of reflective elements lead to a new understanding of professional experiences, which, in turn, leads to the integration of new learning from practice and stimulates personal and professional growth. Learners who undergo this cyclical process become more reflective professionals capable of proposing new design production performances( 19 19 Patel KM, Metersky K. Reflective practice in nursing: aconcept analysis. Int J Nurs Knowl. 2022;33(3):180-7. https://doi.org/10.1111/2047-3095.12350 https://doi.org/10.1111/2047-3095.12350... ).

Considering the above, it’s clear why the activity “observing professionals perform tasks” is one of the most stimulating for residents to express reflective elements, with attentive listening being the most common. In these interactions between students and instructors, reflective practical teaching is established, where residents not only observe skilled performances but also have the opportunity to engage in a mutually reflective dialogue with professionals. This reciprocal exchange between instructors and students tends to encourage a series of design projects, motivating students to enhance their ability to produce competent designs( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ).

In these scenarios, residents themselves emerge as the primary drivers of their reflections, followed by preceptors. Therefore, it’s suggested that self-reflection enhances reflective practice in the daily life of residency, particularly in situations where residents actively participate in the teaching-learning process. The interview findings corroborated this, with participants adopting critical attitudes in their speeches, identifying moments of deeper reflection, and indicating opportunities to further develop this process, towards a more proactive approach to learning.

However, it is evident that the reflection elements expressed by residents focused on reflection-in-action and reflection on action, with few opportunities for reflection on reflection-in-action. The latter refers to the act of professionals reflecting retrospectively on past reflection-in-action, which will consolidate understanding of the situation and thus provide the establishment of new strategies( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 7 7 Assad SGB, Valente GSC, Santos SCP, Cortez EA. Training and practice of nurses in Primary Care management: perspectives of Schön’s Theory. Rev Bras Enferm. 2021;74(3):e20200461. https://doi.org/10.1590/0034-7167-2020-0461 https://doi.org/10.1590/0034-7167-2020-0... , 9 9 Lopes RE, Silva AC, Nóbrega-Therrien S. M. Formação reflexiva no ensino da enfermagem: discussão à luz de Schön. Cad Pesqui (São Luis). 2015;22(1):47-58. https://doi.org/10.18764/2178-2229.v22.n1.p.47-58 https://doi.org/10.18764/2178-2229.v22.n... ). The relevance of nurses developing critical-reflexive thinking throughout their training is emphasized, as practical reality demands the ability to make assertive decisions based on scientific evidence and critical analyses of clinical and social contexts. Additionally, it requires the capacity to promote interprofessional questioning and discussions to ensure the quality of care( 11 11 Oliveira SN, Martini JG, Caravaca-Morera JA, Prado ML, Canever BP, Bortolato MC, et al. Debriefing, a dialogical space for the development of reflective thinking in nursing. Rev Gaúcha Enferm. 2024;45:e20230041. https://doi.org/10.1590/1983-1447.2024.20230041.pt https://doi.org/10.1590/1983-1447.2024.2... ).

An integrative review study contributes to this analysis by stating that teaching strategies used by PHARP need to contribute to making the resident an active participant in their own learning process( 20 20 Mello AL, Arruda GT, Terra MG, Arnemann CT, Siqueira DF. Fatores que interferem no ensino e aprendizagem de residentes multiprofissionais em saúde: revisão integrativa. ABCS Health Sci. 2019;44(2):138-46. https://dx.doi.org/10.7322/abcshs.v44i2.1176 https://dx.doi.org/10.7322/abcshs.v44i2.... ). Learning in service is necessary to stimulate the creativity and independence of the student, as well as provide experiences that lead them to problematize and propose intervention alternatives consistent with the scenarios they experience( 8 8 Vieira ATG, Silva LB. Educação interprofissional na Atenção Básica: um estudo cartográfico da formação de residentes em Saúde. Interface (Botucatu). 2022;26: e210090 https://doi.org/10.1590/interface.210090 https://doi.org/10.1590/interface.210090... , 20 20 Mello AL, Arruda GT, Terra MG, Arnemann CT, Siqueira DF. Fatores que interferem no ensino e aprendizagem de residentes multiprofissionais em saúde: revisão integrativa. ABCS Health Sci. 2019;44(2):138-46. https://dx.doi.org/10.7322/abcshs.v44i2.1176 https://dx.doi.org/10.7322/abcshs.v44i2.... ).

It is reiterated that PHARP proposes the qualified training of healthcare professionals for the SUS, equipped to transform daily practices and understand the needs of public health. For this purpose, it constitutes a formative strategy that operates against the biomedical model and the uncritical reproduction of learners still coming from educational institutions( 21 21 Santos JS, Santos Neto PM. Residencies in health: analysis of a state policy for training professionals for the SUS. Saúde Debate. 2023;47(138):516-30. https://doi.org/10.1590/0103-1104202313811I https://doi.org/10.1590/0103-11042023138... ).

In this context, the challenges faced by nurse preceptors in integrating supervision activities and student guidance into their routine are discussed, stimulating a more active stance that promotes the student’s investigative, critical, and reflective attitudes. Studies point out the accumulation of care, teaching, and management work, which reduces preceptorship to the transfer of work routines and care activities, hampering the adequate training process of residents( 2 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 https://doi.org/10.1590/0034-7167-2022-0... , 22 22 Ziebart C, MacDermid JC. Reflective practice in physical therapy: a scoping review. Phys Ther. 2019;99(8):1056-68. https://doi.org/10.1093/ptj/pzz049 https://doi.org/10.1093/ptj/pzz049... , 23 23 Ribeiro KRB, Prado ML, Backes VMS, Mendes NPN, Mororó DDS. Teaching in health residencies: knowledge of preceptors under Shulman’s analysis. Rev Bras Enferm. 2020;73(4):e20180779. http://dx.doi.org/10.1590/0034-7167-2018-0779 http://dx.doi.org/10.1590/0034-7167-2018... ). The relevance of preceptor pedagogical training is emphasized to implement a teaching-learning process focused on critical-reflexive thinking and action( 2 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 https://doi.org/10.1590/0034-7167-2022-0... , 20 20 Mello AL, Arruda GT, Terra MG, Arnemann CT, Siqueira DF. Fatores que interferem no ensino e aprendizagem de residentes multiprofissionais em saúde: revisão integrativa. ABCS Health Sci. 2019;44(2):138-46. https://dx.doi.org/10.7322/abcshs.v44i2.1176 https://dx.doi.org/10.7322/abcshs.v44i2.... ).

In the residents’ speeches, unusual situations stand out as the moments that most stimulate reflection and, consequently, learning, with the preceptor being the first reference in the face of doubt. Unusual situations reflect the repertoire of knowledge; that is, with each new experience of the learner, the professional enriches their repertoire of knowledge and experiences( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 10 10 Lima MM, Reibnitz KS, Kloh D, Silva KL, Ferraz F. Relação pedagógica no ensino prático-reflexivo: elementos característicos do ensino da integralidade na formação do enfermeiro. Texto Contexto Enferm. 2018;27(2):e1810016. https://doi.org/10.1590/0104-070720180001810016 https://doi.org/10.1590/0104-07072018000... ). Thus, unfamiliar situations become familiar because the resident has accumulated a repertoire that enables them to deal with different situations. In other words, each new experience of reflection-inaction enriches the repertoire( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 22 22 Ziebart C, MacDermid JC. Reflective practice in physical therapy: a scoping review. Phys Ther. 2019;99(8):1056-68. https://doi.org/10.1093/ptj/pzz049 https://doi.org/10.1093/ptj/pzz049... ).

Furthermore, another circumstance that arises during practical activities and contributes to the knowledge repertoire is the practice of learning by doing. Learning by doing corresponds to what is known as active experimentation, wherein the investigator in reflection-in-action confirms or refutes an action or hypothesis, thereby promoting the resident’s autonomy( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. , 9 9 Lopes RE, Silva AC, Nóbrega-Therrien S. M. Formação reflexiva no ensino da enfermagem: discussão à luz de Schön. Cad Pesqui (São Luis). 2015;22(1):47-58. https://doi.org/10.18764/2178-2229.v22.n1.p.47-58 https://doi.org/10.18764/2178-2229.v22.n... ). In their speeches, the interviewees not only regard this practice as a natural phenomenon, through explicit evaluative statements, but also declared that they “learn a lot.”

Doubt and the attempt to act are also triggering and mobilizing elements of learning. Professional artistic talent is defined as the ability of the professional to handle the undetermined zones of practice. Responding to surprises by reformulating strategies, “he behaves more like a researcher trying to model a specialized system than as a ’specialist’ whose behavior is modeled”( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ). Through practical and reflective teaching, students acquire types of artistic talent essential for competence in undetermined zones of practice( 6 6 Schön DA. Educando o profissional reflexivo: um novo design para o ensino e a aprendizagem. Porto Alegre: Artmed; 2000. ).

An integrative review, conducted in the United States, listed the most frequent activities found in the literature that stimulate reflective practice in undergraduate nursing courses. The first mentioned was reflective writing, wherein students construct critical reflective journals to evaluate the course, reflect on issues during clinical placements, or identify strengths and training needs. Additionally, the study highlighted reflective discussions as the second most potent activity for reflection. According to the researchers, discussions reduce learners’ stress and anxiety( 24 24 Contreras JA, Edwards-Maddox S, Hall A, Lee MA. Effects of reflective practice on baccalaureate nursing students’ stress, anxiety and competency: an integrative review. Worldviews Evid Based Nurs. 2020;17(3):239-45. https://doi.org/10.1111/wvn.1243 https://doi.org/10.1111/wvn.1243... ).

It is understood that the daily life of residency can be permeated by various situations of doubt and uncertainty, which should be viewed as opportunities for reflection and learning. Therefore, it is important to provide space for residents to express doubts and share experiences with preceptors and tutors.

Study limitations

Limitations of the study may be linked to the researcher’s ability to capture reflective elements expressed by residents. While attention was devoted to all events during data collection, it is recognized that this limitation is inherent to the observation method. It is worth noting that, thanks to the adherence and collaboration of all study participants, the researcher was present in all teaching-learning moments. Moreover, it can be stated that this investigation sought rigor through triangulation, extended fieldwork, and the logic of replication.

Contributions to nursing, health, or public policy

The research contributes to advancing knowledge in the field of health residency training, while also indicating adaptations in the organization and articulation of the teaching-learning process. PHARP is considered an important training strategy for the SUS.

FINAL CONSIDERATIONS

In the daily life of PHARP, the most performed activities by residents were those in which they expressed fewer elements of reflective practice. Thus, reflection of the knowing-in-action type predominated in the nurse training process in residency programs, especially during practical activities. This reflection was followed by reflections of the reflection-in-action and reflection on action types, with few opportunities for learners to extend reflection to reflection on reflection-in-action. The analysis identified “listening with operative attention” and “expressing doubts” as the most expressed reflection elements by residents. Residents themselves, in self-reflection, were the most potent drivers of reflection. Learning by doing and discussing clinical cases were considered potential strategies for the teaching-learning process, with doubt and the attempt to act serving as triggering and mobilizing elements of learning. There is a need to expand spaces, times, and opportunities to discuss situations of doubt and uncertainty that promote reflection on reflection-in-action, thus enabling more critical performances by residents. Teaching-learning situations should be promoted to enhance opportunities for students to undergo diverse experiences, which facilitate the accumulation of knowledge and experience repertoire by residents, preparing them to tackle the demands of the work routine.

DATA AVAILABILITY AND MATERIAL

https://doi.org/10.48331/scielodata.DXHQUL

ACKNOWLEDGMENT

We acknowledge the residents for their participation in the research and Brazilian Company of Hospital Services (EBSERH).

• 1 Presidência da República (BR). Lei nº 11.129, de 30 de junho de 2005. Institui o Programa Nacional de Inclusão de Jovens - ProJovem; cria o Conselho Nacional da Juventude - CNJ e a Secretaria Nacional de Juventude; altera as Leis nº s 10.683, de 28 de maio de 2003, e 10.429, de 24 de abril de 2002; e dá outras providências [Internet]. Diário Oficial da União. 2005 [cited 2023 Dec 10]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/lei/l11129.htm » https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/lei/l11129.htm
• 2 Araújo MC, Peduzzi M, Mazzi NR, Souza CMS, Leonello VM. Preceptorship contributions to the development of clinical and managerial skills in nursing residency. Rev Bras Enferm. 2023;76(2):e20220510. https://doi.org/10.1590/0034-7167-2022-0510 » https://doi.org/10.1590/0034-7167-2022-0510
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• 18 Ministério da Saúde (BR). Universidade Federal de Goiás. Manuais para o fortalecimento das residências em saúde: Manual 2: Abertura de Programa de Residência em Área Profissional da Saúde modalidades uni e multiprofissional suporte aos apoiadores técnicos loco-regionais [Internet]. Brasília: Ministério da Saúde, 2022 [cited 2023 Dec 10]. Available from: https://www.gov.br/saude/pt-br/composicao/sgtes/residencias-em-saude/publicacoes/2-abertura-de-programa-de-residencia-em-area-profissional-da-saude-web.pdf/@@download/file » https://www.gov.br/saude/pt-br/composicao/sgtes/residencias-em-saude/publicacoes/2-abertura-de-programa-de-residencia-em-area-profissional-da-saude-web.pdf/@@download/file
• 19 Patel KM, Metersky K. Reflective practice in nursing: aconcept analysis. Int J Nurs Knowl. 2022;33(3):180-7. https://doi.org/10.1111/2047-3095.12350 » https://doi.org/10.1111/2047-3095.12350
• 20 Mello AL, Arruda GT, Terra MG, Arnemann CT, Siqueira DF. Fatores que interferem no ensino e aprendizagem de residentes multiprofissionais em saúde: revisão integrativa. ABCS Health Sci. 2019;44(2):138-46. https://dx.doi.org/10.7322/abcshs.v44i2.1176 » https://doi.org/10.7322/abcshs.v44i2.1176
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• 23 Ribeiro KRB, Prado ML, Backes VMS, Mendes NPN, Mororó DDS. Teaching in health residencies: knowledge of preceptors under Shulman’s analysis. Rev Bras Enferm. 2020;73(4):e20180779. http://dx.doi.org/10.1590/0034-7167-2018-0779 » https://doi.org/10.1590/0034-7167-2018-0779
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EDITOR IN CHIEF

Associate editor, publication dates.

• Publication in this collection 06 Sept 2024
• Date of issue 2024
• Received 15 Jan 2024
• Accepted 23 Apr 2024

• https://orcid.org/0000-0001-5729-3658
• https://orcid.org/0000-0003-3924-2122

Corresponding author

Scimago institutions rankings, figures | tables.

• Figures (1)

Chart 1   Study population and distribution of observed nursing residents by unit of analysis, Belo Horizonte, Minas Gerais, Brazil, 2023

• Note: PHARP - Professional Health Area Residency Programs.

Table 1   Number of activities with reflective elements, elements of reflective practice identified, and actors, according to the teaching-learning moments, Belo Horizonte, Minas Gerais, Brazil, 2023

Table 2   Number of activities with identification of elements of reflective practice and categories of elements of reflective practice, Belo Horizonte, Minas Gerais, Brazil, 2023

• Notes: TCR - Residency Conclusion Paper; PHARP - Professional Health Area Residency Programs.

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Reflective Practices in Education: A Primer for Practitioners

Haleigh machost.

1 Department of Chemistry, University of Virginia, Charlottesville, Virginia 22903

Marilyne Stains

Associated data.

Reflective practices in education are widely advocated for and have become important components of professional reviews. The advantages of reflective practices are many; however, the literature often focuses on the benefits to students, rather than the benefits for the educators themselves. Additionally, the extant literature concerning reflective practices in education is laden with conflicting terminology and complex studies, which can inhibit educators’ understanding of reflective practices and prevent their adoption. As such, this Essay serves as a primer for educators beginning reflective practices. It briefly describes the benefits to educators and different classifications and modalities of reflection and examines some of the challenges that educators may encounter.

INTRODUCTION

“Reflection” has become a buzzword in academia and has vast array of implications across fields, disciplines, and subdisciplines. When considering reflection about teaching practices, John Dewey, a psychologist and philosopher who was heavily influential in educational reform, provides a relevant description: reflection is ‘‘the 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 conclusions to which it tends” ( Dewey, 1933 , p. 9). The act of reflection in this context is meant to indicate a process , with Dewey highlighting the necessity of active thinking when encountering obstacles and problems. In less philosophical phrasing, reflection entails considering past or present experiences, learning from the outcomes observed, and planning how to better approach similar situations in the future. Consequently, Dewey suggests that educators embark on a journey of continual improvement when engaging in reflective practices. This is in stark contrast to how reflection is used in higher education. For many educators, the only time they engage in reflection is when they are asked to write documents that are used to evaluate whether they should be promoted, receive a raise, or be granted tenure. Reflection, within an evaluation framework, can be counterproductive and prevent meaningful reflections due to perceptions of judgment ( Brookfield, 2017 ).

This gap may result from the particular adaptation of reflections by some academics. The origin of reflective practices lies not in the realm of academia, but rather in professional training. It is often traced back to Donald Schön’s instrumental 1983 work The Reflective Practitioner , which, while aimed at his target audience of nonacademic professionals, has become foundational for reflective practices in teaching ( Munby and Russell, 1989 ).

In the varied topography of professional practice, there is a high, hard ground where practitioners can make effective use of research-based theory and technique, and there is a swampy lowland where situations are confusing “messes” incapable of technical solution. The difficulty is that the problems of the high ground, however great their technical interest, are often relatively unimportant to clients or to the larger society, while in the swamp are the problems of greatest human concern. ( Schön, 1983 , p. 42)

Schön’s work on the education of various professionals gained traction, as he diverged from common norms of the time. In particular, he disagreed with separating knowledge and research from practice, and methods from results ( Schön, 1983 ; Newman, 1999 ). In doing so, he advocated for practical as well as technical knowledge, enabling professionals to develop greater competency in the real-world situations they encounter. Research in the ensuing decades focused on both gaining evidence for the effectiveness of reflective practices ( Dervent, 2015 ; Zahid and Khanam, 2019 ) and understanding the obstacles that can prevent reflective practices from being adopted ( Davis, 2003 ; Sturtevant and Wheeler, 2019 ).

This Essay is not intended to provide a comprehensive review of this work for use by education researchers; rather, the goal of this Essay is to provide a guide, grounded in this literature, to inform beginning reflective practitioners about the benefits of reflections, the different types of reflections that one can engage in, practical advice for engaging in reflective practices, and the potential challenges and corresponding solutions when engaging in reflective practices. It is also intended as a resource for professional development facilitators who are interested in infusing reflective practice within their professional development programs.

WHY SHOULD I ENGAGE IN REFLECTIVE PRACTICES?

Perhaps the best place to begin when discussing reflective practices is with the question “Why do people do it?” It is common to conceptualize reflection about teaching situations as a way to help “fix” any problems or issues that present themselves ( Brookfield, 2017 ). However, this view is counterproductive to the overarching goal of reflective practices—to continually improve one’s own efficacy and abilities as an educator. Similar to how there is always a new, more efficient invention to be made, there is always room for improvement by even the most experienced and well-loved educators. People choose to be educators for any number of personal reasons, but often the grounding desire is to help inform, mentor, or guide the next generation. With such a far-reaching aim, educators face many obstacles, and reflective practices are one tool to help mitigate them.

Classrooms are an ever-changing environment. The students change, and with that comes new generational experiences and viewpoints. Updates to technology provide new opportunities for engaging with students and exploring their understanding. New curricula and pedagogical standards from professional organizations, institutions, or departments can fundamentally alter the modes of instruction and the concepts and skills being taught. As described by Brookfield, reflection can act as a “gyroscope,” helping educators stay balanced amid a changing environment ( 2017 , p. 81). Through the process of reflection, practitioners focus on what drives them to teach and their guiding principles, which define how they interact with both their students and their peers. Furthermore, reflective practitioners are deliberately cognizant of the reasoning behind their actions, enabling them to act with more confidence when faced with a sudden or difficult situation ( Brookfield, 2017 ). In this way, reflection can help guide educators through the challenging times they may experience in their careers.

One such obstacle is imposter syndrome, which is all too familiar for many educators ( Brems et al. , 1994 ; Parkman, 2016 ; Collins et al. , 2020 ). It is a sense that, despite all efforts put in—the knowledge gained, the relationships formed, and the lives changed—what one does is never enough and one does not belong. These feelings often lead to a fear of being “discovered as a fraud or non-deserving professional, despite their demonstrated talent and achievements” ( Chrousos and Mentis, 2020 , p. 749). A part of reflective practices that is often overlooked is the consideration of everything that goes well . While it is true that reflective practitioners are aware of areas for improvement in their teaching, it is also true that they acknowledge, celebrate, and learn from good things that happen in their classrooms and in their interactions with students and peers. As such, they are more consciously aware of their victories, even if those victories happen to be small ( Brookfield, 2017 ). That is not to say that reflective practices are a cure-all for those dealing with imposter syndrome, but reflections can be a reminder that their efforts are paying off and that someone, whether it be students, peers, or even the practitioner themselves, is benefiting from their actions. Furthermore, reflecting on difficult situations has the potential for individuals to realize the extent of their influence ( Brookfield, 2017 ).

In a similar vein, reflective practices can help educators realize when certain expectations or cultural norms are out of their direct ability to address. For example, educators cannot be expected to tackle systemic issues such as racism, sexism, and ableism alone. Institutions must complement educators’ efforts through, for example, establishment of support systems for students excluded because of their ethnicity or race and the implementation of data-driven systems, which can inform the institutions’ and educators’ practices. Thus, through reflections, educators can avoid “self-laceration” ( Brookfield, 2017 , p. 86) and feelings of failure when the problems experienced are multifaceted.

In addition to alleviating “self-laceration,” developing reflective practice and reflective practitioners has been identified as one of four dominant change strategies in the literature ( Henderson et al. , 2011 ). Specifically, developing reflective practitioners is identified as a strategy that empowers individual educators to enact change ( Henderson et al. , 2011 ). One avenue for such change comes with identifying practices that are harmful to students. Reflecting on teaching experiences and student interactions can allow educators to focus on things such as whether an explanatory metaphor is accessible to different types of students in the class (e.g., domestic and international students), if any particular group of students do not work well together, and whether the curriculum is accessible for students from varied educational and cultural backgrounds. Thus, through the process of reflection, educators grow in their ability to help their students on a course level, and they are better positioned to advocate on their students’ behalf when making curricular decisions on a departmental or institutional level.

An additional part of reflection is gathering feedback to enable a holistic view of one’s teaching practices. When feedback is given by a trusted peer, this invaluable information can guide chosen teaching methods and ways of explaining new information. When feedback is given by students and that feedback is then acted upon, it demonstrates to the students that their opinions and experiences are taken seriously and fosters a more trusting environment ( Brookfield, 2017 ). Furthermore, when discrepancies arise between the intention of the teacher and the interpretation of the students, reflection also aids practitioners in verbalizing their reasoning. Through reflection, educators would need to consider past experiences, prior knowledge, and beliefs that led to their actions. As such, reflective practitioners are able to have honest and informed discussions with their students who may be confused or unhappy with a particular decision. Explaining this to students not only models the practice of continuous inquiry and of considering one’s actions, but it also allows students to understand the rationale behind decisions they may not personally agree with, fostering a more productive student–teacher relationship ( Brookfield, 2017 ).

WHAT ARE THE DIFFERENT TYPES OF REFLECTION?

This section aims to summarize and clarify the different ways reflection has been conceptualized in the literature ( Table 1 ). Specifically, reflections have been described based on their timing, depth, and content. Notably, practitioners of reflective practices must utilize multiple types of reflection in order to more effectively improve different aspects of their teaching ( Griffiths and Tann, 1992 ).

The various conceptualizations and associated types of reflections along with examples of guiding questions

Time-Dependent

To understand the time-dependent conceptualization of reflection, we return to Schön (1983 ). He defines two particular concepts—“reflection-in-action” and “reflection-on-action”—which are delineated based on the time that the reflection takes place. Reflection-in-action is characterized as practitioners reflecting while simultaneously completing the relevant action. Reflection-on-action encompasses a practitioner reflecting on a past action, analyzing the different influences, and carefully considering the observed or potential outcomes. Reflection-in-action is perceived as more difficult due to the multiple factors that teachers have to consider at once while also ensuring that the lesson carries on.

Later work built on this initial description of time-dependent reflections. In particular, Loughran renamed the original two timings to make them more intuitive and added one time point ( Loughran, 2002a ). The three categories include: “anticipatory,” “contemporaneous,” and “retrospective,” wherein actions taken, or to be taken, are contemplated before, during, and after an educating experience, respectively. It should be noted that both Loughran’s and Schön’s models are able to function in tandem with the depth- or content-based understandings of reflections, which are described in the next sections.

Depth of Reflections

Conceptualizing reflection in terms of depth has a long history in the literature (see Section 5.1 in the Supplemental Material for a historical view of the depth-based model of reflections). Thankfully, Larrivee (2008a) designed a depth-classification system that encompasses an array of terminologies and explanations pre-existing in the literature. This classification includes a progression in reflective practices across four levels: “pre-reflection,” “surface,” “pedagogical,” and “critical reflection.”

During the pre-reflection stage, educators do not engage in reflections. They are functioning in “survival mode” ( Larrivee, 2008a , p. 350; Campoy, 2010 , p. 17), reacting automatically to situations without considering alternatives and the impacts on the students ( Larrivee, 2008a ; Campoy, 2010 ). At this stage, educators may feel little agency, consider themselves the victims of coincidental circumstances, or attribute the ownership of problems to others such as their students, rather than themselves ( Larrivee, 2008a ; Campoy, 2010 ). They are unlikely to question the status quo, thereby failing to consider and adapt to the needs of the various learners in their classrooms ( Larrivee, 2008a ; Campoy, 2010 ). While the description of educators at this level is non-ideal, educators at the pre-reflection level are not ill intended. However, the pre-reflective level is present among practitioners, as evidenced in a 2015 study investigating 140 English as a Foreign Language educators and a 2010 analysis of collected student reflections ( Campoy, 2010 ; Ansarin et al. , 2015 ). The presence of pre-reflective educators is also readily apparent in the authors’ ongoing research. As such, being aware of the pre-reflection stage is necessary for beginning practitioners, and this knowledge is perhaps most useful for designers of professional development programs.

The first true level of reflection is surface reflection. At this level, educators are concerned about achieving a specific goal, such as high scores on standardized tests. However, these goals are only approached through conforming to departmental norms, evidence from their own experiences, or otherwise well-established practices ( Larrivee, 2008a ). In other words, educators at this level question whether the specific pedagogical practices will achieve their goals, but they do not consider any new or nontraditional pedagogical practices or question the current educational policies ( Campoy, 2010 ). Educators’ reflections are grounded in personal assumptions and influenced by individuals’ unexamined beliefs and unconscious biases.

At the pedagogical level, educators “reflect on educational goals, the theories underlying approaches, and the connections between theoretical principles and practice.” ( Larrivee, 2008a , p. 343). At this level, educators also consider their own belief systems and how those systems relate to their practices and explore the problem from different perspectives. A representative scenario at this level includes: teachers contemplating their various teaching methods and considering their observed outcomes in student comprehension, alternative viewpoints, and also the current evidence-based research in education. Subsequently, they alter (or maintain) their previous teaching practices to benefit the students. In doing so, more consideration is given to possible factors than in surface reflection. This category is quite broad due to the various definitions present in the literature ( Larrivee, 2008a ). However, there is a common emphasis on the theory behind teaching practices, ensuring that practice matches theory, and the student outcomes of enacted teaching practices ( Larrivee, 2008a ).

The last level of reflection categorized by Larrivee is critical reflection, wherein educators consider the ethical, moral, and political ramifications of who they are and what they are teaching to their students ( Larrivee, 2008a ). An approachable way of thinking about critical reflection is that the practitioners are challenging their assumptions about what is taught and how students learn. In doing so, educators evaluate their own views, assertions, and assumptions about teaching, with attention paid to how such beliefs impact students both as learners and as individuals ( Larrivee, 2005 , 2008b ). Through practicing critical reflection, societal issues that affect teaching can be uncovered, personal views become evidence based rather than grounded in assumptions, and educators are better able to help a diverse student population.

Larrivee used this classification to create a tool for measuring the reflectivity of teachers (see Section 4.1 of the Supplemental Material).

Content of Reflections

The third type of reflection is one in which what is being reflected on is the defining feature. One such example is Valli’s five types of reflection ( 1997 ): “technical reflection,” “reflection-in and on-action,” “deliberative reflection,” “personalistic reflection,” and “critical reflection.” Note that Valli’s conceptions of the two types of reflection—reflection-in and on-action, and critical reflection—are congruent with the descriptions provided in the Time-Dependent and Depth sections of this Essay , respectively, and will thus not be detailed in this section.

In a technical reflection, educators evaluate their instructional practices in light of the findings from the research on teaching and learning ( Valli, 1997 ). The quality of this type of reflection is based on the educators’ knowledge of this body of work and the extent to which their teaching practices adhere to it. For example, educators would consider whether they are providing enough opportunities for their students to explain their reasoning to one another during class. This type of reflection does not focus on broader topics such as the structure and content of the curriculum or issues of equity.

Deliberative reflection encompasses “a whole range of teaching concerns, including students, the curriculum, instructional strategies, the rules and organization of the classroom” ( Valli, 1997 , p. 75). In this case, “deliberative” comes from the practitioners having to debate various external viewpoints and perspectives or research that maybe be in opposition. As such, they have an internal deliberation when deciding on the best actions for their specific teaching situations. The quality of the reflection is based on the educators’ ability to evaluate the various perspectives and provide sound reasoning for their decisions.

Personalistic reflection involves educators’ personal growth as well as the individual relationships they have with their students. Educators engaged in this type of reflection thoughtfully explore the relationships between their personal and professional goals and consider the various facets of students’ lives with the overarching aim of providing the best experience. The quality of the reflection is based on an educator’s ability to empathize.

To manage the limitations of each type of reflections, Valli recommended that reflective practitioners not focus solely on a specific type of reflection, but rather engage with multiple types of reflections, as each addresses different questions. It is important to note that some types of reflections may be prerequisite to others and that some may be more important than others; for example, Valli stated that critical reflections are more valuable than technical reflections, as they address the important issues of justice. The order of Valli’s types of reflection provided in Table 1 reflects her judgment on the importance of the questions that each type of reflection addresses.

HOW CAN I ENGAGE IN REFLECTION?

Larrivee suggested that there is not a prescribed strategy to becoming a reflective practitioner but that there are three practices that are necessary: 1) carving time out for reflection, 2) constantly problem solving, and 3) questioning the status quo ( Larrivee, 2000 ). This section of the Essay provides a buffet of topics for consideration and methods of organization that support these three practices. This section is intended to assist educators in identifying their preferred mode of reflection and to provide ideas for professional development facilitators to explicitly infuse reflective practices in their programs.

For educators who are new to reflective practices, it is useful to view the methods presented as “transforming what we are already doing, first and foremost by becoming more aware of ourselves, others, and the world within which we live” ( Rodgers and Laboskey, 2016 , p. 101) rather than as a complete reformation of current methods.

Focus of the Reflection: Critical Incident

When practicing reflection, a critical incident may be identified or presented in order to ignite the initial reflection or to foster deeper thought by practitioners ( Tripp, 2011 ). Critical incidents are particular situations that become the focus of reflections. Farrell described critical incidents in education as unplanned events that hold the potential to highlight misconceptions and foster greater and newer understanding about teaching and learning ( 2008 ). These can be situations ranging from students not understanding a foundational concept from a previous course to considering how to navigate the analysis of a data set that includes cultural background and socioeconomic status.

Critical incidents are used, because meaningful reflection is often a result of educators experiencing a problem or some form of cognitive dissonance concerning teaching practices and approaches to their students ( Lee, 2005 ). Therefore, it is most effective to combine techniques, which are outlined later in this section, with a critical incident to force practitioners into a new and difficult positions relating to education. Larrivee details that a sense of “uncertainty, dissonance, dilemma, problem, or conflict” is extremely valuable to personal reflection and growth ( 2008b , p. 93). Thus, unsettling experiences encourage changes to action far more than reflecting on typical teaching/learning interactions. This is an inherently uncomfortable experience for the practitioner, as feelings of self-doubt, uncertainty, anger, and self- or peer-rejection can come to the surface ( Larrivee, 2008b ). Yet, it is when educators are in an uncomfortable position that they are best able to challenge their learned assertions about what they are teaching and how they are supporting their students’ learning. This requires a conscious effort on the part of the educator. Humans tend to function automatically based on their past experiences and ingrained beliefs. This results in certain aspects of events being ignored while others become the driving force behind reactions. In a sense, humans have a “filter system” that can unconsciously eliminate the most effective course of action; this results in humans functioning in a cycle in which current, unquestioned beliefs determine which data and experiences are given attention ( Larrivee, 2000 , p. 295).

Critical incidents highlight any dissonance present in one’s actions, enabling practitioners to tackle social, ethical, political, and pedagogical issues that may be systemic to their departments, their fields, or their cultures. Critical incidents foster critical reflection (under the depth- and content-based models) even in novice teachers ( Pultorak, 1996 ; Griffin, 2003 ). It is because of the difficulty and uncertainty posed by critical incidents that they are widely promoted as an invaluable aspect of reflective practices in education. Therefore, the analysis of critical incidents, whether they are case studies or theoretical examples, has been used in educating both pre-service ( Griffin, 2003 ; Harrison and Lee, 2011 ) and current educators ( Benoit, 2013 ).

Scaffoldings Promoting Reflections

Once a critical incident has been identified, the next step is structuring the reflection itself. Several scaffolding models exist in the literature and are described in Section 3 of the Supplemental Material. As reflections are inherently personal, educators should use the scaffolding that works best for them. Two scaffoldings that have been found to be useful in developing reflective practices are Bain’s 5R and Gibbs’s reflective cycle.

Bain et al. (2002) created the 5R framework to support the development of pre-service teachers into reflective practitioners. The framework includes the following five steps ( Bain et al. , 2002 ):

• Reporting involves considering a particular experience and the contextual factors that surround it.
• Responding is when the individual practitioners verbalize their feelings, thoughts, and other reactions that they had in response to the situation.
• Relating is defined as teachers making connections between what occurred recently and their previously obtained knowledge and skill base.
• Reasoning then encourages the practitioners to consider the foundational concepts and theories, as well as other factors that they believe to be significant, in an effort to understand why a certain outcome was achieved or observed.
• Finally, reconstructing is when the teachers take their explanations and uses them to guide future teaching methods, either to encourage a similar result or to foster a different outcome.

This framework facilitates an understanding of what is meant by and required for reflective practices. For a full explanation of Bain’s scaffolding and associated resources, see Sections 1.2 and 3.3 in the Supplemental Material.

A popular scaffolding for promoting reflective practices is the reflective learning cycle described by Gibbs (1988) . This cycle for reflection has been extensively applied in teacher preparation programs and training of health professionals ( Husebø et al. , 2015 ; Ardian et al. , 2019 ; Markkanen et al. , 2020 ). The cycle consists of six stages:

• Description: The practitioner first describes the situation to be reflected on in detail.
• Feelings: The practitioner then explores their feelings and thoughts processes during the situation.
• Evaluation: The practitioner identifies what went well and what went wrong.
• Analysis: The practitioner makes sense of the situation by exploring why certain things went well while others did not.
• Conclusions: The practitioner summarizes what they learned from their analysis of the situation.
• Personal action plans: The practitioner develops a plan for what they would do in a similar situation in the future and what other steps they need to take based on what they learn (e.g., gain some new skills or knowledge).

For a full explanation of Gibbs’s scaffolding and associated resources, see Sections 1.3 and 3.4 in the Supplemental Material.

We see these two models as complementary and have formulated a proposed scaffolding for reflection by combining the two models. In Table 2 , we provide a short description of each step and examples of reflective statements. The full scaffolding is provided in Section 3.6 of the Supplemental Material.

Proposed scaffolds for engaging in reflective practices a

a An expanded version is provided in Section 3.6 of the Supplemental Material.

Even with the many benefits of these scaffolds, educators must keep in mind the different aspects and levels of reflection that should be considered. Especially when striving for higher levels of reflection, the cultural, historical, and political contexts must be considered in conjunction with teaching practices for such complex topics to affect change ( Campoy, 2010 ). For instance, if equity and effectiveness of methods are not contemplated, there is no direct thought about how to then improve those aspects of practice.

Modalities for Reflections

The different scaffolds can be implemented in a wide variety of practices ( Table 3 ). Of all the various methods of reflection, reflective writing is perhaps the most often taught method, and evidence has shown that it is a deeply personal practice ( Greiman and Covington, 2007 ). Unfortunately, many do not continue with reflective writing after a seminar or course has concluded ( Jindal‐Snape and Holmes, 2009 ). This may be due to the concern of time required for the physical act of writing. In fact, one of the essential practices for engaging in effective reflections is creating a space and time for personal, solitary reflection ( Larrivee, 2000 ); this is partially due to the involvement of “feelings of frustration, insecurity, and rejection” as “taking solitary time helps teachers come to accept that such feelings are a natural part of the change process” while being in a safe environment ( Larrivee, 2000 , p. 297). It is important to note that reflective writing is not limited to physically writing in a journal or typing into a private document; placing such a limitation may contribute to the practice being dropped, whereas a push for different forms of reflection will keep educators in practice ( Dyment and O'Connell, 2014 ). Reflective writings can include documents such as case notes ( Jindal‐Snape and Holmes, 2009 ), reviewing detailed lesson plans ( Posthuma, 2012 ), and even blogging ( Alirio Insuasty and Zambrano Castillo, 2010 ; van Wyk, 2013 ; Garza and Smith, 2015 ).

Common methods to engage in reflective practices

The creation of a blog or other online medium can help foster reflection. In addition to fostering reflection via the act of writing on an individual level, this online form of reflective writing has several advantages. One such benefit is the readily facilitated communication and collaboration between peers, either through directly commenting on a blog post or through blog group discussions ( Alirio Insuasty and Zambrano Castillo, 2010 ; van Wyk, 2013 ; Garza and Smith, 2015 ). “The challenge and support gained through the collaborative process is important for helping clarify beliefs and in gaining the courage to pursue beliefs” ( Larrivee, 2008b , p. 95). By allowing other teachers to comment on published journal entries, a mediator role can be filled by someone who has the desired expertise but may be geographically distant. By this same logic, blogs have the great potential to aid teachers who themselves are geographically isolated.

Verbal reflections through video journaling (vlogs) follows the same general methods as writing. This method has the potential to be less time intensive ( Clarke, 2009 ), which may lower one of the barriers facing practitioners. Greiman and Covington (2007) identified verbal reflection as one of the three preferred modalities of reflection by student teachers. By recording their verbal contemplations and reflections, practitioners can review their old thoughts about different course materials, enabling them to adjust their actions based on reflections made when observations were fresh in their mind. Students learning reflective practices also noted that recorded videos convey people’s emotions and body language—reaching a complexity that is not achievable with plain text or audio ( Clarke, 2009 ).

If writing or video journaling is not appealing, another method to facilitate reflective practices is that of making video recordings of teaching experiences in vivo. This differs from vlogs, which are recorded after the teaching experiences. A small longitudinal qualitative study indicated that the video recordings allowed participants to be less self-critical and to identify effective strategies they were employing ( Jindal‐Snape and Holmes, 2009 ). Additionally, beginning teachers found the most value in videotaping their teaching as compared with electronic portfolios and online discussions ( Romano and Schwartz, 2005 ). By recording their teaching practices, practitioners can use a number of clearly outlined self- and peer-assessments, as detailed in Section 4 of the Supplemental Material. However, it should be noted that all three technology-driven methods used in the study by Romano and Schwartz (2005) were helpful for the participants, and as reflective practices are inherently personal, many methods should be considered by practitioners new to purposeful reflection.

Group efforts, such as group discussions or community meetings, can foster reflective thinking, thereby encouraging reflective practices. “The checks and balances of peers’ and critical friends’ perspectives can help developing teachers recognize when they may be devaluing information or using self-confirming reasoning, weighing evidence with a predisposition to confirm a belief or theory, rather than considering alternative theories that are equally plausible” ( Larrivee, 2008b , p. 94). These benefits are essential to help educators reach the higher levels of reflection (i.e., pedagogical reflection and critical reflection), as it can be difficult to think of completely new viewpoints on one’s own, especially when educators are considering the needs of diverse students yet only have their own experiences to draw upon. Henderson et. al . (2011) review of the literature found that successful reports of developing reflective practitioners as a strategy for change had two commonalities. One of these was the presence of either a community where experiences are shared ( Gess-Newsome et al. , 2003 ; Henderson et al. , 2011 ) or of an additional participant providing feedback to the educator ( Penny and Coe, 2004 ; McShannon and Hynes, 2005 ; Henderson et al. , 2011 ). The second commonality was the presence of support by a change agent ( Hubball et al. , 2005 ; Henderson et al. , 2011 ), which is far more context reliant.

Even in the absence of change agent support, peer observation can be implemented as a tool for establishing sound reflective practices. This can be accomplished through informal observations followed by an honest discussion. It is vital for the correct mindset to be adopted during such a mediation session, as the point of reflection is in assessing the extent to which practitioners’ methods allow them to achieve their goals for student learning. This cannot be done in an environment where constructive feedback is seen as a personal critique. For example, it was found that peers who simply accepted one another’s practices out of fear of damaging their relationships did not benefit from peer observation and feedback ( Manouchehri, 2001 ); however, an initially resistant observer was able to provide valuable feedback after being prompted by the other participant ( Manouchehri, 2001 ). One approach to ensure the feedback promotes reflections is for the observer and participant to meet beforehand and have a conversation about areas on which to focus feedback. The follow-up conversation focuses first on these areas and can be expanded afterward to other aspects of the teaching that the observer noticed. Observation protocols (provided in Section 4.2 in the Supplemental Material) can also be employed in these settings to facilitate the focus of the reflection.

For those interested in assessing their own or another’s reflection, Section 4 in the Supplemental Material will be helpful, as it highlights different tools that have been shown to be effective and are adaptable to different situations.

WHAT BARRIERS MIGHT I FACE?

It is typical for educators who are introducing new practices in their teaching to experience challenges both at the personal and contextual levels ( Sturtevant and Wheeler, 2019 ). In this section, we address the personal and contextual barriers that one may encounter when engaging in reflective practices and provide advice and recommendations to help address these barriers. We also aim to highlight that the difficulties faced are commonly shared by practitioners embarking on the complex journey of becoming reflective educators.

Personal Barriers

Professional development facilitators who are interested in supporting their participants’ growth as reflective practitioners will need to consider: 1) the misunderstandings that practitioners may have about reflections and 2) the need to clearly articulate the purpose and nature of reflective practices. Simply asking practitioners to reflect will not lead to desirable results ( Loughran, 2002b ). Even if the rationale and intent is communicated, there is also the pitfall of oversimplification. Practitioners may stop before the high levels of reflection (e.g., critical reflection) are reached due to a lack of in-depth understanding of reflective practices ( Thompson and Pascal, 2012 ). Even if the goals are understood and practitioners intend to evaluate their teaching practices on the critical level, there can still be confusion about what reflective practices require from practitioners. The theory of reflective practices may be grasped, but it is not adequately integrated into how practitioners approach teaching ( Thompson and Pascal, 2012 ). We hope that this Essay and associated Supplemental Material provide a meaningful resource to help alleviate this challenge.

A concern often raised is that the level of critical reflection is not being reached ( Ostorga, 2006 ; Larrivee, 2008a ). Considering the impacts that student–teacher interactions have on students beyond the classroom is always a crucial part of being an educator. In terms of practicality, situations being considered may not be conducive to this type of reflection. Consider an educator who, after a formative assessment, realizes that students, regardless of ethnicity, nationality, or gender, did not grasp a foundational topic that is required for the rest of the course. In such a case, it is prudent to consider how the information was taught and to change instructional methods to adhere to research-based educational practices. If the information was presented in a lecture-only setting, implementing aspects of engagement, exploration, and elaboration on the subject by the students can increase understanding ( Eisenkraft, 2003 ). If the only interactions were student–teacher based and all work was completed individually, the incorporation of student groups could result in a deeper understanding of the material by having students act as teachers or by presenting students with alternative way of approaching problems (e.g., Michaelsen et al. , 1996 ). Both of these instructional changes are examples that can result from pedagogical reflection and are likely to have a positive impact on the students. As such, educators who practice any level of reflection should be applauded. The perseverance and dedication of practitioners cannot be undervalued, even if their circumstances lead to fewer instances of critical reflection. We suggest that communities of practice such as faculty learning communities, scholarship of teaching and learning organizations, or professional development programs are excellent avenues to support educators ( Baker et al. , 2014 ; Bathgate et al. , 2019 ; Yik et al. , 2022a , b ), including in the development of knowledge and skills required to reach critical reflections. For example, facilitators of these communities and programs can intentionally develop scaffolding and exercises wherein participants consider whether the deadlines and nature of assignments are equitable to all students in their courses. Professional development facilitators are strongly encouraged to be explicit about the benefits to individual practitioners concomitantly with the benefits to students (see Section 2 in the Supplemental Material), as benefits to practitioners are too often ignored yet comprise a large portion of the reasoning behind reflective practices.

At a practitioner’s level, the time requirement for participating in reflective practices is viewed as a major obstacle, and it would be disingenuous to discount this extensive barrier ( Greiman and Covington, 2007 ). Reflective practices do take time, especially when done well and with depth. However, we argue that engagement in reflective practice early on can help educators become more effective with the limited time they do have ( Brookfield, 2017 ). As educators engage in reflective practices, they become more aware of their reasoning, their teaching practices, the effectiveness of said practices, and whether their actions are providing them with the outcomes they desire ( Thompson and Pascal, 2012 ). Therefore, they are able to quickly and effectively troubleshoot challenges they encounter, increasing the learning experiences for their students. Finally, we argue that the consistent engagement in reflective practices can significantly facilitate and expedite the writing of documents necessary for annual evaluations and promotions. These documents often require a statement in which educators must evaluate their instructional strategies and their impact on students. A reflective practitioner would have a trail of documents that can easily be leveraged to write such statement.

Contextual Factors

Environmental influences have the potential to bring reflective practices to a grinding halt. A paradigm shift that must occur to foster reflective teacher: that of changing the teacher’s role from a knowledge expert to a “pedagogic expert” ( Day, 1993 ). As with any change of this magnitude, support is necessary across all levels of implementation and practitioners to facilitate positive change. Cole (1997) made two observations that encapsulate how institutions can prevent the implementation of reflective practices: first, many educators who engage in reflective practices do so secretly. Second, reflections are not valued in academic communities despite surface-level promotions for such teaching practices; institutions promote evidence-based teaching practices, including reflection, yet instructors’ abilities as educators do not largely factor into promotions, raises, and tenure ( Brownell and Tanner, 2012 ; Johnson et al. , 2018 ). The desire for educators to focus on their teaching can become superficial, with grants and publications mattering more than the results of student–teacher interactions ( Cole, 1997 ; Michael, 2007 ).

Even when teaching itself is valued, the act of changing teaching methods can be resisted and have consequences. Larrivee’s (2000) statement exemplifies this persistent issue:

Critically reflective teachers also need to develop measures of tactical astuteness that will enable them to take a contrary stand and not have their voices dismissed. One way to keep from committing cultural suicide is to build prior alliances both within and outside the institution by taking on tasks that demonstrate school loyalty and build a reputation of commitment. Against a history of organizational contributions, a teacher is better positioned to challenge current practices and is less readily discounted. (p. 298)

The notion that damage control must be a part of practicing reflective teaching is indicative of a system that is historically opposed to the implementation of critical reflection ( Larrivee, 2000 ). We view this as disheartening, as the goal of teaching should be to best educate one’s students. Even as reflective practices in teaching are slowly becoming more mainstream, contextual and on-site influences still have a profound impact on how teachers approach their profession ( Smagorinsky, 2015 ). There must be a widespread, internal push for change within departments and institutions for reflective practices to be easily and readily adopted.

The adoption of reflective practices must be done in a way that does not negate its benefits. For example, Galea (2012) highlights the negative effects of routinizing or systematizing this extremely individual and circumstance-based method (e.g., identification of specific areas to focus on, standardized timing and frequency of reflections). In doing so, the systems that purportedly support teachers using reflection remove their ability to think of creative solutions, limit their ability to develop as teachers, and can prevent an adequate response to how the students are functioning in the learning environment ( Tan, 2008 ). Effective reflection can be stifled when reflections are part of educators’ evaluations for contract renewal, funding opportunities, and promotions and tenure. Reflective practices are inherently vulnerable, as they involve both being critical of oneself and taking responsibility for personal actions ( Larrivee, 2008b ). Being open about areas for improvement is extremely difficult when it has such potential negative impacts on one’s career. However, embarking on honest reflection privately, or with trusted peers and mentors, can be done separately from what is presented for evaluation. We argue that reflections can support the writing of documents to be considered for evaluation, as these documents often request the educators to describe the evolution of their teaching and its impact on students. Throughout course terms, reflections conducted privately can provide concreate ideas for how to frame an evaluation document. We argue that administrators, department chairs, and members of tenure committees should be explicit with their educators about the advantages of reflective practices in preparing evaluative documents focused on teaching.

CONCLUDING THOUGHTS

Reflective practices are widely advocated for in academic circles, and many teaching courses and seminars include information regarding different methods of reflection. This short introduction intends to provide interested educators with a platform to begin reflective practices. Common methods presented may appeal to an array of educators, and various self- and peer-assessment tools are highlighted in Section 4 in the Supplemental Material. Reflective practices are a process and a time- and energy-intensive, but extremely valuable tool for educators when implemented with fidelity. Therefore, reflection is vital for efficacy as an educator and a requirement for educators to advance their lifelong journeys as learners.

To conclude, we thought the simple metaphor provided by Thomas Farrell best encapsulates our thoughts on reflective practices within the context of teaching: Reflective practices are “a compass of sorts to guide teachers when they may be seeking direction as to what they are doing in their classrooms. The metaphor of reflection as a compass enables teachers to stop, look, and discover where they are at that moment and then decide where they want to go (professionally) in the future” ( Farrell, 2012 , p. 7).

Supplementary Material

Acknowledgments.

We would like to thank Annika Kraft, Jherian Mitchell-Jones, Emily Kable, Dr. Emily Atieh, Dr. Brandon Yik, Dr. Ying Wang, and Dr. Lu Shi for their constructive feedback on previous versions of this article. This material is based upon work supported by NSF 2142045. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

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Reflective practice 101

Why and how to incorporate reflective practice into your teaching and learning

Natalie K.D. Seedan

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“Reflective practice is the ability to reflect on one’s actions so as to engage in a process of continuous learning,” according to American philosopher and professor Donald Schön. It is used in occupations such as medicine and teaching to recall actions taken over a period and their possible or real impact on their patients/students and to identify areas for improvement.

In addition to helping you improve your teaching, engaging in reflective practice can also demonstrate your commitment to continuous skills enhancement for the benefit of both your students and your university.

Reflective practice will look different to everyone. Some might prefer keeping a journal, while others might use electronic spreadsheets or one of the many teaching checklists available online or through your university’s centre for teaching and learning.

The more detailed you are in your reflection, the more improvements you can make. If you can also quantify the impact of your changes (for example, by demonstrating that your new methods resulted in a 40 per cent increase in lecture attendance) it can not only boost confidence, but also serve as a valuable piece of evidence that could work in your favour for contract renewal or promotion. 

Strategies for enhancing your reflective practice

Ask your students: seek your students’ opinions on your teaching and learning strategies during lectures, labs and so on, then implement their feedback for future course iterations.

I have used the “stop, start, continue” method with mine around the third week of teaching. This involves asking them what they think I should stop and start doing and what I should continue to do to improve their experience. The responses you get during this exercise might surprise you, because they could highlight issues you won’t have been aware of, such as lack of access to learning materials. They might also absolutely love what you’re doing so far and tell you so! 

Another method of gathering feedback is through the course reviews. These end-of-semester surveys can be disseminated to students through your university’s student experience team and encourage students to share their thoughts on course design, teaching and learning activities and assessments. If you decide to use this method, you might benefit from additional analytics prepared for you, such as charts and graphs, that offer a visual representation of your results. 

Do not be overly hard on yourself if you receive less-than-pleasing reviews from some students. Try to remember that they want the best experience for themselves and others who might come after, and their feedback is intended to help you improve. 

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• Assessing your assessment: creating inclusive and meaningful assignments
• Design a student-centred curriculum for dynamic learning

Ask your peers: asking your fellow lecturers’ thoughts on your teaching practices can enhance your reflective practice further. You can do this by organising reciprocal classroom observation visits where you can be each other’s student for a day. You don’t necessarily have to stick to staff in your faculty or department – you can learn other ways to engage students from staff outside your discipline.

Decide beforehand what you’d like your peer to focus on during your teaching session and then ask them to record how they thought you did and offer objective suggestions for improvement. You may or may not wish to score each other at the end. Applying this method helps to increase peer support and collegiality , which is vital in university teaching and learning environments.

Ask yourself: self-reflection is the final step in creating a robust reflective practice. You can do this by reviewing your teaching philosophy statement and editing it if appropriate, asking yourself questions such as “How have I changed or grown as a lecturer between when I wrote this previous version and now?” You can try to do this on an annual basis for maximum effect.

You can also complete a self-review checklist looking at aspects of your teaching such as the use of educational technology, knowledge of current trends and online resources for your subject, and authentic assessment design . 

Reflective practice should be one of the cornerstones of your teaching, especially at the tertiary level of education. Seeking constructive input from those around you, such as students and peers, and engaging in self-reflection will keep your pedagogical skills sharp and your teaching engaging and effective.

Natalie K.D. Seedan is a sports sciences laboratory technician and part-time lecturer at the University of the West Indies Cave Hill Campus.

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