SCoR: Reflection – what’s it all about?

Why is reflection such a crucial part of our continuing professional developmSCoR logo high resent (CPD)? Louise Coleman, Therapeutic Radiographer and Education and Accreditation Officer at the Society and College of Radiographers, is here to shed some light on the matter.

What is reflection?  I like a good definition as much as the next person, but the definitive definition eludes me as much as it eludes those who research and write about reflection.  There is no single, accepted version.  There are of course seminal texts and authors, but not everybody agrees on what reflection actually is, or should be, or even how useful it is.

Searching the internet doesn’t help much either:

  • Internet search = 101 million results
  • Large, well known, online book retailer = almost 74 thousand results for reflection and 16.5 thousand for reflective practice.
  • Journal database Cumulative Index to Nursing and Allied Health (CINAH) = 2,165 results for reflection, and 551 entries for reflective practice

With results like these it’s hardly surprising I’m met with groans and sighs when I mention the dreaded “R” word when I visit imaging and radiotherapy departments around the UK.

Despite a lack of agreement on anything to do with reflection, I like to think I’ve figured out the essentials.  My own journey towards reflective practice began fifteen years ago, when I was still working clinically in a radiotherapy department.  I decided to find out what reflection was as the students kept talking about it.  I searched the internet and found a journal article by Brigid Reid that said reflection was “…a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice”.  Reid’s discussion was the first flicker of a light bulb moment.

The next article I found was by a critical care staff nurse, Claire Marks.  She included a picture referred to as “Gibbs’s reflective cycle”.  Suddenly reflection, its purpose and how to do it became a whole lot clearer.  The only questions I still had were, “Will reflecting really improve my practice?” and “Is this CPD?”

The definition of reflection I quoted earlier refers to “a process”. This links very nicely to continuing professional development (CPD) and the “systematic process” that is hinted at in most professional bodies’ definitions of CPD.  What’s often missing from definitions is the link to reflection. This means it isn’t always integrated well into CPD systems. This is especially the case with inputs systems of CPD, in which individuals gather hours, points and prizes such as attendance certificates.

Reflection is the staple of outputs CPD systems.  Reflection, like CPD, is a procedure, a method or formula.  This is great because it means there’s a template we can use to reflect and thus enhance our practice.  In reality, there are many, many templates but this is great too; we can choose one which appeals to us.  Even better, we can pick one that suits what we want to reflect on, our own individual learning style and even the mood we’re in.  However, Gibbs’s model is a good place to start.  Although the model was first proposed in 1988, it remains the predominant model used in healthcare education and practice today.

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The sections in Gibbs’ model are helpfully accompanied by questions and these can be adapted or expanded to meet the needs of the reflector.

The description section asks the reflector to describe the situation they’re reflecting on, but it could easily be a description of something that’s been read, watched, written, discussed or observed.  Don’t write too much for the “description” section.  It’s not the most important section so should be short, clear and concise.

Feelings doesn’t need to be all about the softer side of our personalities.  It could include discussion on our motivations or reasons for acting in the way we did.

Identifying what went well and what went badly in the evaluation section is important.  If we know what when wrong then we can try to avoid doing it again.  However, it’s often more useful to identify what went well.  Then we can strive to do it again and again.

The analysis question may seem a bit obscure at first.  A better question might be “Why?”.  Why did we behave that way?  Say that thing?  Walk out of that meeting?  Shout at that colleague?  Finding reasons for our actions is as important as realising we need to act differently.

The last two sections are straight forward but come with warnings.  It’s far too easy to respond to the conclusion and action plan questions, “There’s nothing more I could have done” and, “I will do exactly the same again”.  These aren’t reflective answers and won’t help improve practice.  It’s better to find something to improve, or to identify a situation when we didn’t act so perfectly.

After action planning, we should experiment with our new-found professional knowledge and awareness.  We carry out our roles and tasks not as we did but in a new and improved way.  The changes don’t need to be big.  They certainly don’t need to cost anything and they needn’t take up any more of our time.  However, they should have an impact on our practice, members or service users.  Ideally a positive impact, but if things don’t work out the way we hoped we can always reflect again and identify further changes.  One piece of CPD should lead to another and this is the reason that most models of reflection have a mechanism which signposts the reflector back to identification and description of practice.

I’ve introduced just one of many reflective models in this article.  There are many more to choose from.  It’s a good idea to use a variety of different models because if you use the same one over and over, it gets boring.  Reflections will become boring and won’t have the impact they once did.

Will reflection improve your practice?  That’s a question only you can answer.  However, if you don’t try it, you’ll never know.

Next steps

  • Search the internet for “reflective model”. Use the images search rather than the web search.  What reflective model appeals to you, and why?

References

Gibbs G (1988), Learning by Doing: A guide to teaching and learning methods. Oxford: Oxford Polytechnic Further Education Unit.

Marks C (2001), Reflective practice in thermoregulatory nursing care, Nursing Standard, 15, (43), p38-41.

Reid B (1993), ‘But we’re doing it already!’ Exploring a response to the concept of reflective practice in order to improve its facilitation, Nurse Education Today, 13 p305-309.

Louise Coleman, Therapeutic Radiographer and Education and Accreditation Officer at the Society and College of Radiographers

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