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Tips for Facilitating Reflective Practice (RP)
When program directors and faculty mentors consistently model RP, residents find it less threatening to reflect in crucial situations and are better able to apply RP methodically to their own practice. Invitations to reflect on practice are most engaging in the context of ongoing, challenging cases (e.g., on teaching rounds), but embedding RP in other educational activities such as routine self-evaluations or formative and summative evaluations of rotations also encourages and reinforces its use. Experts who describe using RP as a teaching method make the following suggestions:
- Using RP means that faculty must be ready to help guide residents as they explore the presuppositions or incorrect reasoning that might become apparent in their reflection and action. Such gaps in critical thinking and judgment often result from residents’ limited understanding and experience. RP does not imply that all residents’ experiences should be accepted uncritically. Simply “thinking through” an activity does not guarantee deeper understanding. RP, therefore, also provides opportunities for more in-depth learning based on demonstrated needs.
- RP sets expectations for faculty and residents to observe their own behavior. For example, reviewing results of 360° evaluations offers excellent opportunities for mentors to guide residents through reflection on their relationships with other members of the health care team and on how these relationships compare to ideals of professionalism.
- When mentors guide residents through personal material (such as results of 360-degree evaluations or other formative evaluations) by combining clear questions with disclosure of their own experiences, they use an empathic approach, creating a climate that encourages honest exchange. It is particularly helpful in sensitive areas such as the response to sudden death of a continuity patient or the occurrence of adverse events and errors.
- Opportunities for reflection on practice with mentors (as individuals or as a group) should be kept confidential. The program should establish an atmosphere where residents feel accountable for their professional performance as well as for their behavior, and where it is safe to explore and learn.
- Epstein (2003) makes several recommendations on how to support RP in a training environment:
- Set expectations for residents to observe their own behavior.
- Create a climate that encourages honest exchange.
- Provoke curiosity and assist residents in internalizing the habit of questioning themselves about their behaviors and practices.
- Discuss actual behaviors rather than theories or abstract expectations.
- Think aloud about one’s own experience, including professional lapses.
Key References (click here for selected references on this topic)
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