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Ali Shakir

Page history last edited by a.shakir@yahoo.com 12 years, 6 months ago

Ali Hussain Shakir Final Essay


The Practice of Reflective Learning and Improvement


 “Follow effective action with quiet reflection.  From the quiet reflection will come even more effective action”(James Levin)  The field of medicine is a field that is constantly changing and requires that practitioners have the ability to change and grow as the field evolves.  The one aspect that can keep a physician to keep improving is the ability to reflect and identify areas of improvement.  Skills of reflection should begin early in medical training, however, it is evident that many physicians are not trained in this aspect and do not possess this ability.  For the field of medicine to have good practitioners with reflective habits, the following three aspects must be developed for current and future physicians:


            1.  Increased Self-awareness for practitioners. 

            2.  Teaching/Learning of self-reflective habits beginning early in the career

            3.  Using self-reflection to effectively improve the quality of practice.


            In order for practitioners to learn from their experiences and provide high quality care; self-reflective habits must be practiced.  These habits of self-reflection result in continued improvements amongst practitioners.  Self-reflection makes practitioners more aware of their practice habits, personal strengths and emotional intelligence.  In Goleman's Learning to Lead with Emotional Intelligence, the core component of self-awareness is based on the habits of reflection.  These reflective habits can increase self-awareness of ones own practice of medicine.  Self-reflection also results in an accurate self-assessment in regards to practice habits, strengths and limitations.  Knowing strengths will build self-confidence in certain areas and weaknesses can help focus on areas of improvements.  Self-reflection ultimately means that practitioners are more self aware of themselves, their practice habits and personal preferences that ultimately influences patient care.

            Teaching reflection to the medical professional has its own challenges.  Since much of education is focused on clinical knowledge, many novice learners may be inexperienced with the concept of reflection.  Therefore, initially it is important to build trust with the learner.  The learner must be able to have the confidence to be open and transparent with the teacher about concerns or weaknesses.  This openness may take time to build, but is important that the learner understands that the teacher is his advocate and not be afraid amongst areas of weakness or concern.  For the teachears, it is important as to assess the learner’s willingness and concepts of reflection.  If the learner can  understand these concepts, reflection will be more effective in using reflection in his/her experiences.  The next step for the teacher is to explain the rationale of reflection to the learner.  If the reasoning is understood, and buy in can be obtained from the learner, the learner will be open to using these abilities of reflection in the future.  Demonstrating good reflective habits can be very influential for novice learners.  Experienced practitioners can demonstrate reflection and the usefulness it has for improving their practice and patient care and show the learners its importance.  These simple steps taken by current practitioners can help learners entering the medical profession in regards to the importance of developing good habits of reflection.

            In learning the ability of using reflection to improve the medical profession, multiple techniques/challenges are present.  First of all, time to reflect is probably the most difficult aspect to ingrain within the busy practice of medicine.  Scheduling a time for beginner learners is important, so that reflection is not forgotten amongst the rush of patient care.  While patient care has always been strongly emphasized, the importance of taking time out before, during and after the event will allow improvement in patient care and development of more effective health care providers.  Reflection before an event can allow one to understand the situation and improve chances of being successful.  As Covey describes in Habit 2, "Seek to understand, before one can be understood."  If one has reflected and subsequently developed a plan for any encounter (patient, staff, colleague), one can improve the overall result.  Reflection can also be effective if preformed during some activities, for example, a procedure.  Stopping during an activity and having a learner share his thoughts, can provide invaluable improvement by understanding thoughts occurring during a procedure.  This reflection during procedures can improve physician’s procedural skills by engaging thought processes to solve difficult procedural situations which may be encountered in the future.  Similarly, reflection after an activity can also be useful, in order to understand what can be done to improve the situation at a future similar encounter. 

            Adequate reflective skills for the medical professional can take time to develop.  Ultimately, once adequately developed, they can have a profound effect on improving the medical professionals quality of care and continued learning within the field of medicine.


Comments (2)

mmolson@geisinger.edu said

at 11:53 pm on Oct 25, 2011

Agreed. Reflection is a very useful and yet, underutilized and often under-appreciated skill. Not only do we face the challenge of time to teach these skills, but I also believe that we lack the experience in teaching these skills. Also, the environment in which we try to encourage these skills will have an effect on our ultimate success. As a surgeon, I personally find that I am fighting against the prevailing culture when trying to spend time teaching these types of skills. I am wondering if you have experienced any similar resistance to these "soft skills" when teaching your fellows? And if you have had any success in changing that culture?
How do you think that we can best prepare faculty to assist in this undertaking - especially since few faculty may have significant experience in this area?

Bev Wood said

at 8:18 pm on Oct 26, 2011

Reflection is important and often overlooked. I have found it is useful to ask learners about why they thought of an answer and what their thought processes were. Often they do not think that way, yet it is a very effective way of having them reflect on their decisions and breaks the habit of assuming the "teacher" knows the answer and will tell you. With one of our current residents, I give him a paper that deals with the topic and have found that not only does he read it, but he also pursues other sources that may or may not conflict. It is a great learning experience, and the first step in becoming a reflective thinker.
It is also a good way for faclty to learn to teach reflection, because decision making and the process is something we do automatically all the time.

To start, just ask "Why do you think that", I believe it is something Michelle mentioned in an early class, and is very effective as a way to analyze one's decision making. Read Jerome Groopman "How Doctors Think".

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