importance for health and education practitioners

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Edith Cowan University
Research Online
ECU Publications 2013
Reflective practice: what is it and how do I do it?
Abigail V. Lewis
Edith Cowan University,
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Part of the Education Commons, and the Speech Pathology and Audiology Commons
This is a copy of an article original published by the copyright holder Speech Pathology Association of Australia in
JCPSLP: Lewis, A. V. (2013). Reflective practice what is it and how do I do it?. Journal of Clinical Practice in
Speech-Language Pathology, 15(2), 70-74.
This Journal Article is posted at Research Online.
Reflective practice – what is it and how do I do it?
‘An unexamined life is not worth living.’ Socrates
Reflective practice holds importance for health and education practitioners in
Australia (Mann, Gordon & MacLeod, 2009), as demonstrated by increased
prominence in the new competency-based occupational standards for speech
pathologists (Speech Pathology Australia [SPA], 2011). This article explores the
topic of reflective practice, in the clinical context, by addressing the following
• What is reflective practice?
• Why is it an important skill for speech pathologists?
• What is the evidence base for reflective practice?
• How do practitioner and students engage in the process of reflection?
In addressing the final question, four methods of facilitating reflection will be outlined:
journal reflection, reflection on a critical incident, reflection following professional
development, and reflection on a clinical encounter.
As early as the 1930s, the educator Dewey stated ‘there can be no true growth
by mere experience alone, but only by reflecting on experience’ (cited by Lincoln,
Stockhausen & Maloney, 1997, p. 100). However, it was only much later in the
1980s that reflective practice (RP) started to be widely discussed following Schön’s
seminal books (Schön, 1983; 1987) and Boud and colleagues’ widely used model of
reflection described below (Boud, Keogh & Walker, 1985). There is now a growing
body of literature supporting the importance of RP across a number of fields
although there is only limited research in speech pathology (for example see
Freeman, 2001; Geller and Foley, 2009; Hill, Davidson, & Theodoros, 2012). This
article aims to describe the evidence base and the importance of RP for speech
pathologists as well as describe four different ways that students and practitioners
can facilitate their own reflection throughout their lifelong learning journey.
What is Reflective Practice?
RP is ‘a generic term for those intellectual and affective activities in which
individuals engage to explore their experiences in order to lead to a new
understanding and appreciation’ (Boud et al., 1985, p. 19). Reflection involves a
number of skills (such as observation, self awareness, critical thinking, selfevaluation and taking others’ perspectives) and has the outcome of integrating this
understanding into future planning and goal setting (Mann et al., 2009).
There are different models of reflection described in the literature which are
usually iterative (a particular experience triggers reflection and results in a new
understanding or decision to act differently in the future) or vertical (describing depth
of reflection from a surface descriptive only level to a deeper critical synthesis level
resulting in changes in behaviour) (see Mann et al., 2009 for a full description). Boud
and colleagues’ comprehensive model of reflection includes both dimensions (Boud
et al., 1985) and this has led to its wide (for example, Chirema, 2007; Wong,
Kember, Chung & Yan, 1998) including in speech pathology (Lincoln, Stockhausen &
Maloney, 1997).
In Boud and colleague’s model the practitioner:
• returns to a situation or event (e.g. interaction with a client, response to
workshop or strong reaction to colleague);
• attends to their feelings about the experience;
• re-evaluates in light of their previous experiences (so making meaning);
• has an outcome or resolution for the situation.
The indicators of depth of reflection are: making associations with previous
experiences, knowledge or feelings; integrating the new information with current
knowledge; validating the new information; changing future behaviour
(appropriation); and finally, setting an outcome for the future (Boud et al., 1985).
Why is RP an important skill for speech pathologists?
The focus on developing RP has increased across teaching, nursing, medicine
and allied health professions in the last twenty-five years (Mann et al., 2009). In this
time the workplace has become more complex and RP is seen as a skill that enables
practitioners to manage increasingly ‘messy, confusing problems which defy
technical solution’ (Schön, 1987, p.28). Within speech pathology courses in
Australia, students develop the knowledge, skills and attitudes required of an entry
level speech pathologist (SPA, 2011) and RP supports the link between the
curriculum and their clinical practicum experiences (Lincoln et al., 1997). Once in the
workforce, a practitioner receiving appropriate supervision and professional support
will continue to develop knowledge, skills and attitudes beyond entry-level (SPA,
2011) on a continuum of competency leading to expertise (King, 2009; Mann et al.,
2009). New graduates as well as experienced practitioners are increasingly
expected to deal with complex cases (Mann et al., 2009), and engaging in
meaningful reflection enables the practitioner to learn from experience and become a
more efficient, effective and skilled practitioner (King, 2009). King (2009) argues
expertise is developed via working through complex cases which involve much
thinking and puzzling. ‘Experts learn experientially, through engagement (deliberate
practice), feedback and reflection’ (King, 2009, p.186).
SPA recognised this increased focus on RP in the revised Competency Based
Occupational Standards for Speech Pathology (CBOS), launched in 2011 (SPA,
2011). In CBOS a new unit of competency entitled ‘Lifelong learning and reflective
practice’ replaces the previous unit ‘Professional Development’ (SPA, 2001) and
Reflective practice enables the entry-level speech pathologist to consider the
adequacy of their knowledge and skills in different work place and clinical
contexts. Reflective practice requires the individual to take their clinical
experiences and observe and reflect on them in order to modify and
enhance speech pathology programs and their own clinical skills. (SPA,
2011, p.36)
Although RP was not specifically mentioned in earlier iterations of CBOS (e.g.
SPA, 2001), the ability to reflect on performance is assessed as a generic
competency in the Competency Assessment in Speech Pathology [COMPASS®], a
nationally adopted tool for assessing students’ development of competency and
readiness for entry-level practice (McAllister, Lincoln, Ferguson, & McAllister, 2006).
In COMPASS® it is expected that, as part of the clinical process, a student ‘reflects
on and evaluates performance against her/his own goals, or relevant standards of
performance…identifies a range of possible responses to insights developed through
reflection’ (p.13) and ‘monitors his/her reasoning strategies through reflection on the
accuracy, reliability and validity of his/her observations and conclusions’ (McAllister
et al., 2006, p. 21).
There is also an increased emphasis on evidence based practice (EBP) across
healthcare (SPA, 2010) and this is incorporated in the revised CBOS (SPA, 2011).
Mantzoukas and Watkinson (2008) state RP and EBP supplement each other. SPA
(n.d.) recommends Dollaghan’s definition of EBP be used:
the conscientious, explicit and judicious integration of 1) best available
external evidence from systematic research, 2) best available evidence
internal to clinical practice, and 3) best available evidence concerning the
preferences of a fully informed patient.’ (Dollaghan, 2007, p.2)
In order for these strands to be integrated and applied appropriately, reflection is
Reflective practice, then, is claimed to be a key component of clinical reasoning
(Higgs & Jones, 2008) and supervision (Driscoll, 2007); part of the process of
implementing evidence based practice (Mantzoukas & Watkinson, 2008); and key to
the ongoing lifelong learning journey towards the expert practitioner (King, 2009).
What is the evidence base for RP?
A systematic literature review by Mann and colleagues (2009) aimed to explore
the evidence that ‘reflective capacity is … an essential characteristic for health
professional competence’ (p. 596). They identified 29 research studies from a range
of disciplines including nursing, medicine and physiotherapy. Although the literature
base was small, there is evidence that health professionals engage in reflection.
They also found a number of tools available to assess RP and evaluate the level of
reflection (Mann et al., 2009). The authors highlighted the association between RP
and learning approach with deep reflectors also using deep rather than surface
learning approaches. Deep approaches to learning involve being interested in the
subject, searching for meaning both in the task and as related to own experiences in
order to form a theory or hypothesis, whereas surface learners rely on rote memory,
do not see links between parts of the subject and see the task simply as a demand
to be met (see Dunn & Musolino, 2011; Leung & Kember, 2003). When compared to
students, experienced practitioners were more able to reflect-in-action and tended to
reflect-on-action only with new, complex or challenging situations (Mann et al.,
2009). Mann and colleagues also described a variation in depth of reflection (for
example descriptive, reflective or critically reflective) amongst students and
practitioners with both groups experiencing difficulty achieving the deeper levels.
Supportive supervision to facilitated reflection, as did reflecting in a supportive
peer group, and a positive outcome of reflection was improved relationships with
colleagues (Mann et al., 2009). As a result of the systematic review, Mann and
colleagues identified a need for authentic context and relevance for reflection
(important for students), support for different learning styles and adequate time
allowed for reflection. Finally they also concluded that RP could be taught when
specific tasks and questions were given (Mann et al., 2009).
There is a need for further research in the area of reflective practice as the links
between reflection and deep approaches to learning are not clearly understood,
neither is the link between reflective practice and clinical reasoning (Mann et al.,
2009). As yet, there is little evidence to support the idea that reflection improves selfawareness or outcomes in clinical practice or client care (Mann et al., 2009).
How do we engage in the process of reflection
Students and practitioners alike have different abilities to reflect and ‘without
some direction reflection can become diffuse and disparate so that conclusions or
outcomes may not emerge’ (Boud & Walker, 1998, p. 193). Researchers have
identified that reflection is a difficult skill that needs to be explicitly taught and
modelled (Baird & Winter, 2005) and it is only possible in an environment that is
safe, respectful and where confidentiality is assured (Sumsion, 2000). Students and
practitioners need to know why reflection is valued, be prepared for reflection and
know what to reflect on (Baird & Winter, 2005).
A number of methods of facilitating reflection, designed to support the process
of reflection across a range of different contexts, have been outlined in the literature
including journal writing, self-appraisal and portfolio preparation (Mann et al., 2009).
Students and practitioners reflect more deeply when given specific prompts and
coaching (Roberts, 2009; Russell, 2005) so the following activities have been
designed to support this process.
Written reflection
Keeping a diary, journal or blog is frequently mentioned in the literature (e.g.
Chirema, 2007; Hiemestra, 2001; Phipps, 2005) as a way of looking back at
experiences in detail in order to learn from them and alter future behaviour
accordingly. Specific prompts or cues (usually a series of questions) can support the
practitioner or student to move from describing experiences to analysing, making
meaning and setting goals for the future (e.g. Boud, 2001; Findlay, Dempsey &
Warren-Forward, 2011; Freeman, 2001; Roberts, 2009). Chapman, Warren-Forward
and Dempsey (2009) developed a checklist of cues for practitioners to use to
facilitate their written reflections and to evaluate their own journal entries (shown in
Figure 1). The levels and cues are based on Boud and colleagues’ (1985) model of
(insert Figure 1 here)
Reflection on a critical incident
Mann and colleagues (2009) suggested experienced practitioners are more
likely to reflect-in-action and so it could be suggested that experienced speech
pathologists may not find processes designed to facilitate reflection-on-action, such
as journal keeping, as beneficial or feasible within a busy work life. Setting aside
time to reflect only on critical incidents, a situation ‘that provoked surprise, concern,
confusion or satisfaction’ (Baird & Winter, 2005, p. 155) is more practical. Findlay
and colleagues (2011) developed a number of Reflective Inventories for use by
Radiotherapists which provide a set of prompts to guide the practitioner through a
reflective writing. Using a Reflective Inventory resulted in a deeper level of reflection
than a freeform reflection in a journal as measured by Boud and colleagues’ model
(Findlay et al., 2011) and one of these (Figure 2) can be used to support deep
reflection following a critical incident.
(insert Figure 2 here)
Reflection following professional development
A second Reflective Inventory (Figure 3) uses reflection to support deep
learning following professional development or any other kind of learning activity
such as reading an article or book chapter (Findlay et al., 2011). This reflection
encourages the practitioner to apply the new knowledge so encouraging deep
learning as well as deeper levels of reflection (Findlay et al., 2011).
(insert Figure 3 here)
Reflection on a clinical encounter
Student practitioners are less able to reflect-in-action than more experienced
practitioners (Mann et al., 2009) and need more structure to support deep reflection
on their experiences. The author of this article along with speech-language
pathology students developed a series of scaffolding questions (Figure 4) to support
students’ ability to answer the clinical educator’s question ‘how did that session go?’
Students use this series of questions to reflect on their clinical experiences (whether
an assessment, intervention or consultation), making brief notes before then
discussing with their clinical educator or peers. This tool could also be used by new
graduate practitioners to support their reflections with their supervisor.
(insert Figure 4 here)
Further ideas for reflective practice
A range of other reflective practices have also been identified in the literature
including telling stories or narratives (Watson & Wilcox 2000). This less structured
approach to reflection often occurs in the lunch room or hallway and helps
practitioners make sense of complex or challenging experiences. Discussion in a
supportive small group increases the depth of reflection and therefore learning that
occurs when sharing these stories (Mann and colleagues, 2009).
Another approach focuses on developing a personal statement of philosophy or
code of personal ethics (Sumsion, 2000) which could be revisited each year as part
of an annual appraisal. This annual reflection allows the practitioner to re-evaluate
the way in which their current work practices align with their overall philosophy and
ethics as a practitioner.
Creative ideas for reflection include using art, visuals (such as reflective
photos), relaxation and visualisation, mind maps and drawings (Sumsion, 2000) and
poetry, collage and sculpture (Newton & Plummer, 2009). These different ideas may
support reflection in practitioners and students with different learning styles.
Reflective practice has been highlighted as an area of importance for the
student, the entry level practitioner and throughout the learning journey to expert
practitioner (King, 2009). This article reviewed the literature in relation to reflective
practice and the areas for further research. Some useful tools and processes that
practitioners and students could use to support their reflective practice were
Baird, M. & Winter, J. (2005). Reflection, practice and clinical education. In M.
Rose, & D. Best, (Eds.), Transforming practice through clinical education,
professional supervision & mentoring (pp. 143-159). Edinburgh: Elsevier Churchill
Boud, D. (2001). Using journal writing to enhance reflective practice. In English,
L.M. and Gillen, M.A. (Eds.), Promoting Journal Writing in Adult Education. New
Directions in Adult and Continuing Education, 90, 9-18.
Boud, D., Keogh, R., & Walker, D. (1985). Promoting Reflection in Learning: a
model. In D. Boud, R. Keogh & D. Walker (Eds.), Reflection: Turning Experience into
Learning (pp. 18-40). New York: Nichols.
Boud, D., & Walker, D. (1998). Promoting reflection in professional courses: the
challenge of context. Studies in Higher Education, 23(2), 191-206.
Chapman, N., Warren-Forward, H., & Dempsey, S. (2009). Workplace diaries
promoting reflective practice in radiation therapy. Radiography, 15, 166-170.
Chirema, K. (2007). The use of reflective journals in the promotion of reflection
and learning in post-registration nursing students. Nurse Education Today, 27(3),
Dollaghan, C. (2007). The handbook for evidence-based practice in
communication disorders. Baltimore: Paul H. Brookes.
Driscoll, J. (2007). Supported reflective learning: the essence of clinical
supervision? In J. Driscoll (Ed.), Practising clinical supervision: a reflective approach
for healthcare professionals (pp. 27-52). Edinburgh: Elsevier.
Dunn, L., & Musolino, G. (2011). Assessing Reflective Thinking and
Approaches to Learning. Journal of Allied Health, 40(3): 128-36.
Findlay, N., Dempsey, S. &Warren-Forward, H. (2011). Development and
validation of reflective inventories: assisting radiation therapists with reflective
practice. Journal of Radiotherapy in Practice, 10(1), 3-12.
Freeman, M. (2001). Reflective logs: An aid to clinical teaching and learning.
International Journal of Language and Communication Disorders, 36 (2
Supplement), 411-416.
Geller, E., & Foley, G. (2009). Broadening the ‘Ports of Entry’ for SpeechLanguage Pathologists: A Relational and Reflective Model for Clinical Supervision.
American Journal of Speech-Language Pathology, 18(1), 22-41.
Hiemestra, R. (2001). Uses and benefits of journal writing. In English, L.M. and
Gillen, M.A. (Eds), Promoting Journal Writing in Adult Education. New Directions in
Adult and Continuing Education, 90, 19-26.
Higgs, J., & Jones, M. A., (2008). Clinical Decision Making and Multiple
Problem Spaces. In Higgs, J., Jones, M. A., Loftus, S., & Christensen N. (Eds.),
Clinical Reasoning in the Health Professions (3rd ed., pp. 3-17). London: Butterworth
Hill, A., Davidson, B., & Theodoros, D. (2012). Reflections on clinical learning in
novice speech–language therapy students. International Journal of Speech and
Language Disorders, 47(4), 413-426.
King, G. (2009). A Framework of Personal and Environmental Learning-Bases
Strategies to Foster Therapist Expertise. Learning in Health and Social Care, 8(3),
Leung, D., & Kember, D. (2003). The relationship between approaches to
learning and reflection upon practice. Educational Psychology: An International
Journal of Experimental Educational Psychology, 23(1), 61-71.
Lincoln, M., Stockhausen, L. & Maloney, D. (1997). Learning processes in
clinical education. In L. McAllister, M. Lincoln, & D. Maloney. (Eds.) Facilitating
learning in clinical settings (pp. 99-129). Cheltenham: Nelson Thornes.
Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice
in health professions education: a systematic review. Advances in Health Sciences
Education, 14(4), 595-621.
Mantzoukas, S., & Watkinson, S. (2008). Redescribing reflective practice and
evidence-based practice discourses. International Journal of Nursing Practice, 14,
McAllister, S., Lincoln, M., Ferguson, A. & McAllister, L. (2006). COMPASS®:
Competency Assessment in Speech Pathology. Melbourne, Australia: The Speech
Pathology Association of Australia Ltd.
Newton, J. & Plummer, V. (2009). Using creativity to encourage reflection in
undergraduate education. Reflective Practice, 10(1), 67-76.
Phipps, J. (2005). E-journaling: achieving interactive education online.
Educause Quarterly, 28 (1), 62-65.
Roberts, A. (2009). Encouraging reflective practice in periods of professional
workplace experience: the development of a conceptual model. Reflective Practice,
10(5), 633-644.
Russell, T. (2005). Can reflective practice be taught? Reflective Practice, 6(2),
Schön, D. A. (1983). The reflective practitioner: how professionals think in
action. New York: Basic Books.
Schön, D. A. (1987). Educating the reflective practitioner. San Francisco:
Speech Pathology Association. (2001). Competency-based occupational
standards for speech pathologists, entry level. Melbourne, Australia: The Speech
Pathology Association of Australia Ltd.
Speech Pathology Association. (2011). Competency-based occupational
standards for speech pathologists, entry level. Melbourne, Australia: The Speech
Pathology Association of Australia Ltd. Retrieved from
Speech Pathology Association of Australia (n.d.). Evidence Based Practice –
EBP. Melbourne: Author. Retrieved from
Sumsion, J. (2000). Facilitating Reflection: a cautionary account. Reflective
Practice, 1(2), 199-214.
Watson, S. & Wilcox, J. (2000). Reading for Understanding: Methods of
Reflecting on Practice. Reflective Practice, 1(1), 57-67.
Wong, F., Kember, D., Chung, L., & Yan, L. (1998).Assessing the level of
student reflection from reflective journals. Journal of Advanced Nursing. 22, 48-57.
Figure 1: Guide to Reviewing Reflective Workplace Diaries
(adapted from Radiography, 15, Chapman, N., Warren-Forward, H., & Dempsey, S.,
Workplace diaries promoting reflective practice in radiation therapy, 166-170, (p.
169), 2009 with permission from Elsevier.)
Level of Reflection CueDescribing the event or
experienceRecollect the experience and replay it in your mind
or written format, allowing all the events and
reactions, of yourself and those involved to be
considered.Defining your reaction and
feelingsAcknowledge the emotions that an experience
evokes. This may involve harnessing the power of
positive emotions or setting in abeyance the barriers
that may accompany negative emotions.Assessing whether this
varies from what you
already knowFeelings or knowledge from the experience are
assessed for their relationship to pre-existing
knowledge and feelings of a relevant nature.Can this new knowledge be
integrated?This involves assessing whether the feelings and
knowledge are meaningful and useful to you,
bringing together ideas and feelings.Question yourself Are the new feelings that have emerged authentic or
the new knowledge accurate?Is this going to change
anything?Describe if the new knowledge will change your
practice and how. Alternatively, have the feelings
and knowledge from the experience changed any of
your attitudes or perspective on a topic?
Figure 2: Significant event entry
(adapted from Findlay, N., Dempsey, S. & Warren-Forward, H. (2011). Development
and validation of reflective inventories: assisting radiation therapists with reflective
practice. Journal of Radiotherapy in Practice, 10, 3-12, p.8)
• Type of event:
• Persons Present:
• Describe the event.
• Why did it happen and what was your initial reaction to the event?
• Have you ever had these feelings before?
• What is your understanding of the outcome of this experience or your feelings
about it?
• Are these feelings valid and why?
• How would you approach this situation if it arose again?
Figure 3: Reflection following professional development
(adapted from Findlay, N., Dempsey, S. & Warren-Forward, H. (2011). Development
and validation of reflective inventories: assisting radiation therapists with reflective
practice. Journal of Radiotherapy in Practice, 10, 3-12, p.7)
• Who facilitated the course or workshop and what was the subject area?
• What were the three main things you learnt from the event?
• Does this differ from your previous knowledge of these areas?
• Do you see any value in the knowledge gained, is it accurate and why?
• Will this new knowledge change your practice?
• Should you take this clinical knowledge back to your department and assess
its relevance in your clinical setting?
Figure 4: Reflection after a clinical encounter
Quick summary
• Were your goals for the session achieved?
• 3 things that went well and why.
• 3 things that didn’t go well and why.
Reflection in relation to your Client
• Were your goals for the session achieved?
• What improvements were built on from previous feedback?
• How would you describe the client’s experience of the session?
• How would you describe the level of rapport/your relationship?
• How did the individual activities go? What did the client respond to?
• Evaluate client responses with evidence
• Steps up/down – did you need them, did you need more?
• Instructions – were they adequate, if not why not?
• How would you describe your feedback to client?
• Outcome measures – did they work?
• What do you need to find out before the next session? (information, evidence)
• What could you aim for in the next session in the light of today’s
Reflection in relation to your own performance
• How did you feel in the session?
• Compare your performance with clients performance and participation in
• What would you improve next time?
Reflection in relation to the client’s significant other – family, other stakeholders
(whether present or not)
• How did significant others engage in the session if present?
• How could significant others be engaged in the activities if not present?
• How would you summarise/represent today’s session to a significant other?
• What improvements could you make for future sessions?

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