‘Reflection’ and ‘Reflective Writing’: Guidance for students in undergraduate Psychiatry.

1. ‘Reflection’ and ‘Reflective Writing’: Guidance for students in undergraduate Psychiatry. Dr Geraldine O’Neill, UCD Teaching and Learning

2. Purpose of this presentation By the end of this presentation, you should be able to: • Describe the benefits of reflection in the practice of medicine, in particular in psychiatry • Write your module’s assignment(s) in a style that demonstrates a depth of reflection

3. Why develop Reflection in Professional Practice? Schon argued that in the real world of practice problems could not be solved solely by the application of technical rationality… Instead, he developed an alternative theory of the professional as a “reflective practitioner” who utilises reflective processes to critically analyse, re-appraise and learn from experiences (Bulman & Schultz, 2004; Donohoe, McMahon & O’Neill, 2009)

4. Why develop Reflection in Medicine? • There is an increasing emphasis on reflective practice and on self-assessment in professional practice in medicine • It is increasingly recognised as a skill crucial to lifelong learning • In their Review of Medical Schools in Ireland 2007, the Medical Council list the encouragement of a “reflective practice” process as one of the key indicators of good practice in assessment (p. 18).

5. Raw et al (2005) describe reflection in medical practice, as a) an awareness of thoughts/feelings about an event or events b) critical analysis of the situation c) the development of a new perspective on the situation.

6. How does ‘reflective writing’ differ to your other academic writing This must be supported by links to the literature and informed by discussions with other students/staff Your experience from your other academic or non-academic life is valued You can use the word ‘I’ in your writing When qualified this would also be from experience in practice When qualified this would be from colleagues, patients, others…

8. How can you do well in the your module assignment(s) • For more details of the weighting of the different assignments, see your module. • The weighting of knowledge, reflection , presentation can be seen on in the module assessment criteria (on Blackboard) • Some examples of good/weaker reflection can also be seen on Blackboard.

9. How can you do well in the reflective writing aspect of your module assignment(s) -Develop a view, -Demonstrate Stepping back, -Seeing topic from different perspective, -Asking questions -Changing a view/stance…. ? ‘View on the issue’ Step Back ‘View on the issue Version 2’

10. Asking Yourself QuestionsMaughan & Webb, 2001; Intro to reflective Writing What is most important /interesting / useful / relevant about the object, event or idea? How can it be explained e.g. with theory? How is it similar to and different from other issues events ? What have I learned from this? What does this mean for my future situations ?

11. Good Reflection • Dialogic reflection: 'Demonstrates a "stepping back' leading to a different level of mulling about discourse with self. Uses the 'qualities of judgements and possible alternatives for explaining and hypothesising'. The reflection is analytical or integrative, linking factors and perspectives. • Critical reflection: and, where appropriate, that the issue is explicable by multiple perspectives, but are located in and influenced by multiple historical and socio-political contexts' (Hatton and Smith, 1995)

12. In Summary • Reflection is important for your medical training and is being supported and assessed in this undergraduate psychiatry module • To do well in this, in addition to demonstrating your understanding of the psychiatry knowledge, you need to: • Talk to others about your views of the psychiatry issues • Demonstrate a depth in your reflection which shows evidence of ‘stepping back’ to look at issues from many angles.

13. References Redmond, B. (2004). Reflection in action: Developing reflective practice in health and social services. England: Ashgate Publishing Limited. Bulman, C., & Schutz, S. (2004). Reflective practice in nursing (3rd ed.). Oxford: Blackwell. Epstein RM, Hundert EM. (2002) Defining and assessing professional competence. JAMA, 287 (2):226−35. Donohoe, A., McMahon, T. & O’Neill , G (2008) Online Communities of Inquiry in Higher Education, In, R. Donnelly & F. McSweeney (Eds)Applied e-learning and e-teaching in higher education, pp262-288. London: Information Science Reference (an imprint of IGI Global). Kolb, D. (1984) Experiential learning. New Jersey: Prentice Hall Eraut, M. (1998). Concepts of competence. Journal of Interprofessional Care, 12(2):127-139. Hatton N, Smith D (1995) Reflection in Teacher Education-towards definition and Implementation. Teaching and Teacher Education, 11, (1) 33-49. Moon J. (2002) Reflective Diaries, Logs and Learning Journals . Teaching Development Unit Course, UCD. The reflectivepractitioner: the essence of work based learning? Preview By: McDonough, Richard. Work Based Learning in Primary Care, Nov2004, Vol. 2 Issue 4, p373-376, 4p; (AN 15380350) The ReflectivePractitioner: Reaching for Excellence in Practice .Preview By: Plack, Margaret M.; Greenberg, Larrie. Pediatrics, Dec2005, Vol. 116 Issue 6, p1546-1552, 7p, 1 chart; DOI: 10.1542/peds.2005-0209; (AN 19165661) Students' reflections on self-directed learning using patient studies in a Masters programme in family medicine in South Africa .Preview By: Lindh, Monica; Hugo, Jannie. Education for Primary Care, Jul2005, Vol. 16 Issue 4, p474-481, 8p; (AN 17531949) The reflectivepractitioner-another way of looking at primary dental care.Preview By: Toy, A.. British Dental Journal, 1/22/2005, Vol. 198 Issue 2, p67-68, 2p; DOI: 10.1038/sj.bdj.4811969; (AN 1601003 Educating the reflective GP: Schon revisited.Preview By: Waters, Mark. Education for Primary Care, Nov2004, Vol. 15 Issue 4, p631-634, 4p; (AN 1515189) Reflective diaries in medical practice Raw, J. Brigden D. Gupta R. (2005) Reflective Practice, Vol 6. No. 1 , pp 165-9 Reflections on teaching observations and the use of a personal development journal in medical teacher education .Preview By: Bill Gransden. Educational Action Research, Mar2004, Vol. 12 Issue 1, p19-32, 14p; (AN 19623026)

14. BOUCH, J. (2003) Continuing professional development for psychiatrists: CPD and regulation. Advances in Psychiatric Treatment, 9, 3-4. MODERNISINGMEDICAL CAREERS (2007) Person Specification. Application to Enter Specialty Training at ST2: Psychiatry. http://www.mmc.nhs.uk/ download_files/ST2-Psychiatry.pdf ROYAL COLLEGE OF PSYCHIATRISTS (2007) A Competency Based Curriculum for Specialist Training in Psychiatry. Core and General Module. http:// www.rcpsych.ac.uk/training/curriculum.aspx SEED, K., DAVIES, L. & McIVOR, R. (2007) Learning portfolios in psychiatric training. Psychiatric Bulletin, 31, 310-312 Branch, W.T., Paranjape, A. (2002) Feedback and Reflection: Teaching Methods for Clincical Settings. Academia, 77, 12, 1185-1188.

15. Reflection in Psychiatry and Other Health Science Practices Dr Geraldine O’Neill, UCD Teaching and Learning

16. Used in Psychiatry and Described in the literature BOUCH, J. (2003) Continuing professional development for psychiatrists: CPD and regulation. Advances in Psychiatric Treatment, 9, 3-4. MODERNISINGMEDICAL CAREERS (2007) Person Specification. Application to Enter Specialty Training at ST2: Psychiatry. http://www.mmc.nhs.uk/ download_files/ST2-Psychiatry.pdf ROYAL COLLEGE OF PSYCHIATRISTS (2007) A Competency Based Curriculum for Specialist Training in Psychiatry. Core and General Module. http:// www.rcpsych.ac.uk/training/curriculum.aspx SEED, K., DAVIES, L. & McIVOR, R. (2007) Learning portfolios in psychiatric training. Psychiatric Bulletin, 31, 310-312

17. Reflection Raw et al (2005) describes reflection in medical practice, as a) an awareness of thoughts/feelings about an event or events b) critical analysis of the situation c) the development of a new perspective on the situation.

18. What is reflective practice? Epstein and Hundert (2002) define reflective practice in medicine as ‘the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individuals and communities being served’. personal reflection is not an alternative, but a supplement to scientific reflection. http://dissertations.ub.rug.nl/FILES/faculties/medicine/2008/l.c.aukes/c1.pdf

19. Difference to undergraduate • Based in experience of practice • Can make changes to practice • Scenarios/dilemmas complex situations used • Reflection-in-Action and Reflection-on-Action • Sharing views with others: • Mixture of novice and experts in Psychiatry • Access to multiple views and contexts

20. Reflective Writing Based on what learned Reflective Writing Based on clinical incident Reflective Writing Knowledge Skills Skills Reflective Writing Skills Reflective Writing Evidence

21. Assessing Reflective Writing Some suggestions Hatton & Smiths (1995) levels of reflection in writing: Descriptive Writing, Descriptive Reflection, Dialogue Reflection, Critical Reflection • An Argument not to assess • Assess a summary • Competent/Not yet Competent • Depends on aims of journal (theory to practice links…)

22. Good Reflection • Dialogic reflection: 'Demonstrates a "stepping back' leading to a different level of mulling about discourse with self. Uses the 'qualities of judgements and possible alternatives for explaining and hypothesising'. The reflection is analytical or integrative, linking factors and perspectives. • Critical reflection: and, where appropriate, that the issue is explicable by multiple perspectives, but are located in and influenced by multiple historical and socio-political contexts' • (Hatton and Smith, 1995)

23. Setting up a process of developing deeper reflection in Practice How can it be explained? why? Peers/ others Resources, library

24. Reflection-in-Action • Reflection generally follows meaningful encounters or teachable moments (Branch & Paranjape, 2002) • Short pauses in action for reflection: ‘What actually occurred with this patient’..’What did we accomplish from this encounter? …. (Branch & Paranjape, 2002) (ROYAL COLLEGE OF PSYCHIATRISTS, 2007)

25. Sharing with others on practice • Case conferences • In corridor discussions • Formalised group/peer support • Technology: On-line discussions • Using different means of representing reflection: writing, verbal, …. • Using a guideline for judging effective reflection

26. A useful Framework for Reflective Practice See Handout p 35 (Rolfe, Freshwater, Jasper, 2001)

27. References Redmond, B. (2004). Reflection in action: Developing reflective practice in health and social services. England: Ashgate Publishing Limited. Bulman, C., & Schutz, S. (2004). Reflective practice in nursing (3rd ed.). Oxford: Blackwell. Epstein RM, Hundert EM. (2002) Defining and assessing professional competence. JAMA, 287 (2):226−35. Donohoe, A., McMahon, T. & O’Neill , G (2008) Online Communities of Inquiry in Higher Education, In, R. Donnelly & F. McSweeney (Eds)Applied e-learning and e-teaching in higher education, pp262-288. London: Information Science Reference (an imprint of IGI Global). Kolb, D. (1984) Experiential learning. New Jersey: Prentice Hall Eraut, M. (1998). Concepts of competence. Journal of Interprofessional Care, 12(2):127-139. Hatton N, Smith D (1995) Reflection in Teacher Education-towards definition and Implementation. Teaching and Teacher Education, 11, (1) 33-49. Moon J. (2002) Reflective Diaries, Logs and Learning Journals . Teaching Development Unit Course, UCD. The reflectivepractitioner: the essence of work based learning? Preview By: McDonough, Richard. Work Based Learning in Primary Care, Nov2004, Vol. 2 Issue 4, p373-376, 4p; (AN 15380350) The ReflectivePractitioner: Reaching for Excellence in Practice .Preview By: Plack, Margaret M.; Greenberg, Larrie. Pediatrics, Dec2005, Vol. 116 Issue 6, p1546-1552, 7p, 1 chart; DOI: 10.1542/peds.2005-0209; (AN 19165661) Students' reflections on self-directed learning using patient studies in a Masters programme in family medicine in South Africa .Preview By: Lindh, Monica; Hugo, Jannie. Education for Primary Care, Jul2005, Vol. 16 Issue 4, p474-481, 8p; (AN 17531949) The reflectivepractitioner-another way of looking at primary dental care.Preview By: Toy, A.. British Dental Journal, 1/22/2005, Vol. 198 Issue 2, p67-68, 2p; DOI: 10.1038/sj.bdj.4811969; (AN 1601003 Educating the reflective GP: Schonrevisited.Preview By: Waters, Mark. Education for Primary Care, Nov2004, Vol. 15 Issue 4, p631-634, 4p; (AN 1515189) Reflective diaries in medical practice Raw, J. Brigden D. Gupta R. (2005) Reflective Practice, Vol 6. No. 1 , pp 165-9 Reflections on teaching observations and the use of a personal development journal in medical teacher education .Preview By: Bill Gransden. Educational Action Research, Mar2004, Vol. 12 Issue 1, p19-32, 14p; (AN 19623026)

28. BOUCH, J. (2003) Continuing professional development for psychiatrists: CPD and regulation. Advances in Psychiatric Treatment, 9, 3-4. MODERNISINGMEDICAL CAREERS (2007) Person Specification. Application to Enter Specialty Training at ST2: Psychiatry. http://www.mmc.nhs.uk/ download_files/ST2-Psychiatry.pdf ROYAL COLLEGE OF PSYCHIATRISTS (2007) A Competency Based Curriculum for Specialist Training in Psychiatry. Core and General Module. http:// www.rcpsych.ac.uk/training/curriculum.aspx SEED, K., DAVIES, L. & McIVOR, R. (2007) Learning portfolios in psychiatric training. Psychiatric Bulletin, 31, 310-312 Branch, W.T., Paranjape, A. (2002) Feedback and Reflection: Teaching Methods for Clincical Settings. Academia, 77, 12, 1185-1188. Rolfe, G , Freshwater, D., Jasper, M (2001) Critical Reflection for Nursing and the helping Profession: A users guide. New York: Palgrave MacMillan.