April 2024 - Encouraging reflective learning

Reflection is a powerful tool that can improve decision-making and support both personal and professional development and practice. This month, guest contributor, Alexandra Webster, Head of CPD at ABDO gives her thoughts on reflective practice. 

Reflection and Reflective Practice by Alexandra Webster, Head of CPD, ABDO

Reflective practice is a standard expectation of healthcare professionals in modern clinical practice. It is embedded in the General Optical Council (GOC) Standards of Practice for Optometrists and Dispensing Opticians1 the Outcomes for Registration and Approved Qualifications2 and the Continuing Professional Development (CPD) scheme3. Additionally, it is an agreed ‘common expectation’ by the UK healthcare regulators4. Therefore, it is essential that learners develop their reflective skills as they undertake their studies and practice-based encounters, so by the time they qualify it is second nature for them to continue this life-long practice. 

According to the GOC, reflective practice is ‘the process where you think about your experiences to gain insights about your practice and to improve the way you work or the care you give to your patients’3. In its most basic form, reflection could be considered as ‘what happened, what was good/bad and why, and what should I do now?’ It is a way to look back on events, such as a particular patient encounter, and take a ‘moment of time to consider’ to learn from it. To do this there is a need for honesty, to neither allow arrogance or a lack of self-esteem or personal attitudes to taint the reality of what actually happened. There is also a need to recognise that each person encountered in practice, be they a patient or a colleague, is a unique individual and their experience of the event needs to be considered also, as much as it is possible to do so. It should be noted that it is equally useful to reflect on positive events and outcomes as much as negative ones, to understand why something went well is equally important to the embedment of good practice as finding out what went wrong.

There are many models of reflection available to support developing reflective skills and it is useful to expose learners to a variety of these so they can formally practice reflecting on situations, testing out which model may work for them. Haydn Dobby, lecturer at ABDO College, provides some simple guidance to using a reflection model in two articles written in the run up to the launch of the GOC CPD scheme5,6

Reflective practice needs to be just that – practiced. Using a model of reflection, it is possible to identify events and use these real-life situations to breakdown the process of reflection. Creating a reflective journal can be one way of practicing the skill. It may be that a number of situations are suggested where the learner can choose several and write about them (or create an audio or video journal) using a formal reflective model. Both patient and colleague encounters should be reflected on, as both influence the practitioners the learners become and the care they provide.

Reflection by its very nature is highly subjective and therefore, assessment of reflective practice should be in the engagement with the process, the quality of the reflection and development of critical reflective skills, rather than on any decision-making outcome. Learning to take critical feedback is in itself a reflective-practice skill and providing staged, formative feedback on a learner’s reflective journal may support development. Using real patient cases the student is already creating as part of their portfolio can be another way to practice reflection. Asking them to use a reflective practice model when they are writing up justification of their clinical decision making, may enable them to rethink the situation and produce a more robust piece of work. Students sharing their anonymised cases in the class environment can support development of a broader practice of reflection by allowing  peer questioning and feedback. 

Learners and practitioners should be encouraged to widen their availability to feedback, to enable them to reflect fully on their role as a healthcare professional. Feedback from formal processes such as audits and appraisals can provide useful points for reflection7. Multi-disciplinary team learning, such as practice-based peer review can be helpful to situate the patient in the centre of practice care, rather than be considered individually by all the professionals the patient encounters. Additionally, inviting patient feedback on care and services can add an important perspective for the whole practice team to reflect on. 

Alexandra Webster

Alexandra Webster MSc, PGDipE, FBDO CL, FHEA, FBCLA is qualified dispensing optician and contact lens optician and has worked in both independent and multiple practice. She is an ABDO practical examiner for both ophthalmic dispensing and contact lenses. Alex is Head of CPD at ABDO and has worked in contact lens professional services and optical education for over 7 years, gaining a Masters degree in Healthcare Professional Education. She is currently undertaking a Professional Doctorate in Education at the Open University. She has worked part-time as a lecturer in Ophthalmic Dispensing and Contact Lenses at Bradford College and currently spends some time in practice as a CLO. Alex is an experienced presenter, facilitator and author of CPD.

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References and Bibliography

[1] Standards of practice for optometrists and dispensing opticians | GeneralOpticalCouncil

[2] Qualifications in Optometry or Dispensing Optics | GeneralOpticalCouncil

[3] Continuing Professional Development (CPD): A guide for registrants | GeneralOpticalCouncil

[4] Benefits-of-becoming-a-reflective-practitioner----joint-statement-2019.pdf (hcpc-uk.org)

[5] Login - ABDO

[6] Login - ABDO

[7] March 2024 - Developing clinical audit skills - College of Optometrists (college-optometrists.org)

Abbott, Joanne BSC (HONS) FBDO SMC (TECH) ABDO regional CET coordinator, October 2019 Reflection: learning from experiences, good or bad

Armson et al, 17 September 2015 Encouraging Reflection and Change in Clinical Practice: Evolution of a Tool

Coulson, Debra & Harvey, Marina, 19 Dec 2012 Scaffolding student reflection for experience-based learning: a framework: Teaching in Higher Education: Vol 18, No 4

Helyer, Ruth, 2015 Learning through reflection: the critical role of reflection in work-based learning (WBL) | Emerald Insight

Hutchinson, Nancy, 2005 Reconceptualizing Teaching Practice: Developing Competence Through Self-Study - Google Books

Jacobs, Steven MN, MA Ed, RN. Reflective learning, reflective practice. Nursing 46(5):p 62-64, May 2016. | DOI: 10.1097/01.NURSE.0000482278.79660.f2

Philip, Lucy 15 December 2015 Encouraging reflective practice amongst students: a direct assessment approach (tandfonline.com)

Sutton, Jeremy, Ph.D 4 June 2021 Learning Through Reflection: 20+ Questions to Inspire Others 

Reflective Learning: Thinking About the Way You Learn