Critical thinking and reflection
Learning to support practice development is influenced by critical thinking and the application of an evidence-based approach. The processes of clinical reasoning and critical analysis are crucial if practice is to be understood and developed. Ideally, practitioners should draw on the best evidence, combining research findings, clinical expertise and patient preference.
The skills of reflection and critical thinking combine to inform practice by development of cognitive skills (See Figure):
Figure: Challenging practice and the application of cognitive skills (Price 2004)
Purpose of Reflection
Reflection informs practice. A number of purposes are known:
- to understand yourself, your motives, perceptions, attitudes and values associated with the delivery of care
- to see practice afresh and challenge the assumptions about delivery of care
- to discuss with others how the episode might be approached differently (and encourage a learning community of practice)
Using reflection to inform practice development
The reflective practitioner begins to examine practice with an event or critical incident and follows a sequence of analysis resulting in actions to inform better practice or professional behaviour. A number of models of reflection capture the learning process; the following cycle indicates the main landmarks of the process of reflection.
Figure: The reflective cycle (Gibbs 1988)
- Description: What happened?
- Feelings: What were you thinking and feeling?
- Evaluation: What was good and bad about the experience(s)?
- Analysis: What sense can you make of the situation?
- Conclusion: What else could have been done?
- Action plan: If the experience arose again, what would you do next time?
Using reflection and critical thinking in practice
The process of reflection and the development of critical thinking are transferable skills that the practitioner is encouraged to develop. Practitioners are able to transform practice through insight and critical reasoning. Reflective practice is an approach to learning and practice development that is patient-centred. Critical thinking is the ability to deconstruct events and to reason the origins and steps of situations. Like reflection, it considers what has gone on before and what may yet happen. In both approaches, there is a retrospective and prospective or creative dimension. Creative thinking involves consideration of the relationship between events. To reflect, or think critically invokes investigating and imagining alternative scenarios.
There a number of ways to engage with learning associated with reflection. Reflection is a dynamic process and thoughts best captured when fresh in the learner’s mind. Reflective approaches include using:
- a reflective notebook: jot down questions, thought or observations as they occur
- a framework: this helps the learner to adopt the discipline of reflection and so capture learning opportunities (see Gibbs model)
- a sounding board: a learner may be encouraged to reflect by a mentor, ‘professional friend’ or learning partner, and should open up different perspectives
Reflective journal and diaries
It is contingent on practitioners to demonstrate reflection as part of evidence in the development of continuing fitness for purpose. It is hence useful to capture the process of reflection regularly so that it will serve as documentation supporting learning through reflection for the purposes of both improving practice and recording critical and creative thinking. Reflective practice and its associated learning is usually allied to forms of writing such as journals or diaries. Descriptive incidents from practice may be logged into journals together with critical, reflective writing applied to these events. The process and practice of critical writing helps to clarify initial thoughts by:
- recording new ideas and understanding
- empowering the practitioner by increasing ownership and confidence
- developing a questioning, problem-solving approach
- applying critical thinking
- clarifying achievements, professional goals and career aspirations
- identifying new learning associated with the practice area
Learning Through Reflection
We learn by experiences that allow us to (Wertenbroch, Nabeth, 2000):
- Absorb (see, hear, feel, taste, smell)
- Do (perform an activity)
- Interact (socialize)
In addition, we also learn by reflecting on such experiences (Dewey 1933). Reflection is thinking for an extended period by linking recent experiences to earlier ones in order to promote a more complex and interrelated mental schema or patterns. The thinking involves looking for commonalities, differences, and interrelations beyond their superficial elements. The goal is to develop higher order thinking skills.
Educators often consider Dewey the modern day originator of the concept of reflection, although he drew on the ideas of earlier educators, such as Aristotle, Plato, and Confucius . He thought of reflection as a form of problem solving that chained several ideas together by linking each idea with its predecessor in order to resolve an issue.
Essentials of Reflection
Hatton and Smith (1995) identified four essential issues concerning reflection:
We should learn to frame and reframe complex or ambiguous problems, test out various interpretations, and then modify our actions consequently.
Our thoughts should be extended and systematic by looking back upon our actions shortly after they have taken place.
Certain activities labeled as reflective, such as the use of journals or group discussions following practical experiences, are often not directed towards the solution of specific problems.
We should consciously account for the wider historic, cultural, and political values or beliefs in framing practical problems to arrive at a solution. This is often identified as critical reflection. However, the term critical reflection, like reflection itself, appears to be used loosely, some taking it to mean no more than constructive self-criticism of one's actions with a view to improvement.
Taking it a step further is Critical Reflection — the process of analyzing, reconsidering and questioning experiences within a broad context of issues (Murray, Kujundzic, 2005). Four activities are central to critical reflection (Brookfield 1988):
Assumption analysis - This is the first step in the critical reflection process. It involves thinking in such a manner that it challenges our beliefs, values, cultural practices, and social structures in order to assess their impact on our daily proceedings. Assumptions are our way of seeing reality and to aid us in describing how the order of relationships.
Contextual awareness - Realizing that our assumptions are socially and personally created in a specific historical and cultural context.
Imaginative speculation - Imagining alternative ways of thinking about phenomena in order to provide an opportunity to challenge our prevailing ways of knowing and acting.
Reflective skepticism - Questioning of universal truth claims or unexamined patterns of interaction through the prior three activities - assumption analysis, contextual awareness, and imaginative speculation. It is the ability to think about a subject so that the available evidence from that subject's field is suspended or temporarily rejected in order to establish the truth or viability of a proposition or action.
Most educators believe that reflection is useful in the learning process, even without the supporting research data. However, it is often difficult to encourage reflection among the learners. Gustafson and Bennett (1999) found that promoting reflection among military cadets by means of written responses in diaries or journals was difficult. Cadets across three different years generally did not produce responses indicating any deep reflection. Although the results were disappointing, they are consistent with the research literature that suggests promoting reflection is difficult to accomplish (Stamper, 1996).
In their work, Gustafson and Bennett (1999) identified variables that affected the cadets' lack of reflective behavior. These eleven variables are grouped into three main characteristics:
1. Learner's skill and experience in reflective thinking
The ability to reflect is a learned behavior that is cultivated by the individual over a period of time. How reflective an individual can become is probably a personality trait. However, designing appropriate learning experiences can develop reflecting skills.
2. Breadth of learner's knowledge of the content area
The ability to reflect on a specific topic is directly proportional to how much one already knows. If a learner's schema for a topic is limited, then there is less ability to relate new information to it.
3. Learner's motivation to complete the reflection task
Both internal and external sources of motivation affect the quality of reflection. Internal motivation by nature is difficult to elevate and even more difficult to accurately estimate or measure. External strategies, such as creating a mental challenge, organizing the learners into pairs, or forming competitive teams enhance motivation, but the effectiveness of these and other strategies for promoting reflection awaits verification.
4. Mental preparation (mental set) for reflecting
Although the mental set of the individual might be considered a motivational variable, it is described separately to highlight its probable importance to promoting reflection.
5. Degree of security felt in reporting actual reflections versus perceived desired responses
When there is confidence in the professionalism and integrity of reviewers, the amount and quality of responses are enhanced. This is particularly true when items call for making judgments about the worth of an activity or the quality of the instruction. This type of reflection can be used to promote thinking about what was and was not included that the learner wanted or needed to learn, what the designer of the instruction may have incorrectly assumed about the learner's entering knowledge or skill, or why the instruction was or was not effective.
6. Physical environment in which reflection occurs
The opportunity for the learner to establish an appropriate mental set for reflecting is related to the nature of the physical environment in which reflection is expected to take place. Other factors may contribute to a poor physical environment, such as competing stimuli (e.g. televisions, personal conversations, ambient noise, poor ventilation, high or low temperature, uncomfortable furniture).
7. Interpersonal environment in which reflection occurs
Environments that promote interpersonal interaction may result in greater reflection (Bandura, 1977). Social interaction may enhance motivation and prolong engagement with the task. Social interaction would almost certainly bring forth more information and ideas that could be shared and perhaps result in deeper thinking about the subject. This interaction might take place during the learning activity or it may occur later in formal or informal group discussions.
Reflection Task Characteristics
8. Nature of the stimulus questions, directions, or probes
The nature of the stimulus to reflect will impact the quality of the reflection. Surbeck, Han, and Moyer (1991) identified three levels of reflection:
9. Format required for reporting reflections
Yinger and Clark (1981) believe that reflection results written down are more powerful than reporting them orally. However, handwriting is slow, requires a writing surface, and revisions or extensions of what has been recorded are less likely than for products produced on a word processor. Word processing has the advantage of easy revision, but requires that equipment be readily available.
10. Quality of the feedback provided following reflection
Feedback takes several forms, ranging from no feedback, to acknowledging that the work was done, to commenting on how well it was done, to extending beyond or elaborating on what was submitted.
11. Consequences of Reflecting
Zeichner and Liston (1996) posited a five-part taxonomy of reflection, of which reflection upon completion of the action is only one type:
Of the eleven variables listed above, number 7 - Interpersonal Environment, may hold the most promise for encouraging reflection.
Hatton and Smith (1995) observed students undertaking a four-year secondary Bachelor of Education degree. They were required to complete several activities designed to encourage reflection. The activities included peer interviews in "critical friend" dyads and written reports where they reflected upon the factors that had influenced their thinking and action.
Their research indicated that engaging with another person in a way that encourages talking with, questioning, or confronting, helps the reflective process by placing the learner in a safe environment so that self-revelation may take place.
In addition, students were able to distance themselves from their actions, ideas, and beliefs, by holding them up for scrutiny in the company of a peer with whom they are willing to take such risks.
The study also identified a framework for four types of writing, the first one is non-reflective, while the other three are characterized as different kinds of reflection.
Descriptive writing for reporting events. Its main purpose is to provide a support or a starting point for the framework.
Descriptive reflection attempts to provide reasons based upon personal judgment. For example, "I choose this problem solving activity because I believe the learners should be active rather than passive."
Dialogic reflection forms a discourse with one's self through the exploration of possible reasons. For example, "I became aware that a number of students did not respond to written text materials. Thinking about this, there may have been several reasons. A number of students may still have lacked confidence in handling the level of language in the text.
Critical reflection involves giving reasons for decisions or events, which takes into account the broader historical, social and/or political contexts.
Strategies for Fostering Reflection
Hatton and Smith (1995) reported four activities that in in the process of reflection:
Action Learning (or action research) projects
Case and cultural studies
Structured curriculum tasks:
Reading fiction and non-fiction
Writing tasks such as narratives, biographies, reflective essays, and keeping journals.
However, although these strategies have the potential to encourage reflection, there is little research evidence to show that this is actually being achieved.
Fact questions that are obvious do not promote reflection (e.g., what are the functional areas of a manufacturing plant?). In addition, posing hypothetical situations produced similarly disappointing results (e.g., Assume you have inherited a significant sum of money and wish to buy land in an environmentally sensitive area on which to build. What factors will go into your decision and why?).
In contrast, the most successful probe is asking learners to write a one page letter to a parent, sibling or other significant person in their lives describing a recent experience or event.
Extending evaluative feedback might have even more powerful effects. Providing probes may cause the learner to continue to think about the topic, such as:
- "Have you thought about how a skilled operator might do this?"
- "How much does safety get compromised when you don't use safety shoes?"
Pointing out other possibilities may also result in additional thinking about relationships among factors not previously considered, such as:
- "Another factor you might consider is how many different tools will be required if you use different size bolts in the design?"
- "But what if the rate of water flow is doubled?"
Although such feedback may be provided via written comments, they are normally the most powerful when used in interpersonal dialogue. Carrying on a dialogue with one or more learners about the work they have submitted is probably the ultimate in promoting reflection via feedback. But the logistics of doing so and having discussion leaders who are skilled in the content and possess good interpersonal skills may be beyond the capacity of the system to provide; unless it is computer mediated in some way.
Other hints for encouraging reflection include:
- Seek alternatives
- View from various perspectives
- Seek the framework, theoretical basis, underlying rationale (of behaviors, methods, techniques, programs)
- Compare and contrast
- Put into different/varied contexts
- Ask, "What if . . . ?"
- Consider consequences
Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall.
Brookfield, S. (1988). Developing Critically Reflective Practitioners: A Rationale for Training Educators of Adults. Training Educators of Adults: The Theory and Practice of Graduate Adult Education. Brookfield (Ed). New York: Routledge.
Dewey, J. (1933). How We Think: A Restatement of the Relation of Reflective Thinking to the Educative Process. Boston: D.C. Heath.
Gustafson, K., Bennett, W. (1999). Issues and Difficulties in Promoting Learner Reflection: Results from a Three-Year Study. http://it.coe.uga.edu/~kgustafs/document/promoting.html
Hatton, N., Smith, D. (1995). Reflection in Teacher Education: Towards Definition and Implementation. The University of Sydney: School of Teaching and Curriculum Studies. http://www2.edfac.usyd.edu.au/LocalResource/Study1/hattonart.html
Zeichner, K., Liston, D. (eds.) (1996). Reflective Teaching: An Introduction. Mahwah, NJ: Lawrence Erlbaum Associates.
Murray, M., Kujundzic, N., (2005). Critical Reflection: A Textbook For Critical Thinking. Québec, Canada: McGill-Queen's University Press.
Stamper, C. (1996). Fostering Reflective Thinking Through Computer Mediated Journaling. Unpublished doctoral dissertation. Tempe: Arizona State University.
Surbeck, E., Park Han, E., Moyer, J. (1991). Assessing Reflective Responses in Journals. Educational Leadership. March, 25-27.
Yinger, R., Clark, M. (1981). Reflective Journal Writing: Theory and Practice. East Lansing, MI: Michigan State University. Institute for Research on Teaching (Occasional Paper No. 50). .
Wertenbroch, A., Nabeth, T. (2000). Advanced Learning Approaches and Technologies: The CALT Perspective. http://www.insead.fr/CALT/Publication/CALTReport/calt-perspective.pdf