The teaching and learning reflective practice in medicine, nursing and physiotherapy: a grounded theory study

Abstract

The purpose of this study is to develop a comparative understanding of the teaching and learning of reflection in medical and healthcare education in two UK universities. Reflection is claimed to fill the gap between theory and practice (Schon, 1987), encourage a deeper level of learning (Entwistle, 1997), and promote lifelong learning (Moon, 1999). Using symbolic interactionism as an interpretivist theoretical perspective, this study adopted the grounded theory methodology. A hermeneutic approach informed both the theoretical perspective and the methodology of the study. The methods of data collection used in the study included semi-structured interviews (n=38), non-participant observation, students' reflective assignments, and students' reflective diaries. Data were analysed by theoretical coding to identify concepts and categories. A constant comparison method (Glaser, 2004) of data analysis enabled the generation of theory. This was supported by the understanding and insight gained through a movement between the parts and the whole of the data in a hermeneutic circle. This study revealed that teaching and learning reflection in different courses is based on the perceived image of the reflective practitioner and the personal and professional benefits of reflection. Different professions use reflection for different purposes. This is influenced by their socio-political stance, social position, and ambitions of the profession. These, in tum affect methods, strategies, and outcomes of reflection. This research contributes to a growing recognition of the sensitivity of assessing students' reflective works, supports the idea that it is problematic and suggests that there are ethical and delicate educational issues to be considered in terms of assessing students' reflective works. This thesis concludes with an acknowledgement of the complexity of teaching and learning reflection in medical and healthcare education. It calls for considering teaching and learning reflection as a "whole" when dealing with its different features (parts) in order to understand and work with the phenomenon. This study has some implications for lecturers, students, and educationalists.