Evidence Based Practice Symposium - McMaster University

not really a conscious competent clinician” (P03).
All preceptor participants engaged in verbal reflection with
their students, whereas only four preceptors provide written
feedback on journals.
Reflection as a tool for professional development
Participants were prompted to describe how RJ has
influenced professional development. Participant descriptions
were assigned to one of the seven competencies as outlined in
the Profile of occupational therapy practice in Canada
(Canadian Association of Occupational Therapists (CAOT),
2007). When removed from the antecedent context, majority of
student participants stating using reflection to “put some of the
pieces together” (S08) and “connect the dots” (S11). In other
words, “you’re making what’s implicit, you’re making it
explicit” (S05).
Over the course of interviews, student and preceptor
participants described the use of RJ in the development of all
seven occupational therapy competencies.
Challenges using reflective journaling
Over half of the student participants commented that lack
of time was a challenge. Student participants discussed
competing priorities, length of time required to write a journal,
fast-paced nature of the placement and the added challenge of
commuting. Preceptor participants stated that it comes down to
what is the priority in your day. Student participant discussed
feeling that there were too many requirements for RJ leading to
reflections that are disingenuous, “meaningless and empty”
(S06).
Student participants also discussed that censoring or editing
their RJ reduced both authenticity and overall benefit of the
journaling process. Student participants who were negative
about sharing reflections with faculty still discussed the value
of having faculty feedback. However, in general, their
comments highlighted that journals would be edited for content
and style.
Recommendations
Student participants made recommendations for RJ
preparation, requirements and feedback. To clarify RJ
expectations, student participants suggested providing an
evaluation guideline or rubric and more meaningful feedback
from faculty, specifically recommending the academic advisor.
Discussion
This study provides an understanding of the experiences of
student occupational therapists and preceptors with reflection
and RJ. The findings of this study are supported by literature in
this area. As reflective practice is individualized, supporting
the student’s reflective style is essential. In order to facilitate
deeper reflection, Hubbs & Brand (2005) highlight the
importance of providing feedback on both the content and
process of RJ. Students discussed feeling uneasy with the
power difference between faculty and students, however, they
also discussed the importance of receiving meaningful faculty
feedback.
In order for RJ to be an effective tool, students must have a
clear understanding of its value (Mann et al., 2009). As the
findings from this study demonstrate, those students with more
preparation, including a solid understanding of RJ, were more
likely to use it in future practice. The challenges of RJ
addressed by participants, such as writing articulating, being
time consuming and disingenuous, were echoed in the
literature (Buckley et al., 2009; Harris, 2007).
Limitations of this study include volunteer bias, probing
participants around the theme of clinical reasoning.
Conclusion
The findings outline five key areas arising from
participants’ journeys through the reflection and RJ process:
student implementation, value, professional development,
challenges and recommendations. These findings support the
need for an approach to RJ that incorporates peer to peer
sharing of RJ, structured evaluation, verbal faculty feedback
and an awareness of challenges.
Program Recommendation
• Year one and year two student, who share the same
academic advisor, paired for mutual submission and
review of written journals
• Academic advisor will meet with pair to provide verbal
feedback and facilitate dialogue on content and process
of RJ
Subsequent research will be required to implement and
evaluate the effectiveness of this recommendation.
References
Buckley, S., Coleman, J., Davison, I., Khan, K., Zamora, J., Malick,
S., et al. (2009). The educational effects of portfolios on
undergraduate student learning: a Best Evidence Medical
Education (BEME) systematic review. Medical Teacher, 31,
282-98.
Canadian Association of Occupational Therapists (2007). Profile of
Occupational Therapy in Canada. Ottawa, ON: CAOT
Publications.
Harris, M. (2007). Scaffolding reflective journal writing – Negotiating
power, play and position. Nurse Education Today, 28, 314-
326.
Hubbs, D.L. & Brand, C.F. (2005). The Paper Mirror: Understanding
Reflective Journaling. Journal of Experiential Education,
28, 60-71.
Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and
reflective practice in health professions education: A
systematic review. Advances in health sciences education:
Theory and practice, 14, 595-621.
Moon, J. (2004). A handbook of reflective and experiential learning:
Theory and practice. London: Routledge Falmer.
Schon, D. (1983). The reflective practitioner: How professional think
in action. London: Temple Smith.
Shimmell, L. (2010). [Canadian University OT program use of
reflection, n=7 schools]. Unpublished raw data.
The authors gratefully acknowledge the support of the McMaster
School of Rehabilitation Sciences Educational Research Grant and
the research contributions of Emma Graham and Anna Goulding,
BHSc.