‘Oh yes, that is also reflection’—Using discursive psychology to describe how GP registrars construct reflection

Abstract

IntroductionLearners in medical education generally perceive that reflection is important, but they also find that reflection is not always valuable or practically applicable. We address the gap between the potential benefits of reflection and its practical implementation in medical education. We examined the perspective of Dutch GP registrars who (must) reflect for their GP specialty training to understand their participant perspective on reflection. Our aim is stimulating alignment between reflective activities that occur in a medical curriculum and the ideals of reflection as a valuable educational activity.MethodsWe conducted, video‐recorded and transcribed seven focus group sessions with GP registrars in 2021 across two Dutch GP educational programmes. We used discursive psychology to analyse the focus group data by focusing on ‘assessments of reflection’. We analysed their discursive features (how something was said) and content features (what was said) and related these to each other to understand how GP registrars construct reflection.ResultsParticipants constructed reflection with nuance; they combined negative and positive assessments that displayed varied orientations to reflection. First, their combined assessments showed complex orientations to norms and experiences with reflecting in practice and that these are not simply negative or positive. Second, GP registrars constructed reflection as a negotiable topic and showed how reflection and its value can be variably understood. Third, through combined assessments, they displayed an orientation to the integration of reflection with other educational tasks, which impacts its value.ConclusionsGenerally, GP registrars speak positively about reflection, but the value of reflection partly depends on its proper integration with other educational tasks. When meaningful integration fails, activities to stimulate reflection can overshoot their own goal and hamper learner motivation to reflect. Developing a healthy ‘reflection culture’ could mitigate some challenges. Therein, reflection is treated as important while learners also have adequate autonomy.

Towards a culture and pedagogy of reflection

“…In this issue of Medical Education, Schaepkens et al consider these questions in a recent study of Dutch GP registrars. 1 They conclude that, while learners speak positively about reflection, its perceived value depends on its proper integration with other learning activities. In essence, meaningful integration into education, along with practice, matters.…”

“…So do faculty. Narrative and reflective writing should be strategically and meaningfully integrated into curriculum, not assigned as a 'bolt on' 1 task or as a performance measure, and the reasons for doing so should be understood by educators and communicated to learners. In this way, we can leverage the unique affordances of writing as part of a broader approach to cultivate a culture of reflection in health professions education.…”

Enhancing nursing students’ reflection through Padlet: an action research

“…It is challenging to teach reflective practice to students and appropriately determine their capability to reflect: First, reflective practice is a complex activity which can be taught and demonstrated in various forms such as verbally or in writing. Reflective practice can also happen in various contexts such as at bedside between students and patient, in a lecture hall or small group discussion 1 , 7 , 8 . However, the assessment tends to focus on students’ capability to demonstrate their reflective practice in writing.…”

“…This is problematic because it is challenging to differentiate the students who need more support on their externalisation i.e. their ‘writing skills’ and students who need more support on internalisation i.e., ‘reflection skills’ 5 , 8 , 9 . Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1 , 7 , 8 .…”

“…their ‘writing skills’ and students who need more support on internalisation i.e., ‘reflection skills’ 5 , 8 , 9 . Second, reflective practice is often positioned as an individual activity; the notion of group reflection, social interactions and their impact on individuals reflection skills tend to be undervalued 1 , 7 , 8 . Third, writing is often a complex activity.…”