Reflection-Based Learning for Professional Ethical Formation

Abstract

One way practitioners learn ethics is by reflecting on experience. They may reflect in the moment (reflection-in-action) or afterwards (reflection-on-action). We illustrate how a teaching clinician may transform relationships with patients and teach person-centered care through reflective learning. We discuss reflective learning pedagogies and present two case examples of our preferred method, guided group reflection using narratives. This method fosters moral development alongside professional identity formation in students and advanced learners. Our method for reflective learning addresses and enables processing of the most pressing ethical issues that learners encounter in practice. IntroductionHow does one become a more ethical practitioner? We suggest that clinicians learn ethics through reflective practice and reflective learning. Reflective learning incorporates the lessons of experience into practice and integrates these lessons into one's body of knowledge, providing context and meaning [1][2][3][4][5][6]. Reflection promotes mindfulness and self-awareness, both of which form the basis of effective patient interactions, especially with patients whom one finds difficult or challenging. Whether "reflecting-in-action" while with a patient or "reflecting-on-action" after having seen a patient [7], the reflective practitioner compares intended with actual outcomes. In ethics as well as other aspects of medicine, the practitioner considers if outcomes are optimal and, if not, what might have been done better. In this way, moral development progresses alongside professional identity formation as a lifelong process [8][9][10]. We will begin this paper with a case illustrating how ethics can be learned and then taught through reflection-inaction and reflection-on-action. We will then describe the various methods for reflective learning, which have been used extensively by one of the authors (WTB) to promote learning of ethics and professional development [11][12][13][14], focusing on two synopses of vignettes that illustrate narrative reflection.

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