Reflection revisited: how physicians conceptualize and experience reflection in professional practice – a qualitative study

Abstract

BackgroundFor the purpose of continuous performance improvement, physicians are expected to reflect on their practice. While many reflection studies are theoretically oriented and often prescriptive in the sense that they conceptualize what reflection should look like, the current study starts with practicing physicians themselves and maps how these physicians conceptualize and experience reflection in daily professional practice.MethodsWe conducted a qualitative study using in-depth interviews with 13 hospital-based physicians from various specialties and institutions. The interviews were transcribed verbatim and were analyzed iteratively, following the interpretative phenomenological analysis approach.ResultsData analysis resulted in the identification of three main topics: fuzziness, domain specificity and dialogical dynamics of reflection in professional practice. Reflection was conceptualized as a fuzzy process of contemplation and action, leading to change and hopefully improvement of personal performance and health care in general. Physicians’ experiences with reflection were different for the patient domain and the team domain. Whereas experiences in the patient domain were recalled first and discussed in relatively clear terms, those in the team domain came second and were discussed in more ambiguous terms. In order to achieve improvement in daily practice, honest and open dialogues were perceived as necessary. These dialogues were regarded as the result of an interplay between an internal and an external dialogue. The internal dialogue required sensitivity and courage of the individual; the external dialogue required psychological safety and encouragement of the environment. Within the team domain however, handling the external dialogue effectively was not self-evident, underlining the importance of psychological safety.ConclusionsThis study draws attention to the interdependence between the individual and the collective contributions to reflective activity in professional practice. Apart from its importance to physicians’ individual medical performance, reflective activity is also important to the functioning of a team of physicians. To allow reflection to rise from an individual activity to a team activity, it is necessary to invest in a safe environment in which people are encouraged to think, act, and be engaged.

Multisource feedback as part of the Medical Board of Australia’s Professional Performance Framework: outcomes from a preliminary study

“…Again, there is some evidence of convergence of agreement between colleague scores received and doctor self-evaluation from a colleague perspective across all three dimensions of behaviour, performance and self-management. The differences of 10 and 12% are consistent with findings that doctors may feel more comfortable with reflection related to patient medical issues than team (colleague) domain issues [18]. This was partly confirmed by the difference in single measures ICCs, where doctors tended to agree more on how to interpret the patient items (0.67) in contrast to the colleague items (0.47).…”

“…Other areas of application include use in training, especially when merged with self-evaluation to MSF [13–15]. Such MSF was initially based on patient and colleague feedback but more recently MSF has started to incorporate doctor self-evaluation for the purposes of promoting reflection on personal performance and identifying reasons for discrepancies between received scores and self-scores [16–18]. Self-evaluation can employ the same questionnaires as used by patients and colleagues, with doctors rating themselves from these alternative perspectives.…”

The Role of Reflection in Family Support Social Work and Its Possible Promotion by a Research-Supported Model

“…However, due to it being more "intangible", or "fuzzy," in character, it can be difficult to measure reflection to prove its value and impact, one possible reason for its not being prioritized (e.g. Bindels, Verberg, Scherpbier, Heeneman, & Lombarts, 2018;Ryding et al, 2018). Productive reflection is a concept used in relation to reflection at work (Boud, Cressey, & Docherty, 2006;Dilschmann & Docherty, 2007).…”

Mento’s change model in teaching competency-based medical education

“…At the core of lessons learned is “ reflection ”. “Reflection is a personal cognitive activity that requires stepping back from an experience to think carefully and persistently about its meaning through the creation of inferences” [64].…”