Another valuable vehicle for learning is the practice of active reflection. Whilst feedback tends to promote skill acquisition and competency, reflection leads to individual growth and interpretation of the greater meaning and implications of an experience or action. It is important to establish a reflective atmosphere with your student (Branch & Paranjape, 2002).

The following methods encourage student engagement in reflective practice:
 

Use of a reflective journal and self-evaluative tools

Where the student can write their feelings down and analyse their actions, as well as make future action plans for improvement (Reid & McKay, 2001)

"Use of self-reflection forms assists students to comfortably reflect in a balanced way, noticing both strengths and areas for improvement" J.Copley, OT clinical educator, multiple-mentoring model (personal communication, May 24, 2007)
 

Peer learning

Through discussion and interaction with peers (particularly advantageous for students participating in the multiple mentoring or collaborative placement models) students can identify areas of strength and limitation as well as draw on one another to find solutions to problems, to share resources and to learn through shared experiences (Reid & McKay, 2001). Peer learning can be encouraged by involving students in group, as well as individual, supervision sessions.
 

De-briefing

This is an effective way of providing immediate support to the student through engagement in formal structured reflection of actions and incidents after they have occurred (generally within 12 to 48 hours). De-briefing can occur either as a group or individual process (Reid & McKay, 2001; Boudreaux & McCabe 2000; Partnerships against Domestic Violence, 2004).

Instances when formal de-briefing may be helpful include: following the students' interaction with a particularly challenging client; where emotional factors heavily influence the client's experience of disability, illness or therapy or when a client has died or behaviour has been alarming. Debriefing should be provided in a safe environment that encourages open expression and normalising of emotional, cognitive and physical reactions to an incident, whilst encouraging positive reactions and discouraging irrational or negative thinking. It is a useful forum for planning any further support or actions required by the student to process the incident (Partnerships against Domestic Violence, 2004). Formal debriefing is a chance for the student to process in depth, what has occurred and his/her responses to the situation, to reflect on what could have been done differently and any resources needed, as well as to consolidate knowledge and to link theory and practice and ideal service delivery to reality in practice (Alsop & Ryan, 1996 in Reid & McKay, 2001; Partnerships against Domestic Violence, 2004).

Ideally, this style of formal de-briefing should be led by a peer leader or health professional with training in the debriefing process, who is supported by the clinical educator (Boudreaux & McCabe 2000).
 

Exchange of Feedback

The student received constructive feedback and has opportunity to provide the clinical educator or supervisor with feedback regarding their experiences of, and contributing factors to, learning in the clinical context.
 

Strategies for Promoting Active Reflection and Self-evaluation

• create time for planned reflection
   
• use "How?" rather than "Why?" reflections.
   
• provide tools for reflective practice: reflective worksheets, systematic questions, the use of an experiential learning diary
   
• encourage use of different modalities: writing, drawing, verbal sharing of thoughts, feelings and responses.
   
• promote learning through cyclical reflection (link meaningful learning experiences with the student's learning goals)
   
• ask leading questions that encourage descriptive responses
   
• ask the student to provide an assessment of their own performance before you provide comment.
• Consider the use of video or audio recording as a useful self-evaluation and feedback tool. Promote peer learning through group and individual supervision sessions.
   
• Provide formal de-briefing, when appropriate or necessary
   
• Endorse exchange of feedback.

(Branch & Paranjape, 2002; CPAC, 1997; Turpin & Fitzgerald, 2006)

For further detail refer to Suggestion Sheet 4.1: How can I encourage reflective practice and self-evaluation?

For ideas and templates for reflection and self-evaluation tools, refer to:

Template 3.1: Self-directed learning and reflection sheet

Reference document 3.1: Procedure for using Experiential Learning Diary (PAHHSD): includes format proposal and sample of a completed structured experiential diary sheet.

Reference document 3.2: PAHHSD Occupational Therapy Department, Self-appraisal form

Resources

'Clinical Reasoning and Reflective Practice. A workbook for Occupational Therapist Clinical Educators.' Handbook by Merrill Turpin & Cate Fitzgerald (2006). Contact: The University of Queensland clinical education administrator ph: 3365 2792
 

How is feedback different from evaluation?

Feedback

• provides objective information and insight about actual performance and how it relates to performance expectations, as well as the consequences of actions.
   
• is formative - pointing the student in the direction of improving professional competency and moving toward goal achievement
   
• encourages reflective and self-evaluative practice.

Evaluation

• is summaritive - presents an assessment about how well a student has performed and/or met a given goal or competency
   
• usually follows feedback and a period of efforts at improving performance in given skills or competencies, within a time-frame.

(Ende, 1983; Branch & Paranjape, 2002)
"A 'cardinal sin of supervision' is giving only positive feedback, and then marking down at evaluation" J. Copley, OT clinical educator, multiple mentoring model (personal communication, May 24, 2007)

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