Introduction to Critical

Reflection

Louise Aronson, MD MFA

Marieke Kruidering, PhD
Patricia OSullivan, PhD
University of California, San Francisco

Learning Objectives
Distinguish critical reflection from
reflection
Identify the role of critical reflection
in professional development
List the contextual elements that
support reflection

Discuss the components of successful

reflection

Critical reflection
What is it?

Why should you care?

How do you do it well?

Reflection v. Critical Reflection

Reflection

A word with many meanings and uses

Reflection

The bending or folding back of a part upon

itself

Reflection

The return of light after striking a surface

Reflection

A thought occurring in consideration or

meditation

Definitions of Reflection
Active persistent and careful consideration of any belief or supposed

form of knowledge in the light of grounds that support it and further the
conclusion to which it tends. (Dewey 93)

A form of mental processing with a purpose and/or anticipated

outcome that is applied to complex or unstructured ideas for which
there is no obvious solution. (Moon 99)
A generic term for those intellectual and affective activities in which
individuals engage to explore their experiences in order to lead to a
new understanding and appreciation. (Boud 95)
The reflective practitioner is one who uses the tool of reflection to
revisit an experience both to learn from it and to frame murky complex
problems in professional practice. (Shon 83)

Critical Reflection is different

Goes beyond consideration or
meditation
A skill developed over time
In medicine, a tool for learning and
life-long professional development

Critical Reflection
Not just what happened (anecdote)
More than personal opinion of events

Requires

Data gathering and analysis

Integration of past, present and future
Contextualizing and reframing
Learning!

Critical Reflection: UCSF

definition

The analysis of personal experience

to enhance learning and improve
future professional behavior and
outcomes.

Quiz

Reflection

=
Critical
Reflection

Bottom line:
Critical Reflection

Not an expert today, but

Not an expert today, but

you can become a surgeon

with training, practice &
feedback

you can become good at CR

with training, practice &
feedback

Critical Reflection
What is it?

Why should you care?

How do you do it well?

Why critically reflect?

Improves performance

Pre-clinical learning
Patient care
Better professionalism
Lifelong learning

Increasingly required
Portfolios
Courses and clerkships
Recertification (coming soon)

Outcomes Data
Sobral: student exam performance
Blatt: student clinical performance
with Standardized Patients

Mamede: resident diagnostic errors

Toy: residents achieving rotation
goals
Sobral 2001, Blatt 2007, Mamede 2008, Toy 2009

Critical Reflection and

Professionalism
Critical Reflection is
a core component of professionalism
a tool useful in addressing traditionally
overlooked aspects of professional
development

professionalism
the informal curriculum
clinical uncertainty/behavioral gray areas
context/conflicts/reasons for behaviors
AAMC 2010, Branch 2002, Hafferty 2010, LCME 2010

The Reflective Practitioner

is able to identify essential

professional problems, to
challenge self-evident truths,
to seek feedback and to use it for
personal professional
development.
Schn, 1983

Critical Reflection
What is it?

Why should you care?

How do you do it well?

UCSF LEaP
LEaP = Learning from your
Experiences as a Professional
Guidelines to foster Critical Reflection
Included in the handout

Effective Critical Reflection

4 part format based on clinical note
structure
4 parts = S.O.A.P.

Subjective
Objective
Assessment
Plan

Subjective
Discusses the experience
What happened?

(content)

How did it happen?

(process)

Why did it happen?

(premise/
assumptions)

Considers emotion as well as intellect

Objective
Includes data
Feedback, multiple perspectives
Peer, patient, other professional, faculty

Scholarly/journal articles
Expert consultation
Open-minded, open-ended queries to
others involved about their
interpretations of events
Web-based resources

Assessment
Draws parallels to past experience
Go beyond the particular experience
How is this a larger challenge or
opportunity for you?

Explicitly identifies learning issues

Those selected must stem clearly from
the information in S and O

Plan
Should be SMART

Specific
Measurable
Attainable
Relevant
Timely

Note when and how you will assess

the plans effectiveness

Keys to success
Focus on the analysis, not the story
Devote most of your time to O, A and P

Remember the LEaP offers guidelines,

not a cookbook
Demonstrate learning from the critical
reflection beyond the experience
Informative data, integration, reframing
Start with the right sort of experience

Choosing the right experience

Read the prompt carefully
Choose a personal experience
where you didnt have the necessary
knowledge or skills
that went well but youre not sure why
which was complex, surprising,
uncomfortable or uncertain
in which you felt personally or
professionally challenged

Lessons we learned
Parameters for learner acceptance
Required exercise
Relevant to current learning & priorities
Faculty champions/ culture of reflection

Structured guidelines more effective

than prompt alone

Feedback signals importance and

supports learning

Summing up
Critical reflection is a skill that can be
developed

Doing it well will take effort, practice,

feedback, mentoring and time

Exercise 2: Start a Critical

Reflection
Read the LEaP Guide to Critical
Reflection before beginning your
reflection

Use the LEaP SOAP note format to

guide your writing
Use as much space as you need.
Worskheet provided in packet