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Reflective Practice in the Clinical Setting: A Multi-Institutional Qualitative Study of Pediatric Faculty and
Jennifer Plant1, Su-Ting T Li, Rebecca Blankenburg
1J. Plant is associate professor, Department of Pediatrics, University of California, Davis, Sacramento, California. S.T. Li is associate professor, Department of Pediatrics, University of California, Davis, Sacramento, California. R. Blankenburg is associate professor, Department of Pediatrics, Stanford University, Palo Alto, California. A.L. Bogetz is associate program director and education program developer, Department of Pediatrics, Stanford University, Palo Alto, California. M. Long is associate professor, Department of Pediatrics, University of California, San Francisco, San Francisco, California. L. Butani is professor, Department of Pediatrics, University of California, Davis, Sacramento, California.
Purpose:
To explore when and in what form pediatric faculty and residents practice reflection.
Method:
From February to June 2015, the authors conducted focus groups of pediatric faculty and residents at the University of California, Davis; Stanford University; and the University of California, San Francisco, until thematic saturation occurred. Transcripts were analyzed based on Mezirow's and Schon's models of reflection, using the constant comparative method associated with grounded theory. Two investigators independently coded transcripts and reconciled codes to develop themes. All investigators reviewed the codes and developed a final list of themes through consensus. Through iterative discussions, investigators developed a conceptual model of reflection in the clinical setting.
Results:
Seventeen faculty and 20 residents from three institutions participated in six focus groups. Five themes emerged: triggers of reflection, intrinsic factors, extrinsic factors, timing, and outcome of reflection. Various triggers led to reflection; whether a specific trigger led to reflection depended on intrinsic and extrinsic factors. When reflection occurred, it happened in action or on action. Under optimal conditions, this reflection was goal and action directed and became critical reflection. In other instances, this process resulted in unproductive rumination or acted as an emotional release or supportive therapy.
Conclusions:
Participants reflected in clinical settings, but did not always explicitly identify it as reflection or reflect in growth-promoting ways. Strategies to enhance critical reflection include developing knowledge and skills in reflection, providing performance data to inform reflection, creating time and space for safe reflection, and providing mentorship to guide the process.
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