Week 2 - Reflection in Paramedicine

WEEK 2 - REFLECTION IN PARAMEDICINE

01. LEARNING OUTCOMES

  • Outcomes to Discuss:

    • Rationale for reflection in paramedicine.

    • Define reflection and professional reflective practice, identifying the goal of the metacognitive process of reflection.

    • Describe different aspects of processes/models for reflection.

    • Demonstrate reflection in relation to personal practice.

02. WHAT IS REFLECTION?

  • Definition:

    • Reflection is an innate, natural mental and emotional process experienced by all humans.

  • Characteristics:

    • It can be performed unintentionally or intentionally on past or current experiences.

    • Focus areas include emotions, thoughts, behaviors, identity, etc.

  • Benefits:

    • Clarifies perceptions.

    • Helps in making sense of experiences.

    • Strengthens memory.

    • Finds meaning and resolves emotional conflict.

    • Solves problems and aids in choosing behaviors.

  • Cognitive Process:

    • Involves a metacognitive shift from automated “System-I thinking” to higher interpretive, evaluative, and analytical “System-II thinking” (Kahneman, 2011).

  • Nature:

    • Reflection is a social (and scientific) construct, closely related to conscious experience, self-determination, growth, well-being, and health.

  • Importance in Practice:

    • Reflective practice is central to higher education and paramedic practice.

  • Philosophical Amid Reflection:

    • Socrates noted, “The unexamined life is not worth living.”

    • Reference: Gerbasi, J. (2025). Plato's Apology and the Politics of Memory. American Journal of Philology, 146(1), 43-71.

PROFESSIONAL REFLECTION

  • Nature of Professional Reflection:

    • Uses innate reflective ability to improve wellbeing and performance in students and health professionals.

    • Initiated consciously to optimize outcomes, contrasting with innate reflection.

  • Regulatory Importance:

    • AHPRA requires practitioners to be reflective, beginning in education.

  • Philosophical Perspective:

    • Foucault viewed reflection as an ethical responsibility for self-care.

  • Tools for Reflective Practice:

    • As a paramedicine student, personal experiences and self-knowledge are key tools.

BENEFITS OF PROFESSIONAL REFLECTION

  • Enhances:

    • Self-awareness and insight.

    • Critical evaluation and positive change implementation.

    • Learning and awareness of needs, contributing to Continuing Professional Development (CPD).

    • Emotional awareness and forward planning.

  • Long-term Outcomes:

    • Increased resilience, job satisfaction, autonomy, and self-regulation.

PROCESSES AND TOOLS IN REFLECTIVE PRACTICE

  • Core Nature:

    • Professional reflection is an intentional metacognitive action to elevate thinking levels.

    • Foundation of all reflective inquiry is self-interrogation or questioning.

  • Techniques and Tools:

    • Mindfulness activities.

    • Informal peer discussions.

    • Checklists.

    • Feedback mechanisms.

    • Reflective frameworks.

    • Debriefing sessions.

    • Supervision and mentoring.

    • Therapeutic practices.

    • Research initiatives.

STUDENT REFLECTION COMPONENTS

  • Discussion Tools Include:

    • Checklists for placement and assessment.

    • Reflection assessments.

    • Tutorial debriefing sessions.

    • Supervision on placements.

    • Counseling services as needed.

    • Research and inquiry methods.

REFLECTIVE LEARNING OUTCOMES

  • Objective of Reflective Approaches:

    • Achieve a higher state of awareness, insight, and agency through transformative processes.

  • Reflection on Experience:

    • Experience without reflection is a poor teacher; applied reflective metacognitive processes lead to deeper learning outcomes.

REFLECTIVE MODELS

  • Donald Schön's Model:

    • Advocated for two types of reflection:

    • Reflection-in-action: Occurs during a case.

    • Reflection-on-action: Occurs post-event.

  • Edwards' Dimensions:

    • Introduced two additional dimensions:

    • Reflection-before-action.

    • Reflection-beyond-action (long-term reflection).

  • Application in Paramedicine:

    • Models can be employed at various stages of education and practice to enhance learning and performance.

REFLECTIVE PRACTICE OPPORTUNITIES IN PARAMEDICINE

  • Benefits:

    • Improved clinical judgment and safer care through structured reflection linking theory to practice.

    • Ongoing competence and professional identity development.

    • Improved emotional processing and resilience in challenging situations.

    • Enhanced cultural safety and patient-centered care.

LIMITATIONS OF REFLECTIVE PRACTICE

  • Challenges:

    • Time pressure and operational realities limit deep reflection opportunities.

    • Unsupportive reflective cultures diminish the value of reflexive practices.

    • Emotional risk and vulnerability associated with reflecting on adverse events.

    • Barriers to understanding reflective models and their applications.

AHPRA REQUIREMENTS

Clinical Reasoning and Problem-Solving

  • Exhibit skills in clinical reasoning and problem-solving to ascertain clinical judgments and decisions.

  • Employ evidence-based practice intertwined with reflective thinking to tackle clinical challenges.

  • Demonstrate logical, systematic approaches to situation analyses and problem-solving.

  • Analyze conflicting information and evidence when making clinical judgments.

  • Formulate diagnoses grounded in patient assessments and contextual analyses.

  • Recognize critical timing of treatments, referrals, handovers, and transport provisions.

Importance of Critical Thinking

  • Incorporate questioning, analysis, synthesis, interpretation, cognitive reasoning, and literature appraisal skills.

  • Engage in reflective practices during and after clinical challenges.

  • Utilize structured and informal reflection to integrate culturally safe practices.

CULTURAL SAFETY PRACTICES

  • Definition:

    • Determined by Aboriginal and Torres Strait Islander individuals and communities.

    • Involves continuous critical reflection on healthcare practices to ensure safety and responsiveness.

  • Practitioner Responsibilities:

    • Acknowledge historical and systemic issues impacting health.

    • Address personal biases and ensure non-discriminatory care.

    • Encourage self-determined decision-making led by the patient and community.

    • Provide leadership to foster a safe environment for all individuals and colleagues.

REFLECTIVE APPROACHES AND MODELS OF REFLECTION

  • Types of Reflection:

    • Professional reflection involves switching from System-I to System-II thinking.

    • Can manifest as:

    • Informal or formal.

    • Structured or unstructured.

    • Solo or collaborative.

    • Literature or standards-bound.

  • Effective Reflection Components:

    • Encompasses self-interrogation, narrative building, evaluation, analysis, and synthesis.

    • Aims to uncover professional identity, behavior, thoughts, and emotions.

    • Identifies assumptions and cognitive gaps while leading to actionable plans.

COMMON REFLECTIVE MODELS

  • Models Utilized in Paramedicine:

    • Schön's reflection-in-action and reflection-on-action

    • Gibbs' Reflective Cycle

    • Johns' Model of Structured Reflection

    • Rolfe et al.'s “What? So what? Now what?”

    • Atkins & Murphy’s model of reflection

  • Gibbs' Reflective Cycle Components:

    • Description.

    • Feelings.

    • Evaluation.

    • Analysis.

    • Conclusion.

    • Action Plan.

GIBBS REFLECTIVE CYCLE: STEP BY STEP

  1. Description:

    • Describe the situation: what happened, who was involved, where and what role did you play?

  2. Feelings:

    • Discuss your emotions during the event, reflecting on thoughts and feelings.

  3. Evaluation:

    • What was favorable or unfavorable in the situation?

  4. Analysis:

    • What knowledge can substantiate your understanding of the event? What went wrong?

  5. Conclusion:

    • What could have been done differently?

  6. Action Plan:

    • How will you change your approach for similar situations in the future?

JONH'S MODEL OF REFLECTION

  • Key Aspects to Consider:

    • Key external and internal factors influencing the situation.

    • Goals and outcomes that stem from interventions.

    • Emotional and knowledge-related reflections post-experience.

LEVELS OF REFLECTION

  1. Stimulated Reflection:

    • Noticing discrepancies and analyzing impacts.

  2. Descriptive Reflection:

    • Recollecting and interpreting events to integrate new information.

  3. Dialogic Reflection:

    • Critically analyzing situations using existing knowledge.

  4. Critical Reflection:

    • Evaluating knowledge and addressing pre-existing notions.

ROLFE ET AL.'S FRAMEWORK

  • Questions asked in the framework:

    • What stage are you at?

    • So what is the significance?

    • Now what will be the next steps?

KOLB'S REFLECTIVE MODEL

  • Stages of Reflection:

    • Concrete Experience: Engage in an experience.

    • Reflective Observation: Reflect on the experience.

    • Abstract Conceptualization: Draw conclusions from the reflection.

    • Active Experimentation: Apply what you learned in the future.