Reflective Writing
What is reflective writing?
Adapted from http://www.monash.edu.au/lls/llonline/writing/medicine
Reflective writing is:
Writing encourages students to adopt a reflective stance, in
order to successfully answer questions such as “What
happened in that encounter?” or “Why does this patient
aggravate me?” In the process of writing, learners can step
back from the immediate obligations and pressures of training
in order to pause and consider the big picture. As one scholar
notes, “Writing slows down the whirlwind of medical
education and allows students to make sense of their
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experience on their own terms.”
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Reflective writing is writing which involves '… consideration of
the larger context, the meaning, and the implications of an
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experience or action'. In medical and health science courses
you are required to produce reflective writing in order to learn
from educational and practical experiences, and to develop
the habit of critical reflection as a future health professional.
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The reflective learning process
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Students sometimes view reflective writing as an annoying
interruption to the serious business of developing content
knowledge in their subject area. However, there are sound
reasons why reflective writing is included in student
assessment.
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"Reflection is indicative of deep learning, and where teaching and
learning activities such as reflection are missing… only surface
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learning can result."
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your response to experiences, opinions,
events or new information
your response to thoughts and feelings
a way of thinking to explore your learning
an opportunity to gain self-knowledge
a way to achieve clarity and better
understanding of what you are learning
a chance to develop and reinforce writing
skills
a way of making meaning out of what you
study
Reflective writing is NOT:
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just conveying information, instruction or
defining an argument
pure description, though there may be
descriptive elements
straightforward decision or judgment (e.g.
about whether something is right or
wrong, good or bad)
simple problem-solving
a summary of course notes
a standard university essay Reflective writing tasks are given to students to help students
learn through reflection, precisely because of the established link between reflection and deeper learning.
As well as facilitating learning and monitoring learning, the intention is to produce graduates who have
acquired the habit of reflection as a means of continuing to learn and grow in their professions. Reflection
can lead to: personal growth, professional growth, and meaningful change.
"Reflection leads to growth of the individual – morally, personally, psychologically, and emotionally, as well as
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cognitively".
Reflection can help you to:
• better understand your strengths and weaknesses
• identify and question your underlying values and beliefs
• acknowledge and challenge possible assumptions on which you base your ideas, feelings and
actions
• recognize areas of potential bias or discrimination
• acknowledge your fears, and
• identify possible inadequacies or areas for improvement.
Reflection can lead to greater self-awareness, which in turn is a first step to positive change – it is a
necessary stage in identifying areas for improvement and growth in both personal and professional
contexts. Taking time to reflect can help you identify approaches that have worked well, and in that way
reinforce good practice.
Common errors in reflective writing
1. Planning: You should be thinking about possible subjects and opportunities for reflective writing
before and during your placements, not only after them.
2. Writing style: Writing too informally: just because it is based on your experience does not mean you
can ignore academic style.
For Example:
Original text
In my opinion, if there are too many 'buts' in my
choosing to practice in a rural area then I must not
be ready for it, so it's better for me to stay put in the
city.
Alternative text
The reservations I currently feel about practicing in
a rural setting suggest that I am not yet ready for
such a move. So at this stage I plan to work in the
city on graduation.
3. Too little or too much detail: You need to describe the experience adequately – the reader needs to
be given enough detail to understand the context in which the experience occurred. However, it is not
enough just to describe the experience in great detail: you also need to analyze and evaluate the events
and the thinking processes involved. You should aim to consider deeper levels of meaning, exploring
moral, ethical, social and/or professional issues.
Take time to organize and structure your writing. Try to focus on what was most significant about the
experience, and relate it to aspects of your course and future career. Be careful that your writing does not
seem to simply drift without direction or focus.
4. Being judgmental: Try to describe events accurately and honestly, but avoid moralizing about
people's behavior.
For Example:
Original text
Alternative text
1.
I was shocked when the doctor showed me
the patient's file without seeking consent. His
disregard for the rules regarding patient
consent caused me to lose respect for him
and to question his ethical standards.
I was surprised when the doctor showed me
the patient's file without seeking consent. It
made me realize that discrepancies can exist
between what is taught on course and the way
in which medicine is practiced in reality. From
my own perspective, as a future doctor I would
seek to maintain high ethical standards, and to
encourage that among staff under my
supervision.
2.
During the second week of my clinical study, I
met a patient who needed an x-ray for her
knee and hip joint. She was overweight and
not very aware of my role as radiographer –
she treated me more like a technician than a
future doctor. Even worse, she was not
cooperative, kept murmuring and shouted out
about her pain throughout the procedure.
Furthermore, this patient didn't listen to our
instructions and wouldn't stay still after
positioning.
During the second week of my clinical study, I
met a patient who needed an x-ray for her
knee and hip joint. This was made more
difficult because she was significantly overweight and not very aware of my role as
radiographer. She appeared distracted and
had difficulty coping with her level of pain,
sometimes shouting out. In terms of the x-ray
procedure the patient was uncooperative –
she did not follow our instructions and would
not stay still after positioning. This made it
very difficult to produce an adequate x-ray.
It could be useful to analyze this incident
further – for example:
What surprised me most about this incident
was the attitude of the patient to the health
professionals. In my culture most people treat
health professionals with great respect, and
acknowledge their authority; they are even
sometimes intimidated by them. I realized that
in the Australian context compliance from the
patient cannot be assumed. The doctor has to
gain the trust and cooperation of the patient,
and this may not always be easy. In this case I
found that talking quietly to the patient and
explaining each requirement in detail
reassured her, and ultimately led to a greater
level of cooperation. However, this made the
consultation much longer than it otherwise
would have been.
Self reflection v. self criticism
Some writers become confused between self-reflection and self-criticism. You need to go beyond simply
admitting a weakness or mistake or failure – what is important is not only what you did, but how you felt,
what you have learnt from that experience, and how it will inform your behavior in the future.
Try not to confine your writing to the event and your feelings. If possible, use it to raise new questions or
to speculate about possible causes and solutions. Remember where possible to link your reflections to
theoretical aspects of your assignment.
For example:
Addressing course issues and topics – comparison
Original text
Alternative text
When the doctor raised his voice to the patient I felt
embarrassed and the patient appeared to feel humiliated.
Clearly this behavior by the doctor was not appropriate, even
When the doctor raised his voice to the
though the doctor was obviously frustrated at the patient's
patient I felt embarrassed. It reminded
apparent inability to understand the instructions. While it is the
me to maintain an appropriate
responsibility of every doctor to behave respectfully with
communication style with patients when I patients, on this occasion an excessive workload and the lack
am a doctor.
of availability of an interpreter no doubt contributed to the
doctor's behavior. It reminded me that structural factors within
the health care system, such as staffing and budgets, can
impact on the quality of attention delivered to patients.
Criteria for assessment
Reflective writing is a vehicle which you use primarily to share your thinking and learning processes with
your lecturers. The event or incident or experience in itself is not important – what is important is your
reaction to it, and how it has informed your thinking and your learning. Assessment tends to focus on how
successfully you have demonstrated a capacity to analyze and reflect on events in order to learn from
them. Also relevant to assessment is how much you are able to relate your current theoretical learning
(for example, about the doctor-patient relationship, or about what constitutes effective communication) to
a real life situation.
Most importantly, you need to be genuine and honest in your reflections, as illustrated in the following
quote from a lecturer:
The most important thing to get across to the students is that they be genuine in their reflections, and not write what
they think I want to hear. For example, empty rhetoric like 'this incident has made me want to go and work with
people in developing countries', 'since this incident I have decided to be the best doctor I can possibly be' or 'in future
I will treat my patients holistically' does not score points.
Scoring
Writing will be given a score of 1-4 using the criteria below.
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1. “Descriptive writing: This is a description of events or literature reports. There is no discussion beyond
description.
2. Descriptive reflection: … some evidence of deeper consideration in relatively descriptive language.
There is no real evidence of the notion of alternative viewpoints in use.
3. Dialogic reflection: … a ‘stepping back’ from the events. There is consideration of the qualities of
judgments and of possible alternatives for explaining and hypothesizing… analytical or integrative,
linking factors and perspectives.
4. Critical reflection: … aware that the same actions and events may be seen in different contexts with
different explanations associated with the contexts.”
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Shapiro & Kasman& Shafer, 2006, p. 234
Branch & Paranjape, 2002, p. 1185
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Biggs 1999 in King 2002
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Branch & Paranjape, 2002, p. 1187 5
Moon, 2004, p. 75
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