Category: Research
Category: Research |
| Teaching and Learning Forum 2008 [ Refereed papers ] |
Jane Grellier
Department of Communication and Cultural Studies
Curtin University of Technology
Diane Fisher and Janice McKay
Department of Imaging and Applied Physics
Curtin University of Technology
For many profession-based programs the development of a reflective approach to learning is seen as important in supporting the subsequent professional role the graduates will assume. In the past two years, we have introduced reflective writing to four groups of first and second year students at Curtin University, a focus that will increase as their courses proceed. Our research backs up the emphasis of many commentators in this area that reflection is difficult for students in their early tertiary years. In particular, students are often confused about how to write reflectively: in comparison with the more formulaic academic genres they are becoming familiar with, the looser and less regimented approach to reflective writing leaves some of them insecure. In this paper we will outline our initiatives in introducing reflective practice to beginning undergraduate students from several courses at Curtin University of Technology. We will describe some of the techniques we used to help them develop their reflective skills, include examples of their reflective writing, and share their evaluations of the process. Ongoing progress within the Medical Imaging undergraduate program will be discussed.
Education is, after all, not only a matter of inducing conformity. It also has the purpose of enabling people ... to express themselves not only as members of discourse communities but as individuals capable of manipulating and challenging the communal conventions of thought and expression (Widdowson, 1993, p.35).Our research over the past semesters has demonstrated that first- and second-year students tend to find reflective practice both difficult and uncomfortable, but that a range of learning strategies can support their early attempts to write reflectively. We concur with Pugach and Johnson (1990, p. 205), who warn of their Education students' difficulties in developing reflective thinking skills.
As we move toward the goal of preparing teachers to be reflective in all aspects of their work, we are obligated to recognize the depth of change its use requires.While the change is difficult, however, we must take the first steps. In this paper we will outline our initiatives in introducing reflective practice to beginning undergraduate students from several courses at Curtin University of Technology. We will describe some of the techniques we used to help them develop their reflective skills, include examples of their reflective writing, and share their evaluations of the process. We do not intend to revisit the theoretical issues of reflective practice or of assessment of reflective writing covered well in many other works (for example, Mezirow, 1981, 1990, 2000; Boud, Keogh & Walker, 1985; Hatton & Smith, 1995; Boud & Walker, 1998; Kember, McKay, Sinclair, & Wong, In Press).
In working to develop reflective practice skills in beginning students, we have found the concepts of different levels of reflection useful, both to inform our own pedagogy and to share with our students. Many eminent researchers in the reflective practice area have worked with these concepts (for example Van Manen, 1977; Mezirow, 1981; Sparks-Langer, Simmons & Pasch, 1990; Wong, Kember, Chung & Yan, 1995; Kember et al. [In Press]). The work of Benner (1982) is particularly useful. She advances the novice-to-expert continuum, which she developed in the context of the nursing profession, based on the skills acquisition model proposed by the Dreyfus brothers in the late 1970s. Benner notes that less experienced practitioners will be more comfortable with Schön's (1983, 1987) reflection-on-practice, being able to stand back and reflect after the event, but as they reach expert status they engage in reflection-in-practice, and demonstrate a much closer and personally integrated understanding. The novice-to-expert continuum provides an interesting model for developing reflective practice skills in students and junior professionals, acknowledging that reflective abilities advance as students develop a deeper and more experienced understanding.
Our work on reflective practice is part of an ongoing project involving both qualitative research - student focus groups, individual interviews with students, observation of their participation in class, and analysis of their reflective writing - and quantitative research - analysis of more than 300 evaluations from three different groups of students.
Grellier and a second colleague also introduced reflective writing to 64 students of Urban and Regional Planning in Semester 1, 2007, requiring them to write weekly in a reflective journal in response to ideas they were encountering in all four units of their first semester studies. We used the same evaluation instrument used in Contemporary Science 101, which we administered to 57 volunteers in the early part of the semester and the same number at the end. Students were also engaged in reflective writing in one other Planning unit in this semester.
In Semester 2, 2007, the first-year Medical Imaging students completed two units that introduced them to the professional focus of their degree: Medical Imaging Science 142 and 152. Students attended a week of clinical observation, designed to encourage them to see the similarities and differences between what they learn in class and the situations in the practice setting. McKay coordinated their reflective writing in these units: they were required to reflect on cases they were observing in their observation clinical unit, writing approximately 800 words on one case.
The second year Medical Imaging students, who had been part of the study conducted by Grellier and Fisher within the Contemporary Science 101 unit in 2006, were involved in two separate reflective writing initiatives in 2007. In Semester 1, they kept a reflective journal while on clinical practice in a unit coordinated by Fisher and a colleague, and completed the same written evaluation as was conducted in the communications units. They also had a period of clinical experience in Semester 2. We asked them to write reflectively on two clinical situations they encountered during the time. Their requirements were raised from those of the first year group, in order to encourage an increasing level of reflective ability - to help them progress along the novice-to-expert continuum (Benner 1982), and also to acknowledge their increased clinical experience compared with the first year group.
Write in full sentences, not in note form. You may include mind maps, drawings, notes and other graphics to support your ideas. You may present your reflections in any form you wish; however, you might ask yourself questions like the ones below.We then offered a range of guiding questions, which students might consider but which were not prescriptive (see Appendix 1). Some students commented during the semester that they appreciated not having to adhere to the conventions of academic writing, as is evident in the following informal comment from an Urban and Regional Planning student.
Why do I enjoy reflective writing? It is an opportunity to let my mind wander to previous ideas, existing knowledge or topics from other classes and see how they connect, without worrying about research, referencing or if it's correct or being marked.In order to focus students on reflecting rather than merely describing, we also provided students in Week 1 with cover sheets for their reflective writing that outlined the criteria on which we would assess their writing. These criteria emphasised commitment to writing and reflective processes, rather than correct grammar and other writing conventions. Working from this information, students submitted their first piece of reflective writing in Week 2, and we responded to it quickly, writing reflective comments ourselves in response to the ideas, and giving feedback on the degree to which each piece was reflective rather than merely descriptive. In Week 3 we handed back these pieces, and ran short teaching sessions where we looked at student examples of good reflective writing.
Throughout the semester we focused consciously on helping the students develop their metacognitive understandings of what it means to think reflectively:
[T]here is some evidence that reflective capacities can be fostered by providing students with strategies and experiences which develop the required metacognitive skills (Hatton & Smith, 1995, p. 43).Two concepts we found useful in doing this with first-year students are the concept of the outside observer and John Dewey's (1910, p. 9) "perplexity, confusion, or doubt". The former concept has resonated with many of our students, who come from a wide range of socio-cultural and ethnic backgrounds. One student, a young Sudanese refugee who has been in Australia for five years, recently commented that he thought reflective writing was easier for him than for those who had never been out of Australia - as he constantly feels like an outsider, he reflects readily on ideas, attitudes and practices other students take for granted. The concept of maintaining a state of "perplexity, confusion, or doubt" rather than rushing to look for quick answers flies in the face of much of students' education to this point, where they have been rewarded for finding answers. We were able to endorse this position, which gave some students a greater sense of security in maintaining it.
This position underlay the Week 3 classes, when we took students through a chain of questions exercise, based on a section in philosopher Alain de Botton's The Art of Travel, where he discusses 19th century German explorer Alexander von Humboldt's reflective response to seeing a fly on the heights of a Peruvian mountain (de Botton, 2003, pp. 116-25). The exercise involved identifying statements from students' reflective pieces such as 'The week was a good start to my university studies because I was always within my comfort zone', and asking them to write a chain of questions that arose from each statement, without looking for answers. Several students found that their chains ended with very broad reflective questions about their learning processes, such as 'Do I learn best when I stay within my comfort zone?' or even 'How do I learn most effectively?' In response to this exercise, one of the Planning students reworked her first reflection as follows.
After receiving feedback from our first reflective writing, I understood a lot more clearly what is being required of me. I re-read my reflection and noticed that it was rather shallow. I needed to push myself out of my boundaries and ask unusual questions that I might not even be able to answer.In this piece of writing, and in the chains of questions many of the students created, students were willing to place themselves into states of perplexity, and began to see the value of not rushing to solve their dilemmas with quick, superficial answers.I looked at curiosity for the second time and found myself wondering 'When did it all start?' I mean, were we born with curiosity or is it a skill that we develop? I looked at my younger sister, 18 months, and I still remember when she was a newborn, and I realised something rather strange. I noticed that through the inability to walk, crawl, sit, speak or even hold your head up there is nothing else to do than to be curious. I think that we may even be at the peak of our curiosity and all challenging questions deteriorate after time.
Another question raised which rather puzzled me was, 'How does curiosity help you to learn?' I think that it can help, however I do believe that it can also hinder. One needs to be curious to be able to raise questions and think outside the box, to push yourself to think more critically. However, it could hinder by stopping us seeing the simple rationale behind some things. Not everything needs such an in-depth reasoning behind things and that is what I believe curiosity achieves.
Asking questions which challenge me makes it a lot easier to push myself further and think outside the box, to see the bigger picture. However, what I have noticed is that questions only lead to more questions, once they start they don't stop, such as 'How is being challenged and asking more questions going to aid me through life?'
Both communication units had online sites available to all students. In the early weeks of the semester we put up on these sites several examples of students' reflective writing, selected because they were very different from each other, in the hope of demonstrating to students that there was no one acceptable model of reflective writing.
As the semesters progressed we collected reflective journals regularly, and continued to write reflective comments in them and to give guidance to students about their writing. In the Contemporary Science unit, the students also attended tutorials with science tutors who discussed the science concepts introduced in the lectures, and who shared responsibility for assessing the journals. The two groups of teachers responded alternately to the journals, with the science tutors focusing on how students reflected on the science content, while we looked at the reflective practice in general as well as at how students reflected on their learning processes.
Of course, this understanding will deepen in future years, as students think critically and reflectively about issues related to their disciplines. Since students were concurrently learning about essay or report writing and making formal oral presentations, they were able to appreciate the differences between the processes required, and began to understand the particular demands and conventions of reflective thinking. For example, one issue that arose regularly in the Planning group, who took this unit in their first semester at university, was that many of them tended to use the journal as a diary, writing day-by-day narratives of their weeks. By discussing openly with them the generic differences between diaries and reflective journals, we were able to help them articulate their understandings of reflective writing. We urged them to pursue in depth one issue or question of concern each week, rather than ranging superficially over a number of them.
During the time of this observation period it is important that you use the experience to deepen and broaden the knowledge you have gained during your studies to date.We also made it clear that the 'personal voice' was appropriate. Before they began to write, we focused on their metacognitive understanding of reflection. We reminded them of the concept of reflective learning, discussed its importance as a means of professional development, and explained the levels of reflection outlined in Kember et al (In Press) - non-reflection, understanding, reflection and critical reflection (see Appendix 2). The assignment did not contribute to the grading for the subject, but we provided feedback to the students, including the assessed level of reflection. We explained to the student group that they were not expected to attain the higher levels of reflection as they had no previous clinical experience - other than this one week of observation - to support that process. This exercise is the beginning of the process of developing a reflective approach to learning and experience within the Medical Imaging context.To encourage you to think about the experience you gain during this observation period, and to support you to develop a better understanding of the clinical learning process, you are to write up a situation you have encountered during the observation week.
The case you write up should be one where the examination procedure, management of a patient, or general department routine were for some reason conducted differently from what you have learnt.
In order to challenge the second-year students to deepen their reflective writing skills, we gave them more specific instructions.
..to think about your clinical experience, and to support you to develop a better understanding of the clinical learning process, you are to write up two (2) cases you encounter in your clinical placement. The cases you write up should be ones where the examination for some reason was, or should have been, altered in some way to ensure the best outcomes from the examination.At second-year level we require Medical Imaging students to make decisions about examination processes they witness or take part in, with the aim of encouraging them to make a judgement based on their increasing levels of theoretical learning and clinical experience.
The 'non reflection-to-understanding' script lacked coherence in that the student provided overall factual information, but it tended to be disjointed and often unrelated.
In general X-ray rooms, radiographers helped patients to position. For example, if the patient is wheel-chaired [sic], radiographers help them get off from the wheel-chair and grip something or lie on the bed. For each position, radiographers help them to position. My clinical placed was XX Hospital. They didn't use conventional cassettes. They all used computed radiography (CR) cassettes. The advantage of CR cassettes were radiographers could read the images immediately after X-ray exposure and the images were saved in computers for records. Radiographers didn't need to go to the darkroom. Before each X-ray, they gave instructions to patients such as 'breath in and hold your breath'.The majority of scripts demonstrated 'understanding', with most students indicating understanding of what they experienced based on the theory they had learnt. For example,
I was very impressed with the level of professionalism with the patients; both verbal and non-verbal communication was very open and friendly, confident without being superior or condescending. They were prepared for any type of patient, and were able to overcome all sorts of language barriers, hearing or vision impairments, the elderly, middle aged and young, cancer patients, ICU patients, etc., and to me, this was very inspiring and gave me a much better idea of how to handle a wide range of patients.The student here has drawn on what she had learnt in MIS152, and places some emphasis on different types of communication and how communication skills need to be adapted for different situations. The student has observed this in action, and has surely gained a deeper understanding of the communication process as covered in the subject.
Those who have shown a progression from understanding, and are transitioning towards reflection, make responses that are beyond, though based on, their theoretical learning, and demonstrate a deeper thinking as a result of the experience gained. This particular example demonstrates how learning can be advanced when peer discussion or collaboration is introduced, but that is a discussion for another paper.
The things that I have learnt came not only from my clinical experience, but also from my peers that shared their experience with us. One of my peers shared a situation where the management of a patient wasn't handled well. It was about a woman who couldn't speak English and she had come in with her brother-in-law. The hospital didn't have a translator, so they had asked the brother-in-law to translate. The woman had to have a rectal examination done and they had the brother-in-law translate whilst the exam was being done. I don't think that it was very appropriate and, in my opinion, a translator should have been brought in or an alternative method of handling the situation should have been done.The student has raised a situation that has been discussed within an immediate group, has been able to pinpoint the inappropriateness of the situation, and has not only come to the conclusion that it was inappropriate but has also looked towards possible solutions.
Two students demonstrated evidence of 'reflection'. One student started by defining her scope.
With limited knowledge of positioning and protocols I decided to concentrate on the lecture content I did know; hygiene management.The student made a good start by deciding to look at an area of clinical practice that she felt comfortable with. The ability to engage in a form of problem solving indicates a move beyond simply understanding the theory, using it to form a decision, and so adapting knowledge to inform a specific situation:
Another thing I noticed was when using the OPG [orthopantomography] machines was the replacement of the disposable slip cover [this machine x-rays the teeth and jaw and is in close contact with a patient's mouth during the examination]. Quite often I was asked whether a new one was placed for the new patient when the radiographer did not know. It would be so easy to forget that you didn't actually replace the slip and have a new patient use a dirty slip. I believe that if a radiographer was not sure they should replace it anyway, but it was an easy thing to forget. Perhaps trying to remove the slip after the patient has stepped out of the machine would be a good way to ensure there was a new slip every time.The results overall from this exercise have been pleasing, with students being willing to engage in reflection, and managing the reflection process as required. As stated previously, it is an outcome of the program that students are able demonstrate a level of skill as reflective practitioners as it is considered an important attribute to take on into professional life.
We hypothesised that a large number of these students would feel insecure about how to write reflectively, and therefore asked students to respond to the statement 'I need more help about how to write in the journal' in both the pre-teaching and post-teaching evaluations. In the pre-teaching evaluations, 70 of 189 students (or 37%) agreed or strongly agreed with this statement. We then implemented a wide range of strategies to guide and support them in their writing, as described above. Table 1 presents a breakdown of these figures according to the students' units.
| Units | Pre-teaching | Post-teaching | ||
| No. of students | % of students | No. of students | % of students | |
| Contemporary Science | 38 (of 93) | 40.9% | 14 (of 53) | 26.4% |
| Communication for Planning | 17 (of 57) | 29.8% | 11 (of 57) | 19.3% |
| Medical Imaging Science | 15 (of 39) | 38.5% | 6 (of 16) | 37.5% |
| Totals | 70 (of 189) | 37.0% | 31 (of 126) | 24.6% |
The value of the teaching strategies is demonstrated in the small but significant improvement in post-teaching evaluation responses to the statement 'I need more help about how to write in the journal', with 12% fewer of the students (31 of 126 post-teaching evaluations, or 24.6%) still agreeing or strongly agreeing with the statement.
It is clear from this table, however, that while there was a small but significant increase (between 10 and 15%) in students' confidence level in reflective writing in the first two units, there was almost no increase in the Medical Imaging unit. Several factors may have contributed to this difference. First, the number of post-teaching evaluations submitted in the Medical Imaging unit was very small, and the results may not reflect the overall response of the student group. It would be interesting to administer the same survey to a larger group in future years to see if the same trend is evident. Second, the focus of the Medical Imaging unit was on clinical practice, and staff spent little time talking to students about how to write reflectively, and had no input during the writing process (students were off campus on clinical placements). In contrast, the two communications units focused on language processes and strategies, and students were given extensive input about how to write reflectively and ongoing individual feedback on their writing (as described above). It seems likely that this input played an important part in improving students' confidence in their ability to write reflectively. This underlines the value of communication skills units (or similar), particularly in the early stages of their university studies.
In a period of up to 8 weeks of tuition, a significant number of students began to feel more secure in their understanding of how to write reflectively. Of course we need to focus on why 25% still felt insecure, and to tailor our teaching to support these students. Our future research will analyse in more detail some of the reasons for this insecurity. In the meantime, our other qualitative research (observation, interviews and focus groups) have suggested several relevant factors, which we will follow up in future work:
The Medical Imaging program is an example of such development. The focus on reflective learning/practice skills in the undergraduate degree is a new development in the Medical Imaging four-year degree program at Curtin. The current first- and second-year students have had the benefit of being introduced to reflective writing in a unit that focuses on their academic literacy. Disciplinary academics will now work to track the development of reflective skills, to be able to provide evidence of student development as they progress and of the overall levels that can be reached upon graduation. This will provide the evidence needed to review, refine and advance the process in future years.
As we approach the Year 2015, it is vital that university graduates develop reflective and critical thinking skills. Professional town planner Robin Thompson reminds us of this in his plea for students to learn to think on many levels - 'the explanatory, reflective and conjectural' - in order to be equipped to 'reconcile the many forces that act upon society from globalization to articulation of community opinion' (Thompson, 2000, p. 133).
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To encourage you to think about the experience you gain during this observation period, and to support you to develop a better understanding of the clinical learning process, you are to write up a situation you have encountered during the observation week.
The case you write up should be one where the examination procedure, management of a patient, or general department routine were for some reason conducted differently from what you have learnt. The length of your reflective writing should be a maximum of 800 words. For example: The case may be associated with a radiographic procedure where the:
You are encouraged to think about the situation in terms of: was it performed in a way that is better than what you have learnt; basically the same but from a different approach; or not as good and if so why. For any situation you need to give your justification for what you are suggesting.
This exercise is not an assessment, but you will receive feedback on your assignment and it is considered an introduction to ongoing reflective work you will be required to do. A way of assessing levels of reflective writing is as follows, and will provide a framework for the feedback you will receive.
N.B. As an initial exercise and with no previous exposure to a clinical situation, the level of reflection is not expected to be high, and it is the ability to reflect at a higher level that this exercise is the beginning steps for.
| Authors: Jane Grellier is a Lecturer in the Faculty of Media, Society and Culture at Curtin University, with many years experience in teaching and curriculum development in the fields of English and literacy. Currently she coordinates the Communication Skills program offered to students in three Divisions of the university. Her research interests are in discipline-specific literacies, reflective practice and the teaching of writing. Email: j.grellier@curtin.edu.au
Diane Fisher is a Lecturer in the Department of Imaging and Applied Physics at Curtin University. She has extensive experience in teaching the practice of Medical Imaging. Diane is the clinical co-ordinator for Medical Imaging and is particularly interested in students developing their abilities to reflect on their clinical experiences. Janice McKay recently joined the Department of Imaging and Applied Physics, Curtin University as an Associate Professor. She came here from Hong Kong where she had been associated with several studies that looked at student centred learning in the context of promoting reflective practice and applied and profession-based education. Please cite as: Grellier, J., Fisher, D. & McKay, J. (2008). Encouraging a reflective approach to learning as a means of strengthening academic and work place learning. In Preparing for the graduate of 2015. Proceedings of the 17th Annual Teaching Learning Forum, 30-31 January 2008. Perth: Curtin University of Technology. http://otl.curtin.edu.au/tlf/tlf2008/refereed/grellier.html |
Copyright 2008 Jane Grellier, Diane Fisher and Janice McKay. The authors assign to the TL Forum and not for profit educational institutions a non-exclusive licence to reproduce this article for personal use or for institutional teaching and learning purposes, in any format (including website mirrors), provided that the article is used and cited in accordance with the usual academic conventions.