Leading in Rehabilitation - Reflect and Learn

Original Editor - Jess Bell based on the course by Jason Giesbrecht

Top Contributors - Jess Bell, Ewa Jaraczewska and Kim Jackson  

Introduction

“We do not learn from experience…we learn from reflecting on experience” -- John Dewey

Effective leadership requires formal and informal leaders to assess the situation, select a leadership approach, implement the approach, and reflect and learn on this process. The first three steps are discussed in the linked articles. The fourth step of reflecting and learning is discussed below.

What is Reflection / Reflective Leadership?

Vilkinas and colleagues proposed that effective leaders need two attributes:

1. They must be able to "read the context or environment accurately to exercise the most appropriate behaviour"
2. Then, they must be "both willing and able to learn from their experiences, to consider the implications of their behaviours and make appropriate adjustments in future interactions"

Reflection is a structured and deliberate process that helps individuals consider, examine or evaluate a situation, decision, event etc in a constructive way. It enables individuals to “learn from mistakes; to identify skills and strengths; and to develop options and actions for change and future success, promoting a lifelong process of learning and development."

Types of Reflection

Donald Schön coined the term reflective practice. He characterised a reflective practitioner as an individual “who uses reflection as a means of learning from experiences to advance one's expertise, but also as a means to navigate through the murky, indeterminate grounds of complex problems that arise in professional practice.”

Schön identified two types of reflection:

Reflection in action

• Reflection in action occurs in the moment (i.e. "thinking on our feet")
• It requires an individual to consider the situation and decide how to act immediately
• In the moment, a person must be able to think ahead, analyse, experience, and critically respond to the situation

Reflection on action

• Reflection on action occurs after an event
• It requires an individual to reconsider the situation and think about what they need to change in the future
• During this process, an individual may think about a situation, discuss it with others or write notes in a reflective journal

Benefits of Reflection

“The ability to reflect on one’s practice when confronted by a novel, unusual, or complex situation distinguishes expert practitioners from novices” -- Donald Schön, 1983

Reflection helps us to:

• Make sense of past events
• Solidify the connection between an experience, meaning, and learning
• Acquire new insights into our behaviour
• Widen our perspective on a problem
• Improve problem recognition and solution finding
• Generate, deepen, critique, and document our learning
• Generate strategies for dealing with a problem
• Enhance our self-awareness

In a health context, research has shown that reflective practice can improve patient outcomes and safety, lead to metacognition, highlight knowledge gaps and enhance evidence-based practice. Reflective practice groups provide an opportunity for group members to "share, learn, reflect and build team relationships". And more specifically in a physiotherapy setting, reflective practice has been used to:

• Enhance patient care
• Support clinical supervision
• Promote collaboration
• Develop clinical reasoning skills

Without reflection, leaders:

• Could be at risk of making poor decisions
• May repeatedly make the same mistakes
• Struggle to lead through unfamiliar circumstances
• Fall victim to assumptions and judgments

Opportunities for Reflection

There are opportunities for reflection during each stage of Jason Giesbrecht's four-step process of leadership:

Assess the situation - reflect on:

• How accurately did I assess the situation?
• What additional information was needed?

Select the leadership approach - reflect on:

• How close was I to selecting the optimal leadership approach for the situation?
• What else could I have done?

Implement the leadership approach - reflect on:

• How did it go?
• What could I have done differently when actioning the selected leadership approach?

Reflective Models

While the self-assessment questions listed above can help us begin to reflect, it can be beneficial to use a model or framework to guide our reflection. Many reflective models are described in the literature. This page will discuss three of the most common frameworks:

• Boud’s Triangular Representation
• Gibbs' Reflective Cycle
• Atkins and Murphy Model of Reflection

Boud’s Triangular Representation

This cyclical model was developed in 1985 by David Boud, Rosemary Keogh, and David Walker. It is a three-step process, which requires the individual to consider:

• Experience (what)
• Reflection (so what)
• Learning (now what)

At its core, this model suggests that “reflection leads to further learning.” However, as this model is quite simple, it might not be suitable for more complex situations.

Gibbs’ Reflective Cycle

In 1988, Graham Gibbs created a six-step reflective cycle. Each step builds on the preceding step:

• Description: What happened?
• Feelings: What was I thinking and feeling?
• Evaluation: What was good or bad about the experience?
• Analysis: What sense can I make of the situation?
• Conclusion: What else could I have done?
• Action Plan: If this situation arose again, what would I do?

The video below explains the Gibbs' cycle:

Atkins and Murphy Model of Reflection

This model of reflective practice was developed in 1994 by Sue Atkins and Kathy Murphy. It requires practitioners to stop and think about experiences. They must consciously analyse decisions in order to change future actions or decisions for the better. This model builds on previous models and aims to simplify and refine the reflective process.

Atkins and Murphy’s model acknowledges that people may find it difficult to think about uncomfortable experiences. However, if an individual reflects on a difficult event, they may be better equipped to deal with similar situations in the future.

This model has five steps:

• Awareness…of discomfort, action, or experience
• Describe…the situation including events, thoughts, and feelings
• Analyse…feelings and knowledge
• Evaluate…the relevance of knowledge
• Identify…any learning which has occurred

The following video provides a brief description of the Atkins and Murphy model of reflection:

Resources

• Hanging the Mirror: The Discipline of Reflective Leadership - Alan Scheffer, Nancy Braun, Mark Scheffer
• The Leader's Guide to Emotional Intelligence - Drew Bird
• The Art of Journaling - Four Loop Learning and Reflective Leadership - Bob Cancalosi