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[edit | edit source]

“We do not learn from experience…we learn from reflecting on experience” -- John Dewey[1]

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?[edit | edit source]

Vilkinas and colleagues[2] 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]
  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"[2]

Reflection is a structured and deliberate process that helps individuals consider, examine or evaluate a situation, decision, event, etc, in a constructive way.[3] 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."[4]

Types of Reflection[edit | edit source]

The origin of reflection is attributed to John Dewey, who describes it as a form of problem-solving.[5]According to Dewey, the reflection can be described as:

  • deliberate and cognitive process
  • process of researching and clarifying to eliminate doubts
  • activated by a problem that requires a solution

In his concept of reflection, its learning aspect is more important than a problem-solving process.[5]

Donald Schön coined the term reflective practice.[6] 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.”[6]

Schön identified two types of reflection:[7]

Reflection in action[1]

  • Reflection in action occurs at the moment (i.e. "thinking on our feet"[8])
  • It requires an individual to consider the situation and decide how to act immediately
  • At the moment, a person must be able to think ahead, analyse, experience, and critically respond to the situation[9]

Reflection on action[1]

  • 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[9]

Benefits of Reflection[edit | edit source]

“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[1]

Reflection helps us to:[1]

  • 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.[9] Reflective practice groups provide an opportunity for group members to "share, learn, reflect and build team relationships".[10] And more specifically, in a physiotherapy setting, reflective practice has been used to [6]

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

Without reflection, leaders:[1]

  • 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[edit | edit source]

There are opportunities for reflection during each stage of Jason Giesbrecht's four-step process of leadership:[1]

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[edit | edit source]

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.[1] This page will discuss three of the most common frameworks:[1]

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

Boud’s Triangular Representation[edit | edit source]

This cyclical model was developed in 1985 by David Boud, Rosemary Keogh, and David Walker.[1] It is a three-step process, which requires the individual to consider:[1]

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

In Boud's model, a reflective activity plan for the learning process starts with returning to the experience. In the first step, it is necessary to relive every experience and review what happened for further learning. Attending to feeling is the next step in Boud's triangle. All positive feelings are subject to reflection as part of the return experience, while the obstructive negative feelings are removed. The final step includes experience reevaluation in the four following steps:

Step 1: Association, which compares newly acquired information with one already experienced

Step 2: Integration, which looks for relationships between new and old

Step 3: Validation of the feelings as a result of experience

Step 4: Ownership when a person's knowledge is part of the process of reevaluation

At its core, this model suggests that “reflection leads to further learning.”[11] However, as this model is quite simple, it might not be suitable for more complex situations.[1]

Gibbs’ Reflective Cycle[edit | edit source]

In 1988, Graham Gibbs created a six-step reflective cycle.[12] Each step builds on the preceding step:[1][13]

  • Description: What happened? A detailed description of the situation from an objective point of view.
  • Feelings: What was I thinking and feeling? A subjective reflection on the situation through the description of feelings and opinions.
  • Evaluation: What was good or bad about the experience? Evaluation of the positive and the negative aspects of the situation.
  • Analysis: What sense can I make of the situation? Analyse why something worked and something did not work.
  • Conclusion: What else could I have done? Summary of stages and reflection on the experience learnt
  • Action Plan: If this situation arose again, what would I do? Planning for the action when a similar situation arises again. It may involve learning a new skill.

The video below explains the Gibbs' cycle:


Atkins and Murphy Model of Reflection[edit | edit source]

This model of reflective practice was developed in 1994 by Sue Atkins and Kathy Murphy. It was specifically designed for nursing practice, and it required that practitioners would stop and think about experiences. Atkins and Murphy’s Model of Reflection has been adopted and used by other healthcare professionals.

The users of this model must consciously analyse decisions in order to change future actions or decisions for the better. 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.[1][12] This model builds on previous models and aims to simplify and refine the reflective process.[1]

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.[1][12]

This model has five steps:[1]

  • Awareness…of discomfort, uncomfortable thoughts, action, or experience
  • Describe…the situation, including events, thoughts, and feelings
  • Analyse…feelings and knowledge relevant to the situation
  • 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:


Conclusion[edit | edit source]

  1. Numerous reflecting models provide the basis for reflection.
  2. It is important to reflect on positive and negative experiences and explore actions.
  3. All experiences provide meaningful learning opportunities.

In healthcare organisations specifically, the following are the potential benefits of using reflective practice:[16]

  1. It can lead to revalidation of practice.
  2. It can improve work behaviours
  3. It can help to identify the areas of improvement in practice
  4. It can improve patients' safety by staff addressing gaps in knowledge

Resources[edit | edit source]

References[edit | edit source]

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 Giesbrecht J. Reflect and Learn Course. Plus. 2022.
  2. 2.0 2.1 2.2 Vilkinas T, Murray DW, Chua SMY. Effective leadership: Considering the confluence of the leader’s motivations, behaviours and their reflective ability. Leadership & Organization Development Journal, 2020;41(1):147-63.
  3. Finlay L. Reflecting on ‘Reflective practice’. Practice-based Professional Learning Paper 52, The Open University, 2008.
  4. Dunn Galvin A, Cooper J, Shorten G, Blum R. Applied reflective practice in medicine and anaesthesiology. British Journal of Anaesthesia. 2019;122(5):536-41.
  5. 5.0 5.1 Göker SD, Bozkus K. Reflective Leadership: Learning to Manage and Lead Human Organizations [Internet]. Contemporary Leadership Challenges. InTech; 2017.
  6. 6.0 6.1 6.2 Ziebart C, MacDermid JC. Reflective practice in physical therapy: A scoping review. Phys Ther. 2019;99(8):1056-68.
  7. Schön DA. The reflective practitioner: How professionals think in action. Aldershot: Ashgate Publishing Ltd, 1991.
  8. Priddis L, Rogers SL. Development of the reflective practice questionnaire: preliminary findings. Reflective Practice. 2018;19(1):89-104.
  9. 9.0 9.1 9.2 Babaniji O, Abdul-Azeez M, Abiye S, Utchay A Jr, Ovunda WG, Constantine E et al. Reflective practice and resident doctors. Nigerian Journal of Medicine. 2021;30(5):625-8.
  10. O'Neill L, Johnson J, Mandela R. Reflective practice groups: Are they useful for liaison psychiatry nurses working within the Emergency Department? Arch Psychiatr Nurs. 2019;33(1):85-92.
  11. Alisauskiene S, Guðjónsdóttir H, Kristinsdóttir JV, Connolly T, O'Mahony C, Lee L et al. Personalised learning within teacher education: A framework and guidelines. In-Progress Reflection No. 37 on Current and Critical Issues in Curriculum, Learning and Assessment. Geneva: UNESCO International Bureau of Education; 2020. p1-50.
  12. 12.0 12.1 12.2 Ingham-Broomfield B. A nurses’ guide to using models of reflection. Aust J Adv Nurs [Internet]. 2021;38(4).
  13. Schoch L. Reflections on the Parkinson’s Project: learning experiences with the Gibbs’ Reflective Cycle. Bachelor’s thesis, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, 2021.
  14. EPM. Gibbs' Reflective Cycle Explained. Available from: https://www.youtube.com/watch?v=-gbczr0lRf4 [last accessed 21/04/2022]
  15. NursingAnswers. Atkins and Murphy Model of Reflection | NursingAnswers.net. Available from: https://www.youtube.com/watch?v=V9y5h-Ec_Wk [last accessed 21/04/2022]
  16. Ingham-Broomfield B. A nurses’ guide to using models of reflection. Aust J Adv Nurs. 2021 Nov. 30;38(4).