Assessing Reflective Thinking and Approaches to Learning

Article excerpt

Background: Facilitation of reflective practice is critical for the ongoing demands of health care practitioners. Reflective thinking concepts, grounded in the work of Dewey and Schön, emphasize critical reflection to promote transformation in beliefs and learning necessary for reflective practice. The Reflective Thinking Questionnaire (QRT) and Revised Study Process Questionnaire (RSPQ-2F) assess skill aspects of professional reasoning, with promise for measuring changes over time. Objective: The purpose of this study was to examine the reliability and responsiveness and the model validity of reflective thinking and approaches to learning measures for U.S. health professions students enrolled in entry-level occupational (MOT) and physical therapy (DPT) programs. Methods: This measurement study addressed reliability and responsiveness of two measures, the QRT and RSPQ-2F, for graduate health professionals. A convenience sample of 125 MOT and DPT students participated in the two-measure, test-retest investigation, with electronic data collection. Results: Outcomes support the stability of the four-scale QRT (ICC 0.63 to 0.82) and the two-scale RSPQ-2F (ICC 0.91 and 0.87). Descriptive data supporting responsiveness are presented. Conclusions: With noted limitations, the results support the use of the QRT and RSPQ-2F measures to assess changes in reflective thinking and approaches to learning. Measurement of these learning outcomes furthers our understanding and knowledge about instructional strategies, development of professional reasoning, and fostering of self-directed learning within MOT and DPT programs. J Allied Health 2011; 40(3):128-136.

REFLECTIVE PRACTICE (RP) is a hallmark of both personal and professional development for health professionals. 1,2 RP includes reflective thinking and self-directed learning. These are essential outcomes to examine for developing, graduate occupational (MOT) and physical therapy (DPT) students to assess measurable changes that may occur within the academic program and translation for future practice. While there are many instructional strategies to facilitate reflection in health professions education, both in the classroom and clinic,3 reflective thinking (RT) remains a challenging concept to fully and pragmatically assess within academic programs and later during practice. RT is a construct grounded in the work of Dewey,1 Schön,2 and Mezirow,4 and others emphasizing the necessity of critical reflection to promote transformation in beliefs and learning for professional practice.

Reflection as a cognitive activity is described by Dewey1 as a systematic, rigorous, disciplined way of thinking that needs to happen in interaction with others. Dewey described the process of RT as moving the learner from one experience to another, with a deeper understanding of relationships within connections, other experiences, and ideas. Dewey1 elucidates that reflection requires attitudes that value both the personal and intellectual growth of oneself and others. Dewey delineated fives stages of reflective thought:

1. Perplexity, confusion, doubt

2. Attentive interpretation of the given elements

3. Examination, exploration, and analysis to define and clarify the problem

4. Elaboration of the tentative hypothesis

5. Testing the hypothesis by doing something overtly to bring about anticipated results.1[p33]

RT focuses on the process of making judgments about what has happened, and Schön2 provided a Model of Reflective Practice from which to examine RT conceptually. This model is based on how professionals think and emphasizes learning from experience. Schön contemplated how professionals in architecture, medicine, law, and other professions readjust to the influences and changes within daily practice. Schön described the following professional practices as hallmarks of RP: "knowing-in-action, recognizing surprise, reflection-in-action, experimentation, and reflection-on-action. …