The first piece of legislation I will reflect on is the [New Zealand] Health Practitioners Competence Assurance Act (HPCA) (2003), specifically sections 12, 15 & 16 which outline the authority to the establishment, accreditation and monitoring of a healthcare programme- namely an undergraduate physiotherapy degree.
One of my more recent roles has included Programme Leader of Curriculum for an undergraduate physiotherapy programme. This role included assisting other lecturers with development of teaching, learning and assessment and ensuring academic quality of the programme to the university Board of Studies and subsequently the Committee on University Academic Programmes (CUAP). Alongside this, the New Zealand Physiotherapy Board (NZPB) accredits our programme as the designated authority under the HPCA (2003).
As a Programme Leader, ad hoc and formal feedback from the clinical supervisors indicated that students were struggling with their reflective practice during their fourth-year placements. With a limited ability to be self-critical (both positive and “gap-finding”), this was causing some conflict during the weekly supervisory meetings. It was also evident that the supervisors themselves did not have a consistent structure for their own reflective practice which made it difficult for the students to “tune-in” to what was expected at subsequent clinical placements.
The New Zealand (NZ) Ministry of Education’s document on Effective pedagogy in the NZ Curriculum highlights that “Reflective learners assimilate new learning, relate it to what they already know, adapt it for their own purposes, and translate thought into action. Over time, they develop their creativity, their ability to think critically about information and ideas, and their metacognitive ability (that is, their ability to think about their own thinking)” (p34). Reflective practice can be categorised primarily as reflection-in-action (thinking reshapes what we are are doing while we are doing it) and reflection-on-action (making sense of an action after it has occurred). The latter may appear more passive, though it does provide students with the opportunity to review their clinical experiences in order to describe, analyse, evaluate and then inform learning about their practice. While there may be widespread acceptance of reflective practice in teacher education, professional groups and some disciplines in the healthcare sector, it is relatively new to physiotherapy practice in New Zealand which is required by the HPCA in 2003.
One of the purposes of the HPCA (2003) is to ensure “lifelong competence of skills” to ensure health and safety of the public. While peer review has been anecdotally practiced in physiotherapy, reflection on practice can be seen as more personal, and indeed considered only to be negative criticism by some- even if not the intent. Education of the purpose, and strength of constructive criticism and self-reflection therefore is required- for those delivering and receiving feedback, and when self-reflecting. In order to embed these skills into clinical practice- it was thought best to be more overt about reflective practice throughout the four-year programme- building reflective skills as the students progressed. Rather than introduce a blanket change- and pull the rug out from all papers (see what I did there…), as Programme Leader I looked to already established papers that reflective practice would align well with already established teaching and assessment. This was – in my mind- more subtle (some might consider covert), to enable minimal disruption to the overall programme. It required some consideration- firstly with respective paper coordinators, other clinicians, then the Programme Committee. In the first year- students reflect on their culture and how this might impact on their interaction with patients (Evidence 1- TTiPP) using Gibbs’ (1988) model (including describe, feelings, evaluate, analyse, draw conclusions and action plan). In second year the students go out on a one week placement and are asked to consider the experience based on the Reflective Statement recommended by the NZPB (Evidence 2- POMFI). Prior to group assessment of their “first patient” on-campus, reflective practice using the Gibbs model is reinforced alongside that of Barksby, Butcher & Whysall (2015) using the acronym of REFLECT (recall, examine, feelings, learn, explore, create and timescale) (Evidence 3- MND). The students are then encouraged autonomy in reflective practice – to use self-selected models and additional resources in their third-year clinical placements. Here, reflective statements incorporated into a submitted ePortfolio (Evidence 4- PPP). The statements include a description; reflection on what went well; what could have been better; what have learnt from the experience; and an action plan for the future- again simulating requirements of the NZPB and subsequently the HPCA (2003). This better prepares the students for their fourth-year where they are evaluated by clinical supervisors (Evidence 5- PPI).
It is understandable that the embedding of reflective practice into the curriculum has been completed over a period of time (2013-2017). Though it is pleasing to say that as the “lifelong competence of skills” of reflective practice are developed to meet HPCA, the clinical supervisors were indicating that they were better equipped to provide constructive feedback on reflective practice and direction for clinical learning. Overall- these lifelong skills are adopted by the students more readily as they are introduced in increments, and have been reported to be invaluable as new graduates and when audited by the NZPB.
Gibbs, G. (1988). Learning by Doing: A guide to teaching and learning methods. London: Further Education Unit. ISBN 1853380717.
Barksby, J., Butcher, N. & Whysall, A. (2015). A new model of reflection for clinical practice. Nursing Times, 111(34-35), 21-23.