Collaborative reflection: how far do 2:1 models of learning in the practice setting promote peer reflection?

This article was downloaded by: [University of Chicago Library]On: 09 October 2014, At: 09:29Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Reflective Practice: International andMultidisciplinary PerspectivesPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/crep20

Collaborative reflection: how far do2:1 models of learning in the practicesetting promote peer reflection?Jane Morris a & Graham Stew aa University of Brighton , UKPublished online: 12 Jul 2007.

To cite this article: Jane Morris & Graham Stew (2007) Collaborative reflection: how far do2:1 models of learning in the practice setting promote peer reflection?, Reflective Practice:International and Multidisciplinary Perspectives, 8:3, 419-432, DOI: 10.1080/14623940701425220

To link to this article: http://dx.doi.org/10.1080/14623940701425220

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

http://www.tandfonline.com/loi/crep20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/14623940701425220

http://dx.doi.org/10.1080/14623940701425220

http://www.tandfonline.com/page/terms-and-conditions

http://www.tandfonline.com/page/terms-and-conditions

Reflective PracticeVol. 8, No. 3, August 2007, pp. 419–432

ISSN 1462-3943 (print)/ISSN 1470-1103 (online)/07/030419–14© 2007 Taylor & FrancisDOI: 10.1080/14623940701425220

Collaborative reflection: how far do 2:1 models of learning in the practice setting promote peer reflection?Jane Morris* and Graham StewUniversity of Brighton, UKTaylor and Francis LtdCREP_A_242406.sgm10.1080/14623940701425220Reflective Practice1462-3943 (print)/1470-1103 (online)Original Article2007Taylor & Francis83000000August [email protected]@brighton.ac.uk

A number of health professional groups have been looking at alternative models to the traditional1:1 model of practice education in order to meet the increasing shortage of practice placements forpre-registration students. One such model that has been explored recently is the 2:1 or collaborativemodel where one practice educator takes responsibility for the education of two or more students.This paper presents the findings of a small research study undertaken to explore facilitation of learn-ing in 2:1 collaborative models of physiotherapy practice education, and focuses on the potential forreflection with particular emphasis on peer reflection within the collaborative model. The studyadopted a qualitative approach. Semi-structured interviews were conducted with thirteen educatorsand eighteen third year physiotherapy students at a number of different NHS practice sites in south-east England. Additional focus groups were held with academic tutors and students at the end ofthe placement period. Findings from the study indicated that learning was facilitated in a variety ofways with students benefiting from peer learning and teaching approaches. Opportunities for peerreflection appeared to be increased in the 2:1 model. However, some practice educators highlightedthe need for further guidance when promoting reflective practice. Further research into the role ofreflection within 2:1 models and the facilitation of reflection during clinical education placementsis needed.

Introduction

Education in the practice setting education is seen to be the essential and most exten-sive element of health professional courses that takes place in a variety of healthcaresettings and contexts (Moore et al., 1997). It is the central point for the integration oftheory and practice providing students with an indispensable and most fundamentalelement of preparation for their professional role (CSP, 2002).

*Corresponding author. School of Health Professions, Faculty of Health, University of Brighton,Robert Dodd Building, 49 Darley Road, Eastbourne BN20 7UR, UK. Email: [email protected]

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4

420 J. Morris and G. Stew

Practice education forms at least a third of any pre-registration physiotherapydegree course and all students are required to successfully complete a minimum of1000 hours before being allowed to register on the Health Professions Council (HPC)and gain Membership of the Chartered Society of Physiotherapy (CSP).

Traditionally most undergraduate physiotherapy students have experienced a 1:1model of education in the practice setting where one student is educated by a seniorphysiotherapist, who adopts the role of practice educator. In the 1:1 model thestudent normally spends most of their time with the same educator. This may resultin the student feeling isolated and becoming too reliant on their educator(Huddleston & Standring, 1998; Moore et al., 2003).

More recently a substantial increase in student numbers and continuing placementshortages has resulted in the need for different models of education in the practicesetting to be explored and evaluated. One of the models which has been underinvestigation is the multiple or collaborative model that promotes peer assistedlearning (Baldry Currens & Bithell, 2003; Moore et al., 2003). In this model ofpractice education a senior practitioner normally takes responsibility for the educa-tion of two or more students at the same time.

Educational changes impacting on practice education

The need to equip graduates with the skills necessary for practising not only within arapidly changing health care environment but also for managing the current explosionof professional knowledge is widely recognized (Best et al., 1999). Most higher educa-tion courses have adopted more student-centred learning and teaching approaches(Knowles et al., 1998; Baxter & Gray, 2001) to equip learners with the skills necessaryfor becoming more self-directed and lifelong learners (Sadlo, 1997).

However, learning and teaching approaches in practice environments have gener-ally failed to keep pace with the parallel changes in higher education, with practiceeducation tending to favour the less collaborative 1:1 model of practice education(Huddleston, 1999).

Extensive and significant international research has been carried out into collabo-rative placements by Ladyshewsky and colleagues (DeClute & Ladyshewsky, 1993;Ladyshewsky, 2000, 2004). Recent research in the UK across health professionalgroups (Baldry Currens, 2000, 2003; Moore et al., 2003; Martin et al., 2004) alsohighlights the importance and value of peer learning within collaborative models aphilosophy encapsulated in the following quotation by Goldschmid and Goldschmid(1976): ‘A student’s colleagues often represent the least recognized, least used andpossibly the most important of all the resources available’ (Goldschmid & Gold-schmid, 1976, p. 23).

Reflection within the context of professional development

The complexity and diversity of professional practice, within today’s practice contextis well recognized, together with the importance of education in preparing students

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4

Collaborative reflection 421

for the changes in practice delivery (Routledge et al., 1997). One of the fundamentalrequirements of pre-registration education is the need to facilitate reflective practiceenabling students to develop the skills necessary for critically evaluating their own prac-tice and promoting continuing professional development (Moon, 1999), an essentialrequirement of all health professionals (Brown & Ryan, 2003; QAA, 2001; HPC, 2005).

Although it is acknowledged that reflection plays an essential contribution to theclinical reasoning process (Higgs, 2003) and is a key tool for enabling experientiallearning (Moon, 1999) it is often the most neglected component of experientiallearning (Boud et al., 1995).

Levels of reflection

Alsop and Ryan (1996) drew on the earlier work of Durgahee (1996) suggesting thatthree levels of reflection exist. The first most superficial level allows the learner torecall an event while the second enables learners to consider what happened duringthe event. The third or micro level of reflection encourages learners to make links withprior knowledge, to identify new learning and to make changes to future practice. Theliterature on reflective practice also identifies a plethora of models of reflection (Boudet al., 1985; Fish et al., 1991; Johns, 1995; Moon, 1999) that provide learners with aframework to enable them to move from a superficial form of reflection to the deeperlevels of critical analysis.

Collaboration and the reflective process

One of the earliest supporters of reflection Habermas (1971) recognized the socialvalues of reflection in practice development advocating reflective dialogue and socialinteraction. More recent proponents of reflection have also challenged the assump-tion that reflection occurs solely in isolation arguing that reflection in isolation mayobstruct professional development (Convery, 1998; Clouder, 2000; Kember, 2001).

The need to develop the skills necessary to enable future health professionals tofunction effectively within a team is well recognized (Barr, 1998; Hilton & Morris,2001) and a number of studies have explored the influence of collaborative reflectionon the development of professional practice.

Collaborative reflection contributing to practice development

Studies across the practice spectrum have been undertaken that have acknowledgedthe benefits of group reflection: in the development of future practice (Bennett &Danezak, 1993; Sinclair & Harrison, 2001); increasing learning gained from experi-ence (Shields, 1995) enhancing professional socialization and practice development(Smith, 1998) fostering role development (Sinclair, 2001) and decreasing stress andisolation (Pololi, 2001).

A small study undertaken by Clouder (2000) indicated that both practitioner andstudent reflection were limited by time constraints. Student participants appeared

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


reluctant to openly reflect on practice for fear of exposing weaknesses to their practiceeducators. The above findings have important implications for learners in the practicesetting who may be reluctant to share their experiences and openly reflect on theirpractice, unless an environment is created that supports such practice.

The importance of reflection within practice organizations to promote lifelonglearning and professional practice was highlighted by David et al. (2000). Findingsindicated that when peers are seen to be key contributors to the learning process asupportive environment is constructed, where both individual self-evaluation andcollective critical reflection are nurtured and ultimately become ‘safe parts of profes-sional practice’ (David et al., 2000, p. 713). ‘Peers become central to the learningprocess, which can help create an environment in which individual and collective self-diagnosis and critical self-reflection are respected and safe parts of professionalpractice’ (David et al., 2000, p.713).

The current study explored the facilitation methods used during a collaborativemodel of clinical education and considered the place of reflective discussion withinthe collaborative 2:1 placement model. The researcher’s interest in reflection on prac-tice placements stemmed from the increased need to focus on reflection to facilitatepractice development and a firm belief that reflection promoted at pre-registrationlevel will enable health professionals to more readily develop the skills necessary forongoing evaluation of their practice (Donaghy & Morss, 2000).

As part of the pre-registration course in physiotherapy, student participants fromthe current study were introduced to a range of models of reflection for use in thepractice setting and were required to submit written accounts about significantincidents from their practice. However, the researcher (JM) felt that it was inappro-priate to include any material from their reflective accounts in the study as theycontribute to the assessed component of a continuing professional developmentmodule.

Aims of the study

● To explore the methods of facilitation used by clinical educators in the implemen-tation of a collaborative model of clinical education.

● To determine if collaborative models of clinical education foster reflectivediscussion.

This paper will focus on the second aim of the study that explored reflection in the2:1 model.

Methodology

A qualitative research approach was chosen to enable facilitation of learning withincollaborative models of physiotherapy education to be explored. All the research withthe exception of two focus groups was undertaken in the setting in which the learningoccurred. Such an approach enabled the views and activities of clinical educators,

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


student and tutors to be explored within the context of the practice learning environ-ment (Jongbloed, 2000).

As course leader for the Postgraduate Certificate in Clinical Education and ClinicalEducation and tutor for two pre-registration physiotherapy courses, the researcher(JM) is actively involved in the role development of practice educators and preparingstudents for placement learning. It was felt that findings from the study would offerthe researcher (JM) further insight into the ways in which learning was facilitated with2:1 models of practice education.

Participant selection

Thirteen physiotherapy clinical educators, 18 final year physiotherapy students andthree academic tutors agreed to take part in the study. A purposive sampling methodwas used (Appleton, 1995) which enabled clinical educators, students and tutors whohad experience of the 2:1 model to be interviewed.

All participants were sent an information sheet that outlined the purpose of thestudy and all participants completed a consent form prior to data collection.

Methods of data collection

Face to face semi-structured interviews and focus group interviews were chosen as themeans of data collection allowing responses to be followed up (Robson, 1994). Twoseparate focus groups were held consisting of 10 students and 4 academic tutors. Thefocus groups enabled the researcher (JM) to follow up issues that emerged from theinitial data analysis (Vaughn et al., 1996). Clinical educators were not invited toattend a focus group as many would have difficulty in accessing additional time awayfrom their practice sites. Pilot interviews were undertaken to enable the researcher torephrase questions before the main interviews. Examples of the key topics areidentified in Table 1.

All the semi-structured interviews with physiotherapy students and clinicaleducators were tape recorded in private rooms in NHS trusts and lasted between 40and 60 minutes. The educators were interviewed alone and the students were

Table 1. Interview topics related to reflective practice

Clinical educators: • How have you encouraged students to learn on this 2:1 placement model?• Opportunities for reflection. How did you facilitate these?

Students: • How has your educator encouraged you to learn on the 2:1 model?• Opportunities for reflection. How has reflection worked in the 2:1 model?

How was it facilitated?

Academic tutors: • Talk to me about about your experience of 2:1 models of practice education.• How does reflection work in the 2:1 model? Opportunities for reflection. How is it facilitated?

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


interviewed in pairs to enable them to share their thoughts regarding the 2:1 place-ment model. Individual students were able to share any additional comments with theresearcher at the end of the interview. Data was stored in accordance with the DataProtection Act (1998).

Ethical clearance was sought and granted by the School of Health Profession’sethics panel and four local research ethics’ committees. In accordance with researchgovernance, approval was granted by the research and development teams of all theNHS trusts.

Data analysis

The interviews were recorded on audio-tapes and transcribed verbatim by theresearcher (JM). In order to determine the credibility of the data a sample set oftranscripts and examples of the interpretation of the data were returned to individualparticipants for verification (Appleton, 1995). Interpretation of the data was alsoexposed to focus group members for their comments (Vaughn et al., 1996). To enablethe data to be managed and analysed in a systematic way a combination of a dataanalysis spiral (Creswell, 2001) and stages of data analysis (Burnard, 1991) wereadopted. The list of categories that emerged was reviewed and organized into keyheadings using participants’ phrases, the number of categories reduced and the datawas finally grouped into emergent key themes. A colleague was invited to review asample of the scripts and to compare their own categories with the researcher’s list toincrease the validity of the analysis in an attempt to prevent researcher bias.

For the purpose of this paper the findings related to reflection in the study will bepresented and discussed.

‘It’s all about reflection isn’t it?’

The above phrase highlights a key theme that emerged from the data relating toreflection in the 2:1 collaborative model. It was encouraging to note that findingsfrom the study indicated that reflection was occurring in the 2:1 model of educationin the practice setting and that on the majority of placements there were opportunitiesfor students to reflect with each other and with their educator. In most cases reflectionfocused around a patient scenario. The main theme related to reflection wassubdivided into four subthemes; see Table 2, below.

Analysis of the findings from clinical educators, students and academic tutorsprovided evidence that student reflection seemed to be increased in the 2:1 model.Students were reflecting together and a number of educators were promoting reflection.

Peer reflection

Educators and students in most settings reported the benefits of the 2:1 in promotingpeer reflection.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


I think it’s better in the 2:1 because they can discuss experiences whereas in the 1:1 it’sonly your experience and your seniors whereas with two there’s a lot more ideas beingthrown around. We discuss patients and think of what we could have done differently.(Clinical educator 3)

Another educator commented: ‘I think it happens automatically with most studentpairs as long as they work well together’ (Clinical educator 8).

Tutors in the focus group also noted that peer reflection was evident in the 2:1model. ‘I think they reflect more because they are always having to communicate witheach other’ (Tutor 3 in focus group).

The majority of students felt that they had reflected more with peer:

I think we probably reflected more on the 2:1 because we’d talk about patients and prob-lems we were having you actually would want to talk to someone so through that talkingand reflecting you go back over what’s happened. (Student 4)

So it helped the learning process … when you were trying to learn to make it stick it becamenatural because we were constantly re-evaluating and reflecting on everything that we hadjust done and because there were two of us and because we were giving feedback it wasjust lots of positive input all the time from it … less intimidating as well. (Student 5)

An educator working with two students on a neurology placement discussed thestudents’ ability not only to reflect and evaluate their practice together following atreatment session with a neurologically impaired patient but also to include theirpatient in the reflective process.

The other thing that was highly enlightening certainly between the third and fourth weekwhere they started to include the patient in that thinking through as well. So that they werenot only just coming and saying well that was a good session they’d explain to the patientthe way that they had thought about it in a logical way and discuss with the patient whichaspects of the session could be changed. … I hadn’t seen that going on for a student everand I think that was because they were working off each other and realized that they hadto include the patients and to explain to the patient why they were going to try this andthat … so they were very good at putting patients at their ease. (Clinical educator 6)

Facilitating reflective practice

During placement learning educators and learners frequently reviewed patient casestogether. Students were encouraged to discuss and reflect on individual cases as oneof the educators in a neurological setting reported:

Table 2. Overarching theme and sub themes relating to reflection

Theme: ‘It’s all about reflection isn’t it?’

Peer reflection.Facilitating reflective practice.

Time for reflectionReflection on the learning process.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


So then we chat about a case that they want to reflect on. We’d look through. … Whathave you done? Could we have done anything else? … You can chip in even if it’s StudentA’s patient. B will have their say’ (Clinical educator 3)

A form of reflection-in-action appeared to be facilitated by educators and studentsopenly problem-solving and reviewing their practice together when treating patients,a finding supported by Clouder (2000) who found that active reflection duringtreatment was particularly evident in specialty areas for example intensive care units(ITU) and neurological rehabilitation units, where educators and students workedclinically as a team.

Yes I think that so many patients we treat as a team because we need to … often reflectionis team-based I think it’s hard for students to come out with constructive reflection totallyunsupported so it’s nice to do that in a group session. (Clinical educator 2)

I find it’s on going in ITU because you’re focusing on multiple pathologies and you’vegot to think what you’re doing and why and how that is going to affect the cardio-respiratory system … so they are constantly reflecting on what they are doing andactually answering questions so it’s just ongoing in ITU that sort of reflective practice.(Clinical educator 10)

However, student perceptions of the ways in which reflection was facilitatedappeared to differ from those of their educators. On some placements students feltthat educators did not actively promote reflection.

One finding that was particularly significant to the researcher’s own practice wasthe concern expressed by some educators that they felt ill prepared to facilitatereflective practice and lacked confidence in their ability to promote reflection in theirlearners.

I feel in some respects in their training they’re well ahead of us. We do need some kind offormal training on how to initiate and facilitate reflective working and I’m not sure whenit comes to the crunch we actually know what we’re doing in terms of reflective practice.It works well with students who take to that kind of thing naturally but if there’s some ofthem who aren’t so good then I don’t think we’re skilled enough to facilitate that really.(Clinical educator 6)

Another educator also talked about their perceived limitations when facilitating thereflective process: ‘I think they reflect better to each other than they tend to do to mebecause I’m not a very good reflector’ (Clinical educator 8).

In the future all health professionals will be required to provide evidence of theirability to reflect on their own practice both as practitioners and as educators. It istherefore essential for higher education providers to ensure that educators aresupported in their engagement in the reflective process.

Time for reflection

The amount of time available for reflection was seen to be a constraint by bothstudents and educators in a community setting. One educator on a communityplacement made use of time between patient visits for reflection. ‘It’s a good time

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


it’s private when there’s no-one else around and we have maybe twenty minutes inthe car and if we didn’t do it then we lose time to do it at other times’ (Clinicaleducator 1).

The majority of participants felt that the time available for reflection was increasedon a 2:1 placement as they were able to reflect with their peer on a regular basis andto discuss and review treatment options together. Time constraints prevented themfrom reflecting with their educator who had their own caseload and other manage-ment duties to address. In the traditional 1:1 model of practice education studentsoften rely on their educator setting time aside for reflection.

I think it’s competent reflection as well because as we were saying we discussed all the timeif we sat down to write our notes I’d say what’s happening here? What do we do with thispatient? Why did you do that? We were reflecting on what treatments and what outcomesall the time. (Student 5)

I think sometimes you can’t reflect with your supervisor just because it’s too much timeout of the day. So I’d probably go to X and reflect so it would be easier to have a peer hereto reflect with them, less intimidating as well. (Student 7)

Reflection on the learning process

Coupled with reflection on practice was the acknowledgement by both educators andlearners of the importance for reflection to occur on the learning process ‘as a whole’in the 2:1 model.

One student mentioned that their educator: ‘would sit and reflect on how the wholeplacement was going and if we wanted to change anything’ (Student 7).

Students also needed to reflect on their approach to their peer within the 2:1model. One educator highlighted the challenge they faced when a student wasunaware of their impact on a fellow student:

It would have been nicer not to have had to say hey just pull back a moment and listen towhat you sound like to the other student you’re just running away … just take a stepbackwards. (Clinical educator 7)

Discussion

Overall findings from the study indicated that students were actively engaged in peerreflection in the 2:1 placement model. Participants in the study felt that opportunitiesfor reflection with their peer were increased in the 2:1 model. Reflection formed a valu-able part of the learning process, enabling them to openly evaluate their practice whilstgaining support from a peer (Atkinson & Claxton, 2000; Stanley & Ramage, 2004).

It was apparent that not only were students reflecting together in the 2:1 model butsome educators appeared to be actively facilitating the reflective process. This tendedto be increased when educators and learners worked together as a team for examplein neurological rehabilitation settings and ITU environments.

However, in some instances student opinion appeared to differ from that of theireducators. A number of students felt that their educators did not actively promote

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


reflection. This difference may be explained by a comment made by one academictutor who felt that clinical educators generally promote reflection in a covert way,through joint discussion during patient reviews, using methods of facilitation thatmay not have been instantly recognized by student participants.

Students reported that reflection with a peer was less intimidating than with theireducators (Boud et al., 2001) enabling them to evaluate their practice more openly afinding supported by Clouder (2002). Students appeared to be thinking about theirpractice and the ways in which it could be developed in the future. However, we feelthere is insufficient evidence from analysis of the findings to allow us to identify thelevels of reflection that the students were achieving.

Time is often a scare commodity in busy practice settings and in some practiceenvironments both students and educators acknowledged that time constraintsprohibited educators from promoting reflection, a finding supported by Clouder(2000) and Fade (2004). However, as the 2:1 model provided students with moreopportunities for reflecting together on placement, they appeared to become lessreliant on their practice educators setting time aside for reflective activities. A modelof practice education that promotes peer reflection, may help practice educators whosometimes struggle to balance their role as educators against their commitment topatient care and other service needs (Cross, 2006).

The need to encourage learners to actively reflect on the whole learning process wasfelt to be an essential component of the 2:1 model, enabling learners to identifypositive and negative aspects of the learning experience. Individual learners were alsoencouraged to reflect on their contribution within the 2:1 model, to allow them toanalyse the effect their behaviour may be having on their fellow learner. Although theresearcher currently promotes reflection on practice, students may need to be moreactively encouraged to reflect on the learning process as a whole and their possibleimpact on other learners.

Some practice educators observed that student pairs who were actively engaged indiscussion during treatment sessions readily included the patient in the reflectiveprocess. This appeared to be facilitated by one student focusing on the treatmentwhile the other student was able to evaluate its effectiveness and involve the patientin the discussion. This finding may be worthy of further exploration as the need topromote patient centred approaches to healthcare provision is seen to be an essentialcomponent of effective health care provision (Reynolds, 2005)

Reflection-in-action was facilitated by educators and learners openly problem-solving and reviewing their practice together (Schön, 1991). This was particu-larly evident in specialist practice areas for example ITU (intensive care units)and rehabilitation units, where practice educators and students worked clinicallyas a team (Clouder, 2002). Ladyshewsky (2004) highlights the particular value ofteam reflection for the development of clinical reasoning skills for the novicepractitioner.

One finding that was particularly significant to the researcher’s own practice andits future development, was the concern expressed by some educators that theyneeded help engaging in the reflective process. This finding was also cited in the

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


literature by Fade (2004) who noted that the inability of some educators to supportreflective practice needs further exploration.

The development of reflective skills forms an essential learning outcome of theQuality Assurance Agency’s benchmarks (QAA, 2001b) and the current curriculumframework for the Chartered Society of Physiotherapy (CSP, 2002). In order to meetthe registration requirements of the Health Professions Council (HPC, 2005) allhealth professionals from novice to expert are required to reflect on their practice andto provide evidence of their continuing professional development (CPD). Thisincreased emphasis on reflective practice makes it essential that role developmentstudy days for practice educators support the needs of those educators who may beless confident with their ability to engage in the process of reflection.

Limitations of the study

This was a small-scale study that had a number of limitations. The use of a reflectivelog as an additional tool for data collection for use by student participants and moreprobing interview questions may have yielded richer data on reflection within the 2:1model enabling the researcher to explore the levels of reflection in more depth.Student participants were confined to one year of the course and to one healthprofessional group, a factor that may have significantly limited the findings. Theresearcher’s role as clinical education tutor (JM) for a pre-registration course mayhave deterred educators and students from reflecting the reality of their experiencesand withholding some negative perceptions.

Conclusion and recommendations

Whilst the authors were encouraged that reflective practice was being promoted andmay have been increased within the 2:1 model we feel that it is essential thateducators continue to be supported in developing this key aspect of their role. Whendesigning role development courses for clinical educators education providersshould ensure learning opportunities allow practice educators sufficient time forexploring the purpose of reflection within experiential learning and professionaldevelopment.

Further research is needed to explore the potential for reflection within collabora-tive models of practice education with particular focus on interprofessional education(IPE) opportunities for learners in the practice setting.

Notes on contributors

Jane Morris is a principal lecturer with a lead role in practice education within theSchool of Health Professions at the University of Brighton. She is currentlycourse leader for a Postgraduate Certificate in Clinical Education. Her researchinterests include feedback in practice education, collaborative models of practiceeducation and interprofessional learning.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


Dr Graham Stew is a principal lecturer within the School of Health Professions andis currently Programme Leader for the Professional Doctorate in Health andSocial Care at the University of Brighton. His research interests include inter-professional learning, reflective practice and mindfulness in healthcare.

References

Alsop, A. & Ryan, S. (1996) Making the most of fieldwork education: a practical approach (Chelten-ham, Nelson Thornes).

Appleton, J. V. (1995) Analysing qualitative interview data: addressing issues of validity andreliability, Journal of Advanced Nursing, 22, 993–997.

Atkinson, T. & Claxton, G. (Eds) (2000) The intuitive practitioner. On the value of not alwaysknowing what one is doing (Buckingham, Open University Press).

Baldry Currens, J. (2000) An evaluation of three clinical placement models for undergraduatephysiotherapy students. Report on Phase 11 of the Clinical Education Project, University ofEast London.

Baldry Currens, J. (2003) The 2:1 clinical placement model: a review, Physiotherapy, 89(9),540–554.

Baldry Currens, J. & Bithell, C. P. (2003) The 2:1 clinical placement model: perceptions ofclinical educators and students, Physiotherapy, 89(4), 204–217.

Barr, H. (1998) Competent to collaborate: towards a competency-based model for interprofes-sional education, Journal of Interprofessional Care, 12, 181–187.

Baxter, S. & Gray, C. (2001) The application of student-centred learning approaches to clinicaleducation, Journal of Interprofessional Care, 12, 181–187.

Benett, I. & Danezak, A. (1993) CME-a time for reflection?, Postgraduate Education for Generalpractice, 4, 6–10.

Best, D., Cust, J. & Prosser, P. (1999) The implications of student learning for health scienceeducation, in: J. Higgs & H. Edwards (Eds) Educating beginning practitioners. Challenges forhealth professional education (Oxford, Butterworth Heinemann).

Boud, D., Cohen, R. & Sampson, J. (2001) Peer Learning in higher education. Learning from andwith each other (London, Kogan Page).

Boud, D., Cohen, R. & Walker, D. (1994) Using experience for learning (Buckingham, OpenUniversity Press)

Boud, D., Keogh, R. & Walker, D. (1995) Reflection turning learning into experience (London,Kogan Page).

Brown, G. & Ryan, S. (2003) Enhancing reflective abilities: interweaving reflection into practice,in: G. Brown, S. A. Esdaile & S. E. Ryan (Eds) Becoming an advanced practitioner (Oxford,Butterworth Heinemann)

Burnard, P. (1991) A method of analysing interview transcripts in qualitative research, NurseEducation Today, 11, 461–466

Chartered Society of Physiotherapy (2002) Curriculum framework for qualifying programmes(London, CSP).

Clouder, L. (2000) Reflective practice in physiotherapy education: a critical conversation, Studiesin Higher Education, 25(2), 211–223.

Clouder, L. (2002) Reflective practice: realising its potential, Physiotherapy, 86(10), 527–522.Cohn, E. S. (1989) Fieldwork education: shaping a foundation for clinical reasoning, The

American Journal of Occupational Therapy, 43(4), 240–244.Convery, A. (1998) A teacher’s response to ‘reflection-in-action’, Cambridge Journal of Education,

28(2), 197–205.Creswell, M. (2001) Qualitative inquiry and research design (Thousand Oaks, Sage).

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


Cross, V. (2006) Preparing for practice through peer learning, Physiotherapy, 92(1), p. 1.David, M., Frankford, J. D., Melina, A., Patterson, M. A. & Konrad, T. R. (2000) Transforming

practice organizations to foster lifelong learning and commitment to medical professionalism,Academic Medicine, 75(7), 709–717.

DeClute, J. & Ladyshewsky, R. (1993) Enhancing clinical competence using a collaborativeclinical education model, Physical Therapy, 75(6), 504–510.

Donaghy, M. & Morss, K. (2000) Guided reflection: a framework to facilitate and assess reflectivepractice within the discipline of physiotherapy, Physiotherapy Theory and Practice, 16(1), 3–14.

Durgahee, T. (1996) Promoting reflection in post-graduate nursing: a theoretical model, NurseEducation Today, 16, 419–426.

Fade, S. (2004) Reflection in the dietetic curriculum, in: S. Tate & M. Sills (Eds) The developmentof critical reflection in the health professions. Occasional paper 4. (London, Higher EducationAcademy for Health Science and Practice Subject Centre).

Fish, D., Twinn, S. & Purr, B. (1991) Promoting reflection: the supervision of practice, in: D.Fish, S. Twinn, B. Purr (Eds) Health visiting and initial teacher training (London, West LondonInstitute Press), 23–70.

Goldschmid, B. & Goldschmid, M. L. (1976) Peer teaching in higher education: a review, Highereducation, 5, 9–33.

Habermas, J. (1971) Knowledge and human interests (London, Heinemann).Health Professions Council (2005) Key decisions from our consultation on continuing professional

development. Available online at: www.hpc-uk.org (accessed 10 December 2005).Higgs, J. (2003) Do you reason like a (health) professional?, in: G. Brown, S. A. Esdaile & S. E.

Ryan (Eds) Becoming an advanced practitioner (Oxford, Butterworth Heinemann)Hilton, R. & Morris, J. (2001) Student placements—is there evidence supporting team skill devel-

opment in clinical practice settings?, Journal of Interprofessional Care, 15(2), 171–183.Huddleston, R. (1999) Clinical placements for the professions allied to medicine. Part 2:

Placement shortages? Two models that can solve the problem, British Journal of OccupationalTherapy, 62(7), 295–298.

Huddleston, R. & Standring, J. (1998) Clinical placements for the professions allied to medicine.Blackpool: NHSE (North West) and the Lancashire and South Cumbria Education andTraining Consortium.

Johns, C. (1995) Framing learning through reflection. In Carper’s fundamental ways of knowingin nursing, Journal of Advanced Nursing, 22, 226–324.

Jongbloed, L. (2000) Choosing the methodology to explore the research, in: K. H. Hammell,C. Carpenter & I. Dyck (Eds) Using qualitative research. A practical introduction for occupa-tional and physical therapists (Toronto, Churchill Livingstone), 13–21.

Kember, D. (2001) Reflective teaching and learning in the health professions (London, BlackwellScience).

Knowles, M., Holton, E. & Swanson, R. (1998) The adult learner: a neglected species (London, GulfPublishing Company).

Ladyshewsky, R. (1993) Clinical teaching and the 2:1 student to clinical instructor ratio, Journal ofPhysical Therapy Education, 73(10), 683–697.

Ladyshewsky, R. K. (2000) Peer-assisted learning in clinical education: a review of terms andlearning principles, Journal of Physical Therapy Education, 14(2), 15–22.

Ladyshewsky, R. (2004) The impact of peer coaching on the clinical reasoning of the novicepractitioner, Physiotherapy Canada, 56(1), 15–26.

Martin, M., Morris, J., Moore, A., Sadlo, G. & Crouch, V. (2004) Evaluating practice educationmodels in occupational therapy: comparing 1:1; 2:1 and 3:1 placements, British Journal ofOccupational Therapy, 67(5), 192–200.

Moon, J. (1999) Reflection in learning and professional development (London, Kogan Page).Moore, A., Hilton, R., Morris, J., Caladine, L. & Bristow, H. (1997) The clinical educator: role

development. A self-directed learning text (Edinburgh, Churchill Livingstone).

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4


Moore, A., Morris, J., Crouch, V. & Martin, M. (2003) Evaluation of physiotherapy clinicaleducation models comparing 1:1; 2:1 and 3:1 placement models, Physiotherapy, 89(8),489–501.

Pololi, L., Frankel, R., Clay, M. & Jobe, A. (2001) One Year’s experience with a program tofacilitate personal and professional development in medical students using reflection groups,Education for Health, 14(1), 36–49.

Quality Assurance Agency for Higher Education (2001) Code of practice for the assurance of academicquality and standards in higher education. Placement learning (Gloucester, QAA).

Reynolds, F. (2005) Communication and clinical effectiveness in rehabilitation (London, Elsevier).Robson, C. (1994) Real world research a resource for social scientists and practitioner—researchers

(Oxford, Blackwell)Routledge, J., Willson, M., McArthur, M., Richardson, B. & Stephenson, R. (1997) Reflection on

the development of a reflective assessment, Medical teacher, 19(2), 122–129.Sadlo, G. (1997) Problem-based learning enhances the educational experiences of occupational

therapy students, Education for Health, 10(1), 101–114.Schön, D. A. (1991) Educating the reflective practitioner (San Francisco, Jossey-Bass).Shephard, K. F. & Jensen, G. M. (1990) Physical therapist curricula for the 1990s: educating the

reflective practitioner, Physical Therapy, 70(7), 566–575.Shields, E. (1995) Reflection and learning in student nurses, Nurse Education Today, 15, 452–458.Sinclair, K. (2001) Promoting discussion from reflective writing, in: D. Kember (Ed.) Reflective

teaching and learning in the health professions (Oxford, Blackwell Science).Sinclair, K. & Harrison, T. (2001) Writing reflective journals, in: D. Kember (Ed.) Reflective teach-

ing and learning in the health professions (Oxford, Blackwell Science).Smith, A. (1998) Learning about reflection, Journal of Advanced Nursing, 28(4), 891–898.Stanley, H. & Ramage, C. (2004) Reflective practice in teacher preparation, in: S. Tate & M. Sills

(Eds) The development of critical reflection in the health professions. Occasional Paper No. 4 (London,Higher Education Academy for Health Science and Practice Subject Centre).

Vaughn, S., Scum, J. S. & Sinagub, J. (1996) Focus group interviews in education and psychology(London, Sage).

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

9:29

09

Oct

ober

201

4

Documents

Collaborative reflection: how far do 2:1 models of learning in the practice setting promote peer reflection?