Reflective Practice: Co-Creating Reflective Activities for Pharmacy Students
Abstract
:1. Introduction
2. Materials and Methods
2.1. Educational Setting
2.2. Conceptual Framework
2.3. Instructional Design
3. ADDIE Framework
3.1. Analysis
My interest in this project stems from my own experiences with reflection. My mother is an advocate of reflection and was a role model for me, so I had some experience with reflecting on experiences. One experience stands out for me related to an OSCE-style exam in the first year of the program. I recall experiencing intense nervousness during the exam. When I left the exam, I was unhappy with one of my answers. Usually when this happens, I am satisfied to review what I recall about questions and answers and continue on. However, in this situation, my discomfort troubled me for days following the exam. I asked myself questions such as: “Will I ever be able to learn all I need to know?” or “Is this experience going to drive my self-confidence as a student?” After discussions with my mother and time to process the event, I came to the realization that making a mistake in a safe environment is okay as a learner and was able to move beyond the experience. This outcome reinforced the value of reflection to me. As a result, my dedication to reflective practice for personal and professional growth has remained strong. My positive regard for reflective practice is not status quo among all of my classmates. I understand that a large portion of classmates dislike the process of reflection and the associated assignments. Fellow students comment that reflections are a “waste of time”, “not valuable”, “a time-filler” or “taught wrong,” which were similar sentiments to what I was reading in the literature. I also learned that these perspectives were shared by students in other programs. This project provides an opportunity for me to understand more about students’ perspectives, advocate for students, and contribute to curriculum development with my professors to support reflection and reflective practice for pharmacy students.
3.2. Design
- Define reflective practice;
- Describe the purpose of reflection;
- Engage in different types of reflective activities;
- Explore reflective activities individually and with peers;
- Respond to formative and summative assessments;
- Identify changes for future learning or practice; and
- Apply reflective skills in practice.
3.3. Development
3.3.1. Target Audience Review
3.3.2. Expert Review
3.3.3. Reflection Assignment Templates
3.4. Implementation
3.5. Evaluation
4. Discussion
As a student who has never attempted creating educational materials, this was a very eye-opening experience. Now I can understand the work and time that has to go into creating these assignments; it is not as simple as writing up a task with a rubric. My primary goal going into this project was to increase the positive perception and understanding of reflective practices for the next generation of professionals. Was I able to achieve this? Yes, and no. I feel I was able to increase the positive notion behind reflection among the students who were part of the project. However, they make up an incredibly small portion of our student body. I also feel I was able to increase my own understanding of reflection and reflective practices through reading and analyzing journal articles.
The major change of heart (my own critical incident) I experienced during this project occurred when students reviewed the reflection assignment template for personal development with the option to share a reflection with a peer. My assumption was that students would embrace the opportunity to “save face” and remain anonymous when sharing their reflections and experiences with other students. Students loved the idea of discussion boards to anonymously post reflections and learning experiences with one another. However, when it came to the peer feedback, students stated they would prefer the reviewers be identified. Students related this to what they have learned in the PharmD program. They recalled that during lectures and learning to give feedback, they were taught the CORBS model [59]. The “O” stands for owned. Students stated commitment to best practices of feedback and to be honest with who is providing the review. My perspective changed because of this experience. I originally thought students would prefer anonymous feedback. My assumptions were reinforced by what I was reading in the literature. I see now this is not the case. I have a new appreciation for seeking input from students representing the target audience for the learning activity.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Reflection Assignment Templates
Appendix A.1. Personal Development
- Identify and explore an event you experienced that is significant to you;
- Develop a feasible action plan in response to the event.
- What were your thoughts, feelings and/or reactions about the incident?
- What did you learn from this incident?
- How does your learning relate to prior thoughts, assumptions, feelings, or experiences?
- How can you apply what you learned to future situations?
Activity | Format | Assessment | Rationale and Resources |
---|---|---|---|
Explore feelings and emotions following a critical incident | Reflective journal entry Written Essay | Self-assessment Formative with instructor feedback Summative with instructor feedback and grade assigned from rubric Summative (Complete/Incomplete) Portfolio | Reflection requires a significant incident [13,19,22,42] |
Apply reflections on a critical incident to further learning | Combine with a second reflection following feedback Develop a continuing professional development plan | Formative with instructor feedback Summative with instructor feedback and grade assigned from rubric Portfolio | Reflection improves decision-making [1,13,19,42] |
Share a reflection with peers | Blog post Small group discussion (asynchronous) | Formative with peer-feedback (1–2 peers, anonymous) Formative with peer-feedback (1–2 peers, established group) | Sharing reflections with other students improves self and peer-reflective ability and development [13,19,22,42,56] |
Provide (or incorporate) peer feedback techniques | Incorporate peer assessment into a selected assignment (essay, blog post, portfolio, etc.) | Formative with peer-feedback (1–2 peers, anonymous) Formative with peer-feedback (1–2 peers, established group) | Sharing reflections with other students improves self and peer-reflective ability and development [13,19,42,45,55,56] |
Appendix A.2. Professional Development
- Understand the benefit of reflection for professional development;
- Identify and explore a professional skill that you plan to further develop in yourself;
- Understand the difference of reflection for professional development and a reflection on professional development.
- What insights did you gain from the experience about your professional goals or skills?
- What professional skills do plan to develop?
- What professional skills do you want to practice during the experience? Why are these important to you? How will you go about this? How will you know if you are improving?
- Did the experience confirm your expectations about careers and roles in this area or were you surprised? If you were surprised, please document why?
- How does your experience impact your career path?
- How will you apply these skills?
Activity | Format | Assessment | Rationale and Resources |
---|---|---|---|
Discuss how your notion of the role of a pharmacist has changed or remained the same | Written Essay Written group assignment identifying a skill a pharmacist needs to have | Formative with grade assigned from rubric | Reflection aids in professional development Improvement of clinical decision-making [1,13,19,42] |
Discuss key skills that are required for a pharmacist to have | Small group discussion Continuing professional development plan | Self -reflection on own time | Sharing with other students improves self and peer reflective ability and development [13,19,42,55,56] |
Share a professional learning plan with peers | Blog post Small group discussion (asynchronous) Portfolio | Formative with peer-feedback (1–2 peers, anonymous) Formative with peer-feedback (1–2 peers, established group) | Sharing reflections with other students improves self and peer-reflective ability and development [19,22,42,45,56] |
Appendix A.3. Professional Identity Formation
- Reflect on the meaning of your role in a specific practice context;
- Identify aspects of behaviour you do or do not want to be part of your own professional identity;
- Consider how others affect your understanding or enactment of your role.
- What was the practice experience and context? Who else did you encounter?
- How do you describe the pharmacist’s role related to this experience?
- What insights did you gain from the experience about your professional role?
- What did others say about, or how did they react to, your role?
- How did other pharmacists or professionals model this role? What aspects of behaviour do you want, or not want, to be part of your own professional identity?
- Did the experience confirm your expectations about pharmacists’ roles in this area or were you surprised? If surprised, please indicate the reasons why.
- Did your understanding of your role as a pharmacist change or remain the same after this experience?
- How will this experience influence how you enact this role in the future?
- Is there anything you would like to learn before you return to this role in the future?
Activity | Format | Assessment | Rationale and Resources |
---|---|---|---|
Identify aspects of behaviour you do or do not want to be part of your own professional identityConsider how others affect your understanding or enactment of your role | Reflective journal entry Written Essay | Self-assessment Formative with instructor feedback Summative with instructor feedback and grade assigned from rubric Summative (Complete/Incomplete) Portfolio | Professional identity is developed though reflection on experience [48] |
Apply reflections on a critical incident to further learning | Combine with a second reflection following feedback Develop a continuing professional development plan | Formative with instructor feedback Summative with instructor feedback and grade assigned from rubric Portfolio | Reflection improves critical decision-making [1,13,19,42] |
Share a reflection with peers | Blog post Small group discussion (asynchronous) | Formative with peer-feedback (1–2 peers, anonymous) Formative with peer-feedback (1–2 peers, established group) | Sharing reflections with other students improves self and peer-reflective ability and development [13,19,22,42] |
Provide (or incorporate) peer feedback techniques | Incorporate peer assessment into a selected assignment (essay, blog post, portfolio, etc.) | Formative with peer-feedback (1–2 peers, anonymous) Formative with peer-feedback (1–2 peers, established group) | Sharing reflections with other students improves self and peer-reflective ability and development [13,19,22,42,55,56] |
Compare experiences, understanding and enactment of roles in different contexts | Small group presentations Written Essay Journal entry Blog post Presentation | Formative with grade assigned from rubric Peer-feedback using a rubric during discussion | Sharing with other students improves self and peer reflective ability and development [13,19,22,42,55,56] Reflection aids in professional development and improvement of clinical decision-making [13,19,22,42] |
Appendix B
Process | Non-Reflective | Reflective | Critically Reflective |
---|---|---|---|
Returning to experience: Provides a clear description of the experience or task | Statement does not provide a clear description of the task itself | Statement provides a description of the task | Statement provides description of the task chronologically and clear of any judgments |
Attending to feelings: Attends to both thoughts and feelings | Statement provides little or no evidence of personal feelings, thoughts, and reactions? | Statement conveys some personal feelings and thoughts of the experience but does not relate to personal learning | Statement conveys personal feelings, thoughts (positive and/ or negative) of the experience and relates to future personal learning |
Associating: Relates new knowledge with previous knowledge | Statement does not provide any relationship between new knowledge with previous knowledge | Statement provides evidence that perhaps prior knowledge may be consistent with new knowledge gained through this task | Statement clearly relates new knowledge learned with previous knowledge and sees that accommodating new knowledge will assist with future practice |
Integrating: Integrates prior knowledge, feelings, or attitudes with new knowledge | Statement shows no evidence of integration of prior knowledge, feelings, or attitudes with new knowledge, feelings, or attitudes, thus not arriving at new perspectives | Statement provides some evidence of integration prior knowledge, feelings or attitudes with new knowledge, feelings or attitudes and arriving at a new perspective | Statement clearly provides evidence of integration of prior knowledge, feelings or attitudes with new knowledge, feelings or attitudes, thus arriving at new perspectives |
Assessing: Self-assesses prior beliefs, approaches, assumptions in relation to experience | Statement shows no evidence of self-reflection and self-assessing of previously held beliefs, assumptions, approaches and does not relate it to previous experience | Statement demonstrates self-reflection, self-assessment of previously held beliefs, assumptions, approaches, and occasionally relates it to previous experience and previous knowledge | Statements clearly conveys self-reflection and self-assessment of previously held beliefs, assumptions, approaches, consistently relating it to previous experience and previous knowledge |
Internalizing: Adapts the information in a way that is personally meaningful; applies new knowledge as own | Statement does not indicate owning of knowledge | Statement shows owning of knowledge and makes inferences relating to prior knowledge and prior experience | Statement clearly shows evidence that inferences have been made using their own prior knowledge and previous experience throughout the task |
Changing: Describes how reflection led to change or supports future change; applies outcome of reflection to create new practices | Statement shows little or no reflection on own work, does not show how to improve knowledge or behaviour and does not provide any examples for future improvement | Statement shows some evidence of reflecting on own work, shows evidence to apply new knowledge with relevance to future practice for improvement of future pharmacy practice. Provides examples of possible new actions that can be implemented most of the time. | Statement clearly shows evidence of reflection and:
|
Appendix C. Implementation of Reflection Assignment Template
- Revisiting your prior experience and knowledge of the topic you are exploring;
- Considering how and why you think the way you do;
- Examining your beliefs, values, attitudes, and assumptions that form the foundation of your understanding;
- Recognizing that you bring valuable knowledge to every experience;
- Clarifying important connections between what you already know and what you are learning;
- Becoming an active, aware, and critical thinker and learner;
- Identifying how reflection leads to change, supports future change, or new practices, approaches and/or strategies.
- Documenting your response to experiences, opinions, events, or new information;
- Communicating your response by evaluating your own thoughts, feelings, and reactions;
- Seizing an opportunity to “start with you” or gain self-knowledge;
- Applying a way that professions learn;
- Achieving clarity and better understanding of what you are learning;
- Developing and reinforcing writing skills;
- Making meaning out of what you study as a professional.
- Explore an event you experienced in lab that is significant to you
- Develop a feasible action plan in response to the event
- Deal with conflicting emotions from other healthcare professionals
- What were your thoughts, feelings and/or reactions about the incident?
- What did you learn from this incident?
- How does your learning relate to prior thoughts, assumptions, feelings, or experiences?
- How can you apply what you learned to future situations?
- How did this guided group reflection help you in writing an informed response to the physician? (Added for the Group Reflection)
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Focus | What Works Well? | What Could Be Improved? |
---|---|---|
Reflection for personal development | 500 words is an appropriate amount for a reflection. It allows for just enough filler to provide background information. (Year 2 Student) I really enjoy the prompting questions. I could think of an example to reflect on as soon as I read these questions! (Year 1 Student) | Change the wording from “critical incident” to “significant incident.”(Year 1 Student) I don’t understand the meaning of “appropriation” of knowledge [in the rubric]. Is that not the same as “integrating”? (Year 1 Student) |
Reflection for professional development | I like having no numerical value/grade tied to the rubric. I do not believe students should be assigned a grade on reflections. How can a grader value one person’s thoughts more superior to another? (Year 3 Student) I like the variations that allow for peer feedback. I know I would personally put more effort into my work if I knew my colleagues would be looking at it. (Year 2 Student) | I think asking us [as first-year students] to complete this assignment in first semester might be difficult as we are just beginning to grasp concepts. (Year 1 Student) I think the student could also reflect on what the pharmacist is like. Are they friendly or jaded? Overworked or bubbling with energy? (Year 2 Student) |
Reflection for professional identity formation | Public speaking is a great way to integrate other skills we need to have as a professional and allows for a good tie in with PHARM 454 [experiential education—hospital placement]. (Year 2 Student) I like how this rubric is applicable across all three assignments so we can integrate the aspects we should be touching on when reflecting. However, the rubric is quite wordy, it could be simplified. (Year 3 Student) | Students should be provided examples of reflection from their professors and how it has driven their practice to provide us [students] with a good reason to use reflection in the future. (Year 2 Student) I wish the assignments were not so fragmented [in the curriculum]. I wish we could have done a reflective portfolio that could have been tracked across our four years of pharmacy so we could see how we have grown. (Year 3 Student) |
Fall Term | Winter Term | Spring/Summer Term | |
---|---|---|---|
Focus | Personal development | Professional development | Professional identity formation |
Concepts taught in curricular streams | Reflective practice, reflection, critical incident | Learning, continuing professional development | Role of pharmacists, professional identity |
Social | Student “near peer” shares experiences developing reflective practice | Discussion with peers | Sharing with peers |
Format | Reflective writing (Critical incident) | Continuing professional development plan (Learning needs) | Blog entry (Practice experience) |
Assessment | Formative | Formative, Summative | Formative |
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Hokanson, K.; Breault, R.R.; Lucas, C.; Charrois, T.L.; Schindel, T.J. Reflective Practice: Co-Creating Reflective Activities for Pharmacy Students. Pharmacy 2022, 10, 28. https://doi.org/10.3390/pharmacy10010028
Hokanson K, Breault RR, Lucas C, Charrois TL, Schindel TJ. Reflective Practice: Co-Creating Reflective Activities for Pharmacy Students. Pharmacy. 2022; 10(1):28. https://doi.org/10.3390/pharmacy10010028
Chicago/Turabian StyleHokanson, Kalbie, Rene R. Breault, Cherie Lucas, Theresa L. Charrois, and Theresa J. Schindel. 2022. "Reflective Practice: Co-Creating Reflective Activities for Pharmacy Students" Pharmacy 10, no. 1: 28. https://doi.org/10.3390/pharmacy10010028