The Reflective Practitioner: Reaching for Excellence in Practice

Reflection is widely accepted as a tool for learning in higher education. It has been addressed in some areas of medical education but not in the pediatric literature.1–8 It is considered essential to professional practice. Reflection allows for the interconnections between observations, past experiences, and judgment to come to the fore in clinical decision-making.9,10 Reflection gives meaning to experience and promotes a deep approach to learning because it encourages trainees to reframe problems, question their own assumptions, and look at situations from multiple perspectives as they analyze their lived experiences.6,9–14 Reflection fosters lifelong learning because it encourages trainees to recognize gaps in their own knowledge and attend to their own learning needs.6 Reflection is particularly important in medicine, in which evidence-based practice and client-centered care require the physician to analyze best evidence while considering his or her values and assumptions vis-a-vis the values, beliefs, and goals of each patient. It enables trainees to recognize their own assumptions and how those assumptions might impact the therapeutic relationship and their clinical decisions. Reflection also helps practitioners develop a questioning attitude and the skills needed to continually update their knowledge and skills, which is essential in today's rapidly changing global health care environment.6 The importance of the reflective process is further acknowledged by the Accreditation Council for Graduate Medical Education (ACGME) as underlying a number of the expected competencies is the development of reflective practitioners.15 Much has been written about reflective practice, particularly with respect to how it can be incorporated into the classroom. However, little has been written about what reflection is, how it can be assessed, or how it can be facilitated in the clinical setting. To enable pediatric academic faculty and practicing pediatricians to facilitate reflective … Address correspondence to Margaret M. Plack, PT, EdD, Program in Physical Therapy, George Washington University School of Medicine and Health Sciences, 900 23rd St NW, Suite 6145, Washington, DC 20037. E-mail: hspmxp{at}gwumc.edu