Some action on reflection.

The healthcare professional in our age needs to PERFORM in complex and challenging healthcare environments. The importance of reflection, reflective practice and teaching and training to develop a reflective practitioner is frequently established in the literature. In fact, recent research on pedagogy stresses the importance of establishing a link between reflective learning and reflective practice as a means to developing adult learning and life long learning skills. Reflection and its three categories of reflection-in-action, reflection-on-action and reflection-on-the-future have been established as the panacea of all things wrong in the health education and health care delivery systems. Activities, therefore, to promote reflection are now being incorporated into undergraduate, postgraduate, and continuing medical education, and across a variety of health professions. Many definitions of reflection can be found. Dewey defined reflection as ‘active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it ends’. This definition shares our understanding of critical thinking. Brockbank and McGill identify reflection as a ‘process or means by which an experience, in the form of thought, feeling or action, is brought into consideration, while it is happening or subsequently’. Secondly, and deriving from the first, ‘the creation of meaning and conceptualisation from experience and the potentiality to look at things as other than they are’. Action can specifically occur before reflection and thus something that requires reflexive ‘action’ and ‘practice’, can occur during reflection (and here on the continuum of action can change or remain unchanged as a result of reflection-in-action) or can be the consequence of reflection-afterprevious-action. The argument related to the balance between action and reflection is not a simple one. How much reflection follows as a result of action and vice versa is largely context, action, and ‘reflector’ dependent. This context, action, reflection, relationship is presented in Table-1. The Upper Right square is the square that represents maximum action with maximum reflection. Again the balance between action and reflection is very situation, subject, experience, context, person and position dependent. Table-1: Context, Action, Reflection, Relationship (CARR) Reflection No Action Reflection Action No Reflection No Action No Reflection Action