Writing the comparative report

This resource is designed to assist you in completing your comparative report for iSAP assessment tasks. For this task you are asked to:

systematically compare your Student Response with the Expert Response, and in the process, reflect upon and demonstrate your learning outcomes.

By working through this resource, you will have an improved understanding of the reflective process required to complete this task. These reflective skills are transferable, and can be used when completing similar future assessments. We will begin by exploring the reflective process and the thinking that needs to go into this task.

Reflective Practice

Reflection is an important part of evidence based practice in Medicine, Nursing and Health Sciences. The reflective process enables you to evaluate and change your practice based on most recent information - whether that comes from new research findings, new government or organisational policies, or new  patient or client experiences. By reflecting on your experiences, you will improve your ability to think critically as a health professional (Howard, 2019).

The comparative report is not simply about comparing your student response to the expert response and pointing out what you missed.

Instead, it is about considering why your response was different. This requires you to reflect on your health care practice, by considering how the differences you identify have deepened your understanding of the issues involved.

There are many ways in which reflection can be expressed in writing. One common method, known as Gibbs' Reflective Cycle (Bassot, 2016), is to analyse and reflect on a situation, including your feelings, in five or six steps. The following video is a good introduction to reflection using this approach.

Click to play or view transcript

Another approach to reflection is the Driscoll Model (Bassot, 2016). This approach requires you to answer three questions:

  • What? When considering "what?" you ask questions that allow you to identify the key elements of the experience or situation.
  • So what? The "so what?" questions allow you to analyse and better understand the meaning and implications of the situation to yourself and others.
  • Now what? Asking "now what?" questions allows you to identify what you could or should do in similar situations in the future.

Now that you have an idea of what the reflective process looks like, let's consider how this applies to your task. The purpose of the comparative report is for you to use the comparison of your work with the expert example as a learning opportunity. That means, focusing on the ways in which the expert example can change, challenge or reinforce your understanding of the issues involved. The instructions for your comparative report require you to break your reflection into three parts - comparison, reflection on learning, and implications for practice.

 Driscoll Model: What, So what, Now what in connected cycles

The Driscoll Model

Comparison

In this section, you are identifying the differences and similarities between your response and the expert response.

However, it is not enough to identify the differences and similarities. You must also explain why you think these occur (e.g. why is your response the same as the expert response, why is the expert response different?).

How do you take this step? - Identifying "What?"

In order to move beyond simple comparison, you need to consider what knowledge advantage the expert has - this could include experience in practice, wider reading of the research, or more advanced technical skills.

However, simply stating the difference is due to increased experience is not enough. Consider what that experience is and how it adds to the expert report - do they have greater insight into the needs of the population? Do they have a wider awareness of current treatment options?

You might also identify something in your response that the expert has not considered. Consider what this omission might indicate - do you have a knowledge advantage over the expert? Is the research you have read more recent than that of the expert? This is an important consideration when engaging in evidence based practice.

Reflection on learning

The focus of this section is how the expert response has impacted your understanding of issues within the scenario. This follows on from the previous section - by identifying what additional knowledge the expert response contains, you are already beginning to identify what you can learn from the expert response. This section requires you to make this learning explicit. Again, it is not enough to identify what has changed, you also need to incorporate why and how your thinking has changed.

To formulate your response, you will need to use the similarities and differences you have previously identified in this section. You can focus on what each similarity and each difference taught you about the case.

You can also use the learning objectives of the iSAP (found on the second page of the case) to help you identify what you learned from the expert response. You can do this by turning the objectives into questions. For example, ‘What did I learn about the importance of oral health to overall general wellbeing?’.

How do you take this step? - Asking "So what?"

Here it is important to consider what you thought before you read the expert response. You can then compare your previous thinking to your new understanding. Did the expert response reinforce what you already knew (similarity)? Did it challenge your assumptions or change your thinking (difference)?

One way of reflecting on what you learned is to think about:

  • what you knew (or thought you knew)
  • what new information you discovered
  • the importance of the new information for your future practice

Impact on practice

In the final section of your comparative report, you need to consider the implications of your new understanding of the case.

This means that you need to use the learning you have identified in the earlier sections as the focus of your reflection on your future practice. How does your new understanding of the theory relate to your role as a health care professional? What issues might arise in the future related to the ideas in the case? What will you do differently now that you have undergone this learning process?

How do you take this step? - Considering "Now what?"

In order to consider the future implications, you need to imagine the context in which the learning may be relevant (e.g. where is your health care practice taking place?). Once you have a context, you can then picture the type of patient or client who might present, and consider the issues you would need to consider when treating that individual.

Student vs. the expert

What might the health practitioner have done differently if they had recognised the cultural background of the patient?

Read the student example. Identify similarities and differences between the student & expert responses by clicking on the relevant sentences in the expert response.

Student response

If the health care practitioner had paid careful attention to the medical file before the consultation, they would have seen that the patient identified as Aboriginal and Torres Strait Islander. Instead of raising the potential of Thalassemia, they could have focused more on the issues relevant to the patient. In particular, they could have discussed the heartburn the patient mentioned, instead of dismissing the complaint with "OK, no medications." If they had taken the complaint more seriously, they could have discussed food or drink that could be avoided, and considered changing the medication the patient has already tried (Australian Government Department of Health, 2019). Investigation into other causes, such as infection and cancer, should also have been pursued (Australian Government Department of Health, 2019). As a result, the patient would have felt that the practitioner was actively listening and engaging with her concerns.
The practitioner could also have directed the patient to Aboriginal and Torres Strait Islander support programs, such as Koori Maternity Services (Victoria State Government, 2020). These services aim to provide a holistic approach to antenatal care, which has proven to be important for Aboriginal and Torres Strait Islander women (Kildea et al., 2016). As such, these programs incorporate social, emotional, cultural and physical wellbeing of the patient.
Finally, if the practitioner might have been aware of research which demonstrates that Aboriginal and Torres Strait Islander people have a higher risk of prematurity and low birth weight (Ford et al., 2018). As such, they could have targeted their questions to risk factors.

References

Australian Government Department of Health. (2019). 56 Reflux (heartburn). https://www.health.gov.au/resources/pregnancy-care-guidelines/part-i-common-conditions-during-pregnancy/reflux-heartburn

Ford, E. J., Cade, T. J., Doyle, L. W., & Umstad, M. P. (2018). Pregnancy risk factors associated with birthweight of infants born to Australian Aboriginal women in an urban setting - a retrospective cohort study. BMC Pregnancy and Childbirth, 18, 382. 10.1186/s12884-018-1946-3

Kildea, S., Tracy, S., Sherwood, J., Magick-Dennis, F. & Barclay, L. (2016). Improving maternity services for Indigenous women in Australia: Moving from policy to practice. MJA, 205(8), 375-379. 10.5694/mja16.00854

Victoria State Government. (2020). Aboriginal maternity services. https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/perinatal-reproductive/maternity-newborn-services/aboriginal-maternity-services

Expert response

The health care practitioner might have recalled studies indicating that Aboriginal and Torres Strait Islander people are a high-risk group for chronic Helicobacter pylori. infection and taken the heartburn complaint more seriously.

While both highlight the need to take the heartburn complaint more seriously, the expert response includes a specific condition that is relevant to the patient to justify the concern.

She may have considered the likelihood of low birth weights for Indigenous mothers and asked more targeted questions to identify risk factors associated with this. The average age for pregnancy for Indigenous mothers is 25 while the age for non-Indigenous mothers is 31, with fertility rates for older Indigenous mothers declining significantly beyond the age of twenty, so at 35+ the patient in this scenario is in a high-risk demographic for pregnancy issues.

This is a key difference - the expert response discusses statistics around the pregnancy risks for Aboriginal and Torres Strait Islander people, which the student response fails to include.

Aboriginal mothers are also statistically far less likely to access ante-natal care, and do so far later in their pregnancies than non-Aboriginal women. Knowing this, a health practitioner may take extra care to make the patient experience more positive, inviting, welcoming and safe, encouraging return visits.

Instead of discussing accessing ante-natal care, the student response focuses on the need for holistic care.

Cardio-vascular, renal and some neoplastic pathologies are statistically far higher for Aboriginal people, so the family histories of the clients in this scenario might deserve some more detailed scrutiny in these areas.

This is another detail overlooked in the student response.

This is another detail overlooked in the student response.

Strength-based approaches to this kind of population data can also be helpful – for example Indigenous childhood diabetes is lower than mainstream rates, as well as breast cancer and some other cancers. Aboriginal people are also statistically more likely to be non-drinkers than non-Aboriginal people are, as was the case in this scenario. This kind of data can help practitioners maintain respect and an accurate view of Aboriginal people based on reality rather than deficit-focused data and negative stereotypes.

The student response did not consider these factors either.

There is significant data showing a correlation between cultural/land connection and improved Indigenous health outcomes, so acknowledging and affirming culture is also a good practice that can be informed by familiarity with (and application of) Indigenous health research.

This is similar to the student response's discussion of holistic care.

Awareness of the National Aboriginal and Torres Strait Islander Health Plan, Indigenous Australians' Health Programme, the Aboriginal and Torres Strait Islander Health Performance Framework, and Closing the Gap Targets may have helped convince the doctor in this scenario of the importance of mandated policy around Indigenous identification and delivering the appropriate model of care. For example, the doctor may have enquired as to whether the patient had been put in contact with the Aboriginal Health Worker at the hospital to ensure her needs were being met. She may also have referred the patient to local Indigenous health initiatives and support groups in her area.

The student response also refers to Aboriginal and Torres Strait Islander support programs, but lacks the detail of the expert response.

Reflection is NOT...

  • a description of the expert example
  • a summary of the differences between your response and the expert response
  • a list
  • everything you think and feel put together
  • a series of complaints or criticisms

Taking this on board as you prepare your reflections will also help you avoid the trap of talking only about your personal opinions or biases instead of truly reflecting.

Writing the comparative report

When writing your reflection, there are a number of points to consider:

A common challenge in reflective writing is finding a balance between description and analysis. While description is important to set the context and "describe" the situation and evidence, you will also need to demonstrate your ability to analyse it, for example by identifying a pattern of behaviour or a medical condition, or by connecting aspects of the scenario to your professional knowledge. You need to keep your description brief and relevant.

Annotated Assignment

Legend:

Good Problem Suggestion Question

Click the icons next to each paragraph to show the lecturer’s comments. Click again to hide the comment.

Comparison

comment-1 comment-2 comment-3

One of the key differences between my response and the expert response is the focus on heartburn. While I considered the implications of heartburn, I looked only at the standard concerns when a patient presents with those symptoms, using the Australian Government guidelines. The expert response, however, focused on the issue of heartburn for Aboriginal and Torres Strait Islander people who are pregnant. That is, they noted that Aboriginal and Torres Strait Islander people have a higher risk of chronic Helicobacter pylori infection. Problem
This description is too long. It would be better if this was more concise.
The expert response also included a wider range of Aboriginal and Torres Strait Islander support services. Good
This description is concise and precise. This difference occurs because the expert has more experience with the health and support of Aboriginal and Torres Strait Islander people. Their experience has increased their awareness of health services which are designed for this cultural group, as well as the government policies which promote Aboriginal and Torres Strait Islander health.
In addition, they possess a greater awareness of research about the health of Aboriginal and Torres Strait Islander people, allowing them to identify risk factors in more detail. Good
Here the student has clearly engaged in reflection on the reason for the difference. They have gone beyond the superficial idea that the expert has more experience to identify what that experience has provided the expert that the student does not have.

Another key difference is the discussion of holistic treatment. While I had noted the importance of holistic approaches to health for Aboriginal and Torres Strait Islander people, I had not made the connection between this approach and encouraging access to health care, which the expert response discusses. The expert had a better understanding of how Aboriginal and Torres Strait Islander people engage with health services. However, I had engaged with more recent research that indicated the importance of holistic care. This highlights the importance of staying up-to-date with research for evidence based practice.

Reflection on learning

Knowledge was consolidated:

  • there are higher risk factors for this group that about which a health practitioner needs to be aware
  • it is important to remain up-to-date with research about the health needs and risks of people from a range of cultural backgrounds
Knowledge was challenged: comment-4
  • Aboriginal and Torres Strait Islander people do not access health care in the same way as other patient populations Suggestion
    This example is written using dot points. Read your assignment instructions carefully to see if this is acceptable for your comparative report.

Impact on future practice

comment-5 comment-6

My learning has two important implications for my future practice. First, Good
The student has used signposting in their writing. This helps the reader follow their argument.
I am more aware of gaps in my knowledge of services available to support Aboriginal and Torres Strait Islander people. Therefore, in my future practice, I will ensure that I familiarise myself with all available options in the area. Good
The student has identified a concrete application for their future health care practice.
Second, I will endeavour to remain up-to-date with research not only about health risks and treatments, but also about approaches to practice. This will ensure that I am asking the correct questions and recommending the best treatments.

Assignment instructions

Different academics have different expectations around the structure and presentation of a comparative report. It is important to read all assessment instructions carefully. This includes reviewing the marking rubric, if it is provided. This will give you details about structure and word count specific to your task.

Label the parts of the example reflections

References

Bassot, B. (2016). The reflective practice guide : An interdisciplinary approach to critical reflection. London: Routledge.

Howard, J. (2019). Cognitive errors and diagnostic mistakes: A case-based guide to critical thinking in medicine. New York: Springer. doi:10.1007/978-3-319-93224-8