Reflective practice in Pharmacy and Pharmaceutical Sciences

It is the intention of health care to ‘do no harm’. Despite this, the World Health Organization (WHO) estimates that millions of people every year experience permanent injury or even death as a consequence of medical errors (World Health Organization, 2007). This is particularly concerning as many errors are considered preventable. Often, these errors are related to the way medications are prescribed and used.

In Australia, the percentage of adverse medication related events has remained stable at 10% with the rate of medication-related hospital admissions at 2% - 3% a year (Australian Commission on Safety and Quality in Health Care, 2013).

Medical errors can be partly attributed to the failure of many health practitioners to reflect on their professional practice. According to Mamede, Schmidt & Rikers (2006) reflective practice, “…can reduce [the] likelihood of failures in clinical reasoning for solving complex cases” (p. 144). It does this by enabling the practitioner to think critically about the way they apply knowledge to real life scenarios and reassess their clinical decision making with a view to becoming  better  practitioners.

Reflective practice is...


An approach where a person deliberately reflects on their thoughts and actions in a situation, and then evaluates the effectiveness. It is a method of self-learning with the intention of developing a person’s critical thinking and understanding” ( IpAc, p.19).

On the next screen, you will see a model (Gibbs, 1988) to help you think and write reflectively. Models for reflective practice are designed to help you go deeper into the experience or situation that triggers the reflection, in order to create new understandings and ultimately lead to greater awareness  of  self  and  others.

At a basic level, a reflective approach involves you asking yourself the following three questions:

  • What just happened?
  • So what? (Why is it  important or interesting? Why do I need to reflect on it?)
  • Now what? (What action do I take to improve the situation or make a good situation even better?)

Gibb's Reflective Cycle

Activity

Click to see what questions you should ask yourself at each step of the cycle.

Student sample reflection

Read the student reflection sample below. Click the Comment icons next to each paragraph to show the lecturer’s comments. Click again to hide the comment.

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I met with my team today and it seems we are having difficulty agreeing on the direction of our oral presentation.Describes what happened This is making me quite frustrated and worried.Describes the emotions felt I think we should focus mostly on new drugs for epilepsy, but my team members think we need to spend more time talking about other aspects, like symptoms and prognosis.Evaluates what was good or bad about the experience I’m concerned that we only have 10 mins and we will waste our time not talking about the most interesting part!Analyses why the experience was good or bad We really need to agree on the scope of what we want to talk about in the oral presentation otherwise our talk won’t gel. It will seem disjointed.Makes some general conclusions or observations I suggested that we each go away and find information on new therapies for epilepsy, which we share in a Google folder and that we come to our next meeting, next week prepared to share what we have found.Suggests an action plan or a way forward Perhaps that will help us all ‘get on the same page’.

Common features of reflective writing

While a reflection cannot be considered ‘wrong’, the quality of a reflection depends on how deep and thought-provoking the exploration of the event that triggered the reflection has been. Good reflections are honest and deal  with the problems encountered in learning or in practice  and try to work internal conflicts out. Hence, your reflection should focus on the process you’ve taken to learn something, or realise something, not the outcome.

Read the student reflection sample below. Click the Comment icons next to each paragraph to show the lecturer’s comments. Click again to hide the comment.

Example

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Yesterday’s lecture on the ‘Seven star pharmacist’ introduced the idea that there are many important roles that the pharmacist plays besides being an expert in medication such as being a teacher, a care-giver and a decision-maker.Good description of EXPERIENCE / EVENT triggering the reflection I found this inspiring because I have been thinking a lot about why I’m doing this course and what direction I would like a career in health, particularly in pharmacy, to take.The author’s voice is clear. Tone is appropriately personal While watching Michael Morsley on SBS television last weekIntroduces ‘everyday’ life experience that links to the course content well I realised that what we know about the human body changes all the time and to be at the forefront of my field I would have to commit to learning all the time. It also seems to me, that although knowledge about drugs is important, the human aspect is also really important. I think I’ve just realised that I will be working with vulnerable people. People who are sick, or in pain or suffering. This means I need to have the interpersonal skills to match the knowledge that I might have too.The style is relatively informal, yet still uses full grammatical sentences I have decided to get a part-time job in a pharmacy over the summer break.Shows engagement by coming up with an action plan that allows for continual learning I think it would help prepare me for future placements, which won’t begin until next year, but which I’m already nervous about!

Seven star pharmacist concept by World Health Organisation

Language for reflective writing

Writing for reflection is usually not as formal nor academic as writing an essay or report. Nevertheless, it should still follow the rules of good writing and some academic conventions such as referencing any source material you may draw from.

You may find that the key difference you experience as a reflective writer is the space to write more subjectively than you’re used to in your academic work. That means, you can use the pronoun ‘I’ or ‘we’ and most importantly, you are encouraged to articulate and engage  with your feelings! This is useful if you are trying to deal with conflicting emotions that you may encounter in your learning or in your professional development (for example, when you’re on placement at a pharmacy or hospital).


Vocabulary

Below is some vocabulary that you may find useful when it comes to writing for reflection. Please do not limit yourself to this list. You should add items to this list of useful words as you develop.

For me the (most) (Adjectives) (Nouns) (Verbs)
meaningful aspect(s)  
significant element(s) was/were
important issue(s)  
useful idea(s)  
key experience(s)  
  learning arose from
happened when
resulted from

How to write about your experiences

Read the student's reflections below. Click the information icons to see how language is used in reflective writing.


Tips for developing reflective practice

The best reflective learners and practitioners are constantly engaged in the processes described above. The act of becoming reflective is a daily practice and involves making time to think about the experiences one has had. Of course, you may need to revisit a single experience many times to "figure  it  out"  or gain a deeper understanding of it.

Writing about your experiences should help you achieve this. A journal, diary or notebook might help establish the habit and provide you with valuable information when it comes to writing down these insights for a future assignment.


Questions

Below are some questions suggested by Holm and Stephenson (1994) designed to prompt deeper reflection:

  • What was my role in the situation?
  • Did I feel comfortable or uncomfortable? Why?
  • What actions did I take, if any?
  • How did I and others act?
  • Was it appropriate?Why/ why not?
  • How could the situation be improved in the future?
  • Have I learnt anything new about myself?
  • How has it changed my way of thinking?
  • What theory or knowledge can I apply to the situation?
  • What bigger issues arise from the event or experience?
  • What do I think about the broader issues?

References

Australian Commission on Safety and Quality in Health Care. (2013). Literature Review: Medication Safety in Australia. Available from https://safetyandquality.gov.au/wp-content/uploads/2014/02/Literature-Review-Medication-Safety-in-Australia-2013.pdf

Gibbs, G. (1988). Learning by doing: a guide to teaching and learning methods. Oxford: Further Educational Unit, Oxford Polytechnic.

Holm, D. & Stephenson, S. (1994) Reflection- A Student’s Perspective. In Palmer, A., Burns, S. & Bulman, C. (eds) Reflective Practice in Nursing: the growth of the professional practitioner (pp. 53-62). Oxford: Blackwell Scientific Publication.

IpAC Unit. (n.d.). Interprofessional learning through simulation, Reflective practice: a tool to enhance professional practice, Edith Cowan University. Retrieved from https://www.ecu.edu.au/__data/assets/pdf_file/0011/376958/User-Manual-Reflective-Practice-FINAL.pdf

Mamede, S., Schmidt, H., & Rikers, R. (2006). Diagnostic errors and reflective practice in medicine. Journal of Evaluation in Clinical Practice, 13(5), 138-145.

Thamby, S.A.& Subramani, P. (2014). Seven star pharmacist concept by World Health Organisation [editorial] in Journal of Young Pharmacists, 16(2),1-3.

World Health Organization. (2007). WHO launches ‘nine patient safety solutions'. Available from http://www.who.int/patientsafety/events/07/02_05_2007/en/