By Nicole Hasoon, Amie Smith, Daisy Ridsdill Smith, Khalil Jiwa, Helen Watson, Helen Rogers and Faith Campbell

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What is reflection?

Reflection has been defined as the '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 tends'.1 It provides the foundation of meaningful learning whereby we can analyse our own experiences in order to actively challenge pre-existing beliefs, assumptions and behaviours.

Why should dental students reflect?

Reflection is a widely established tool used in dentistry. Reflective practice allows us to explore significant events and can help us maintain or improve the way we conduct ourselves- ensuring the highest quality patient care. It helps shape undergraduate students as they start their careers. However, as we know from Continuing Professional Development (CPD), learning is a life-long process and does not stop after graduating from university. Regular reflection is paramount for all qualified dental practitioners - from the general dental practitioner to the hospital consultant. Due to the well-evidenced importance of reflection, the General Dental Council (GDC) introduced mandatory demonstration of reflection for all its registrants in 2018.2

Attention should be focused on the most significant and relevant experiences. Situations worthy of reflection will be different for everyone.

Top tips on reflection

1. Learn how to reflect

Reflection is not an innate skill. Initially, it may feel like an unnatural and arduous task because it is new to us. Alike learning to play the piano, it should be taught, learnt and practised. When learning to reflect, using a 'Reflection model' can help to structure and organise your thoughts. Several models have been suggested within literature. For example, Gibbs' Reflective cycle, developed in 1998, is well-known and has become a mainstay within health and social care. The Gibbs' model consists of six prompting questions which have been designed to facilitate deep contemplation. In 2015, a new model was described.3 The mnemonic REFLECT was employed to make the stages easier to remember. Table 1 shows the framework of these models. Many models have similar stages to the reflection so it is often down to personal preference when choosing which one to use. Try to avoid models which over-simplify the process as you may not be able to tackle all the relevant issues.

Table 1 Summary of reflective approaches from two models
Full size table

Attention should be focused on the most significant and relevant experiences. Situations worthy of reflection will be different for everyone. Select the bad and the good experiences. Fundamentally, reflective practice should be structured by questions… and possibly even leaving you with more. Understand that reflection involves acknowledging the connections between the experience and your thoughts and feelings.

2. Make time to reflect

In order to reflect, we need to find and choose an appropriate time for it. Having a lack of time is one of the main barriers to reflection. However, the best learners will set aside protected quiet time for focused practice. Take the time to determine when there is space in your schedule for it, whether that be daily or weekly. Each session doesn't have to be long if you make it short but regular. Many students try to hastily attempt reflection at the time or just after the situation has occurred and this can lead to superficial thoughts. In order to allow time for deep contemplation, an arbitrary time frame should pass between the event taking place and when the reflection takes place. It is also helpful as it allows time for rest and rejuvenation.

Each session doesn't have to be long if you make it short but regular. Many students try to hastily attempt reflection at the time or just after the situation has occurred and this can lead to superficial thoughts.

3. Find the right method for you

The large majority of reflective practice is illustrated through written form. Recent literature has highlighted the absence of evidence to support any particular method of recording reflection.4 Undergraduate students are often assigned reflective essays to write and this can be resented as it is seen as extra coursework. As dentistry is traditionally a practical course, some students can also find essay writing difficult. This could be tackled by signing up for essay writing skill sessions offered at university. Writing prompts can also be used to help provide the framework of written pieces.5 See Figure 1 for a mind map of prompts.

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Fig. 1 A mind map of prompts to help facilitate reflective practice

As a profession, we may begin to see a shift away from the traditional methods of recording reflection and begin to explore different options. For example: creative methods could include diagrams for visual learners or even through song for the musically inclined students.

Collective reflective practice is already a common activity done in many health care organisations. The advantages of group reflection are that everyone collaborates together by sharing their thoughts. We are able to help each other thoroughly unpack situations by discussing several different lines of enquiry. Where appropriate, it is very helpful to utilise collective reflection as well as doing so as an individual.

Conclusion

Reflection is one of the most important skills for development in our professional and personal lives. It is often overlooked and under prioritised. Try not to think of it as part of a tick box assignment but make it a habitual exercise. Reflection can help bridge the gap between theory and practice to consolidate what is learnt in formal education. There is always room for improvement with clinical practice, no matter what stage of your career. Reflection forces clinicians to be critical and challenge their patterns and behaviours. It has also been shown to improve self-awareness which can lead to increased confidence, integrity and communication. Through using these tips and meaningful practice of the skill, the act of reflection will start to feel easier and, more importantly, you will become a well-rounded dental professional.