Library resource guides: ANZCA & FPM CPD Program resources: Critical reflection

Guide index

Critical reflection

Use a series of questions to review (see questions to use as prompts for critical reflection)

Your practice (practice reflection), or
Your current health and wellbeing (Own health and wellbeing reflection) to develop an Action plan or Personal Wellbeing plan.

After completing an annual structured conversation/critical appraisal, either participant may choose to undertake a critical reflection activity to determine how to incorporate feedback received or reflection on the experience of providing feedback into practice improvement.
After completing a multi-source feedback (MsF), patient experience survey (PES) or peer review of practice you may choose to undertake a critical reflection activity to develop a plan for practice change.
After competing a peer review of educational practice, either participant may choose to undertake an individual critical reflection activity to determine how to incorporate feedback received or reflect on the experience and providing feedback into practice improvement.
Individual participants in a peer support group may choose to undertake a critical reflection activity and reflect on the matters discussed at the peer support group.
Following an analysing healthcare outcomes meeting, AHO attendees may choose to undertake an individual critical reflection activity.
After completing a clinical audit or practice audit (clinical support) you may choose to undertake a critical reflection activity on what went well/not so well or what would you do differently in a future audit?
After completing a quality improvement project you may choose to undertake a critical reflection activity on what went well/not so well or what would you do differently in a future QI project/cycle?
After a work event - such as a near miss or conflict situation - you may choose to undertake a critical reflection activity and develop a plan for practice change.
After completing a workshop - or other learning experience - you may choose to undertake a critical reflection activity and develop a plan for practice change.
Consider a change to an aspect of your current work role - such as a career transition - and undertake a critical reflection activity and develop a plan for practice change.
Note: Several wellbeing reflection models, including two developed by and for Māori, are in the guideline.

See also: The CPD for clinical support roles guide for numerous critical reflection examples for fellows/CPD participants without direct patient care

CPD Value: CPD participants may claim this under the Practice evaluation - reviewing performance Critical reflection activity.

External resources

The Lime Network: The Critical Reflection Tool
The CRT is a dynamic document that addresses broad contextual issues that impact on Indigenous health curriculum development. The CRT can be understood as a management tool for faculties and schools where responsibility for Indigenous health is shared across the organisation.

This resource supports medical students, doctors in training and doctors engaging in revalidation on how to reflect as part of their practice. It has been developed jointly by the Academy of Medical Royal Colleges (UK), the UK Conference of Postgraduate Medical Deans (COPMeD), the General Medical Council (GMC UK), and the Medical Schools Council (UK).

The Reflective Practitioner: Guidance for Doctors and Medical Students by Developed by the Academy of Medical Royal Colleges, the UK Conference of Postgraduate Medical Deans, the General Medical Council, and the Medical Schools Council.
Publication Date: 2021

DunnGalvin A, Cooper JB, Shorten G, Blum RH. Applied reflective practice in medicine and anaesthesiology. Br J Anaesth. 2019 May;122(5):536-541. Editorial
Gayathri B, Vedavyas R, Sharanya P, Karthik K. Effectiveness of reflective learning in skill-based teaching among postgraduate anesthesia students: An outcome-based study using video annotation tool. Med J Armed Forces India. 2021 Feb;77(Suppl 1):S202-S20 Keywords: Anaesthesia; Reflective learning; Skill; Video annotation.
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Abstract
Background: Medical education all over the world is undergoing paradigm shift. Video recording of student's performance and self-annotation are emerging as valuable tools for self-directed learning among students. Study was conducted to find the effectiveness of video annotation tool in reflective learning. The learning outcome was to find whether the video annotation is helping in critical reflection and improving the perception of students on guideline compliance while learning the technique of epidural insertion.

Methods: In phase 1; following pretest, the students were made to observe three epidural insertions and perform one epidural insertion. In phase 2; following posttest, two faculty members analyzed the depth of reflection using the Reflection Rubric. Students perception was recorded using the Reflective practice survey.

Results: The average score of students after pretest was 76%. The posttest score was 84% (p value 0.003). In depth analysis using the reflection rubric we found 52.38% of the total reflections had a score of two, showing they were at introspection level only. 25.71% of reflections were having score of one, showing that they were just habitual answers. Only 21.9% of the total reflections had score of three; and none of them were critically reflecting. All the students (18/18) agreed that recording the session was meaningful.

Conclusion: The art of critical reflection is learnt by relentless effort. Yet it helps the students to reflect on the whole process introspecting and understanding what went wrong. Video annotation turns out to be a valuable tool in reflective learning.
Goy RWL, Lee JSE, Ithnin F, Sng BL. Current state of reflective learning in anaesthesiology residents: a call for 'reflection-on-action' training in Singapore. Singapore Med J. 2022 Jun;63(6):319-324. Keywords: anaesthesia; challenges; education; reflective learning.
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Abstract
Introduction: Reflective learning is the cognitive process whereby information from new experiences is integrated into existing knowledge structures and mental models. In our complex healthcare system, reflective learning (specifically 'reflection on action') is important for postgraduate learners. We observed that our anaesthesiology residents were not building on their competence through deliberate experiential and reflective practice. This qualitative study explored the current state and challenges of reflective learning in anaesthesia training in Singapore.

Methods: This study was conducted at KK Women's and Children's Hospital, Singapore, from 1 January 2018 to 31 October 2018. A semi-structured interview format was used in focus groups. Information collection continued until data saturation was reached. The interviews were coded and analysed, and themes were identified. Seven focus group interviews involving 19 participants were conducted.

Results: Reflective learning was found to be poor. It was of concern that the stimuli for reflection and reflective learning emerged from medical errors, critical incidents and poor patient outcomes. Challenges identified were: (a) lack of an experiential learning framework; (b) need for reflective training; (c) quality of experiential triggers; (d) clinical pressures; and (e) poor learner articulation and feedback. We described some strategies to frame, teach and stimulate reflective learning.

Conclusion: This study described the state and challenges of reflective learning in anaesthesia training. We advocate the implementation of reflective training strategies in postgraduate training programmes in Singapore. Research is warranted to integrate patient feedback and outcomes into reflective practice.
Patel S. Role of Reflection in Education and Practice in Anaesthesia: Purpose, Process, Pitfalls and Promotion. International Medical Education. 2023; 2(4):262-275. Keywords: anesthesia; anesthesiologists; reflection; professionalism; education; reflective learning
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Abstract
Reflection facilitates medical education and professional practice by enhancing active and deep learning from experiences. The reflection period is a time for self-awareness and self-assessment of learning events and experiences to improve future experiences (e.g., skill acquisition). Advocates for reflection suggest that reflective practice has the power to enhance professionalism as it provides an opportunity for critical thinking. It can be of variable length and depth; however, the process should be explorative and factual. Critical reflection is a broader and in-depth consideration of historical, cultural and political contexts to challenge and change one’s or a group’s assumptions and actions. Although the process is beneficial to achieving the intended learning objectives, its impact on educational and clinical outcomes remains unclear in anaesthesia. The usefulness of reflection in the learning process or work practices varies depending on personal, professional and organisational factors. Several models and approaches are described to facilitate the reflection process. However, assessment of reflection within the curriculum boundaries and for workplace-based learning activities is complex and challenging due to the lack of validated tools for different types of reflection. PubMed and Google Scholar were searched for articles on reflection and its application in anaesthesia. The anaesthesia literature has minimal information on the theoretical and research aspects of reflective learning and teaching. This review aims to outline the purpose of reflection, discuss the utilisation of commonly used reflection models and underline the intricacy of reflection in anaesthesia learning, teaching and practice. This article highlights crucial factors which may foster or hinder reflection and its effectiveness in achieving meaningful intended outcomes.
Shafer SL. Critical thinking in anesthesia: eighth Honorary FAER Research Lecture. Anesthesiology. 2009 Apr;110(4):729-37. Topics: logic, bible, impedance threshold device, internet, peer review

CPD Value: CPD participants may claim this under Knowledge and skills journal reading activity.

Learn@ANZCA

Use the links below to access additional support resources contained on the Learn@ANZCA platform.

Note: Resources located in Learn@ANZCA require that you first register before accessing.

Critical Incident Debriefing [Learn@ANZCA]
The module and podcasts have been developed for anaesthetists who are wanting to learn the what, why and how of running a debrief and for trainees who should know what to expect when being part of a debrief.

CPD Note: CPD participants will automatically have this activity populated in the CPD portal under Knowledge and skills wellbeing education sessions activity.

ANZCA & FPM resources

CPD Activity Guide
This guide contains a list of all the activities associated with the ANZCA and FPM CPD Program, as well as links to associated individual activity guides and forms.
ANZCA and FPM CPD Program: Critical reflection guideline
This guideline assists CPD participants complete the critical reflection activity.
ANZCA and FPM CPD Program: Critical reflection – Practice reflection template
This template is for personal use only. Please do not upload it to the ANZCA and FPM CPD portfolio.
ANZCA and FPM CPD Program: Critical reflection CPD verification form
Use this CPD verification form once you have completed your critical reflection.
ANZCA: Critical Incident Debriefing (CID) Toolkit
Our Critical Incident Debriefing Toolkit provides a comprehensive, evidence-based resource on what are critical incidents, how to provide support and a hot debrief following a critical incident. It can be read in sections or as a whole.

Library resources

Critical Reflection in Practice: Generating Knowledge for Care by Gary Rolfe; Dawn Freshwater The terms 'critical reflection' and 'reflective practice' are at the heart of modern healthcare. But what do they really mean? Building on its ground-breaking predecessor, entitled Critical Reflection for Nursing and the Helping Professions, this heavily revised second edition analyses and explores reflection. It presents a structured method that will enable you to both challenge and develop your own practice. This book is the essential guide to critical reflection for all students, academics and practitioners. New to this Edition: - Expanded to meet the needs of all healthcare practitioners - Redefines self-evaluation as a catalyst for personal and professional development - Fully updated edition of a respected book: now includes a chapter on the rise of professional knowledge
ISBN: 9780230209060
Publication Date: 2010-11-03