Reflective commentaries are essential companion pieces and push participants to more

deeply examine their practice, growth and change. It promotes independent learning

and offers a nonthreatening forum for analyzing one’s own practice. Reflection helps

each participant learn what is expected of them and helps them to become active

participants in determining the criteria for success in clinical activity. It allows

each participant to display their growing strengths, rather then simply exposing their

weaknesses. It promotes ownership of learning, encouraging participants to use and

shape knowledge as they see fit.

With reflection, the portfolio becomes an episode of learning. Without reflection, it may

be little more than an exercise in amassing papers. Reflection provides participants an

opportunity to summarize the documents in the portfolio and trace how the documents

and the training activity have captured and portrayed growth, integration and learning.

How to write a reflection:

Reflection is thinking and wondering, either individually or with colleagues, of moments that touch us, of decisions made, and of the realization that something needs to change. The following guide questions may help refine the process of reflection.

• What happened?
  • Begin by simply writing down what happened without jumping to analysis or judgment. This involves creating a brief narrative of the portfolio documents and of the training activity. Only then can the second step be addressed.
• Why did it happen?
  • Attempting to understand why an event happened the way it did is the beginning of reflection. Search the context within which the event occurred for explanations. Consider underlying structures within a clinical that may be part of the event and examine deeply held values. More questions than answers may surface. Answer the questions in a way that make sense to you. Reflection often stops here; however, more in-depth searching is needed. The search for meaning is step three.
• What might it mean?
  • Reflection is a way to find meaning. It is only through reflection that we recognize we had choices, that we could have done something differently. Recognizing that there is no one answer is an important step. Explore possible meanings rather than determine the meaning. But understanding by itself does not create changes in classroom practice. The last step involves holding our practices to the light of those new understandings.
• What are the implications of my practice?
  • Consider how your practice might change given any new understandings that have emerged from the earlier steps. What new insights occurred? This is an entry into rethinking, changing practice and what we do with our patients.

Growth and Change:

The growth and changes may be reflected in the learning portfolio by the following types

of evidence:

• Changes in the knowledge base:
  • Pre and post clinical notes.
• Changes in skill level and use:
  • Self-assessment checklist, interviews, observations, clinical supervision or coaching discussion notes of clinicians using the skills or practices
• Changes in attitudes:
  • Immediate measurements of satisfaction is not enough. Interview and survey, meeting minutes, observation and changing character of informal discussions among participants, building sense of community and ownership, increasing sense of efficacy and confidence should also be considered.
• Changes in patients:
  • Information on patients progress related to the new practices and techniques
    • being learned. Formal assessment, observations, and interviews