Pharmacy Students’ Perspectives on Reflection for Effective Learning During Practicum 

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By: Yucella Liu PharmD, Arun Verma BSc., BSc (Pharm)., ACPR., MSc., PhD and George Pachev PhD

Reflection is an integral part of experiential learning. It can occur during the moment of practice, known as “reflection-in-action,” or after an event, known as “reflection-on-action.”1 Kolb’s learning cycle2, Gibbs’ reflective cycle3, and similar reflection models provide a framework for educators to draw upon when integrating reflective practice into experiential education.

Many programs have implemented reflective activities into rotations to augment meaningful learning experiences.4 These assignments have learning benefits, such as increased self-awareness, improved critical thinking, and better integration of theory into practice.5 Despite this, students often perceive these assignments as “busy work.” However, some students also report initiating reflective processes independently.

Entry-to-Practice PharmD students at the University of British Columbia (UBC) must complete a reflection assignment during practicum. It is in the form of “self-assessment,” where students evaluate their own performance and compare it to competency outcomes. Students respond to prompts related to their development of knowledge, skills, and professionalism. Based on the self-assessment, students develop an improvement action plan. Preceptors will review the reflection and provide feedback. In addition to the required reflections, students are encouraged to reflect spontaneously in any form, such as internal thoughts, journaling, or conversations with peers. These self-initiated reflections are not required as part of coursework.

To better appreciate pharmacy students’ perspectives on reflection, UBC PharmD students in years one to four were invited to participate in semi-structured individual or focus group interviews to share instances of reflection during community-based experiential clerkship. The interview questions were focused on the roles of reflection for effective learning. Students were asked to describe how reflection aided learning and explore the differences between the required and self-initiated reflections. The interviews from ten students were recorded, transcribed verbatim, and analyzed for thematic content.

What did the Students Say? 

Student responses from the interviews were centered around three broad themes.

  • Theme 1 of Student Reflections: Differences Between Assigned and Self-Initiated Reflections

Students noted the differences between assigned and self-initiated reflections. With the assignment, students looked at the entire practicum experience and considered learning in a broader context. They assessed learning by comparing it to course objectives rather than specific instances. With self-initiated reflections, on the other hand, students examined individual experiences to evaluate their performance and identify areas of improvement. 

  • “The midpoint and endpoint [reflections] are more summative in nature, but the daily learning is more like specific reflections about events during the day.” (PY2 student)
  • Theme 2 of Student Reflections: Personalization
    Students think self-initiated reflections are more beneficial for individualized learning. Students could choose reflective activities that best suited them, set personal goals, and monitor their learning progress without a set of educational outcomes. Self-initiated reflection demonstrated a sense of ownership in student learning.
  • “You don’t have to think about that whole section in the handbook where it lists all the skills, knowledge, and professional components. You basically reflect on what you find most relevant.” (PY3 student)
  • Theme 3 of Student Reflections: Attitudes Towards Reflection Assignment
    Students reported that the reflection assignment was perceived as redundant to their personal reflections. They spent minimal effort on the assignment instead of reflecting critically. The assignment was viewed as a checkbox to complete practicum requirements.
  • “Your mindset is just completing this assignment … make sure you have stuff written down, even though it might not be exactly what you’re focusing on in your practicum.” (PY2 Student)


Final Thoughts

Reflection is a valuable learning tool for students. The process of reflection enables students to draw meaning from their experiences. It also helps students retain knowledge and transfer learning to other situations.

Students should reflect using various methods, as each kind of reflection has its role in learning. However, faculty places a huge emphasis on reflection assignments. These writing assignments primarily use the “reflection-on-action” model and fail to capture other forms of reflections. On the other hand, self-initiated reflections can allow students to combine the flexibility of different reflections. Ultimately, it is important for students to recognize different reflection types and how to use them effectively for learning. 

What can educators do to engage students in different forms of reflection? 

  • Introduce and demonstrate various reflection models.
  • Encourage students to reflect before, during, and after patient encounters.
  • Make reflection an interactive process. Preceptors can support interactivity by moderating reflective discussions and guiding students in the reflective process. 
  • Invite students to share their learning experiences and reflect with each other.

How do you promote the value of reflection at your institution?

References

  1. Schon DA. The reflective practitioner: How professionals think in action. Routledge. 1992 https://doi.org/10.4324/9781315237473
  2. Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice Hall, 1984.
  3. Gibbs G. Learning by doing: A guide to teaching and learning methods. Further Educational Unit, Oxford Polytechnic, Oxford. 1988.
  4. Deslandes R, Lucas C, Hughes ML, Mantzourani E. Development of a template to facilitate reflection among student pharmacists. Research in Social and Administrative Pharmacy. 2018;14(11):1058-1063. doi:https://doi.org/10.1016/j.sapharm.2017.11.010
  5. Tsingos C, Bosnic-Anticevich S, Smith L. Reflective Practice and Its Implications for Pharmacy Education. American Journal of Pharmaceutical Education. 2014;78(1):18. doi:https://doi.org/10.5688/ajpe78118

Author Bio(s):

Yucella Liu is a recent pharmacy graduate from The University of British Columbia. Her educational scholarship interests include effective learning strategies and experiential education. She enjoys hiking, traveling, and learning new languages in her free time.

Arun Verma is an Associate Professor of Teaching at the Faculty of Pharmaceutical Sciences, University of British Columbia. Educational scholarship interests include transfer of learning, group learning, and assessment. In his free time, Arun enjoys spending time with his three children and watching sports when he can.

George Pachev is Lecturer and Educational Assessment Director in the Faculty of Pharmaceutical Sciences at the University of British Columbia. Educational scholarship interests include educational assessment and measurement, research in problem-solving, reasoning, and curriculum design. In his free time, George enjoys reading, listening to music, or fishing for salmon in British Columbia’s beautiful rivers.


Pulses is a scholarly blog supported by a team of pharmacy education scholars.

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