My presentation will report the initial findings from a study aiming to explore in rich detail the nature of reflection on critical incidents as demonstrated by student Healthcare Science (Respiratory and Sleep Science) practitioners studying at a post 1992 University. The type of incident students choose to make critical together with the level and nature of reflection demonstrated within both written reports and peer discussion will be explored. The Modernising Scientific Careers curriculum introduced by the Department of Health in 2010 requires Healthcare Science (HCS) students to produce reflective reports within a record of clinical competence. The HCS programme includes academic study and clinical work-based placements exposing students to professional practice providing opportunities to gain practical skills. Students are required to engage with reflection throughout their studies. Reflection considered as, ‘… taking our experiences as a starting point for learning … thinking about them in a purposeful way – using reflective processes ‘ (Jasper, 2003, p. 1). Any experience can become a topic for reflection as ‘critical incidents are produced by the way we look at a situation: a critical incident is an interpretation of the significance of an event.’ (Tripp, 2012, p. 8). Students attending the institution within this study are required to regularly reflect on their experiences producing monthly written reflective reports for inclusion within their record of clinical competence, and participate in group discussions to introduce the concept of peer supported reflection. These naturalistically occurring reflective events are the subject of this investigation which forms part of a doctoral enquiry. There are small numbers of students within single cohorts of this specialised area of practice; the findings presented are from one cohort comprising three students. A social constructivist approach was taken as individuals were considered to make sense of their experiences through construction of meanings. Thematic analysis using a constant comparative technique was used to determine the type of incident students considered, level of reflection determined using Kember, et al., (2008) and Johns (2010) framework was used to explore the nature of reflection demonstrated. The preliminary findings may be used to help inform the introduction of reflection to help facilitate the development of reflective skills, and could be transferable to other similar programmes involving work-based clinical professional practice.

1. Professional Context Key Research Questions
The Research Issue
Healthcare Science students are required to
produce reflective journals whilst on clinical
placement to demonstrate:
 Professional progress
 Academic progress
 Improvement in skills of critical analysis
Reflective reports provide insights into how
students perceive themselves as developing
practitioners and how they prepare for
independent practice. These reports are a
personal review illustrating how reflection on
experience may demonstrate development
academically, professionally and personally.
What type of clinical incident do student practitioners
choose as a focus for reflection?
What level of reflection do students demonstrate
within their written reflective reports utilising the
frameworks of Kember et al (2008), Gibbs (1988) and
Johns (2010)
Is there any relationship between level of reflection
(using any framework) and clinical incident type
chosen for the focus of reflection?
Participants
 5 Student Healthcare Science practitioners
 Researcher – Experienced practitioner– intimately
associated with culture under investigation
Initial Results
Clinical
incident
type
Gibbs
Framework
(1988)
Kember et al
Framework
(1999)
Johns
Framework
(2010) – in
progress
Initial Findings Overview:
Focus of reflection Nature of written reflective reports
Student practitioners appear to focus reflection on:
 Clinical events involving patient interaction
 Improving patient experience during clinical events
 Negative / judgemental concerning own actions and
behaviour in practice
 Lack of professional ‘control’?
References
Method and Data Analysis
All current professional guidance advocates the
use of reflective journals to help support
healthcare science students and qualified
practitioners professional development.
Overview of Clinical Incident Type
Four participants:- ‘patient refusing to comply
with medical advice’
One participant:- empathy and emotions in
healthcare
Overview of reflective reports - percentages
for each framework descriptor identified.
Subject
One
Description 14.8% 9.7% 25% 29% 28%
Literature 36.3% 55.8% 20.4% 20.2% 32.9%
Habitual Action 0% 0% 0% 0% 0%
Introspection 10.3% 4.6% 12.1% 11.5% 11.8%
Thoughtful Action 9.4% 5.6% 20.8% 12.6% 5.6%
Content Reflection 9.9% 3.6% 11.3% 11.5% 3.1%
Process Reflection 3.1% 8.2% 7.9% 12.0% 13.0%
Premise
16.1% 12.3% 2.4% 3.3% 6.2%
Reflection
Subject
One
Description 19.3% 5.1% 23.3% 35.5% 22.2%
Literature 16.1% 47.2% 22.1% 3.9% 30.7%
Feelings 6.7% 2.1% 6.3% 11.1% 15.7%
Evaluation 2.7% 12.3% 15.4% 7.7% 14.4%
Pre-analysis 6.7% 4.6% 6.7% 6.% 0%
Analysis 27.3% 13.3% 13.8% 15% 7.8%
Conclusion 17.5% 9.7% 9.5% 15.6% 5.2%
Action Plan 3.6% 5.6% 2.8% 4.4% 3.9%
Reflexive Thoughts
Subject
Two
Subject
Three
Subject
Four
Subject
Five
Kember et al (1999)
Subject
Two
Subject
Three
Subject
Four
Subject
Five
I am finding thematic / iterative qualitative analysis
challenging. Initial analysis clearly demonstrates my
‘scientific’ tendencies as I quantified stages of each
framework as opposed to thematically investigating the
nature of reflection. However, this has provided a useful
starting point with the students reports now ‘chunked’
into more manageable segments for further analysis.
Initial analysis suggests:
 Focus does not impact on level of reflection demonstrated Kember et al (1999)
 Proportion of analysis appears related to conclusion but this does not impact
perceived ability to plan future actions – now need to consider the
appropriateness of planned actions?
 There may be a relationship between thoughtful action and premise reflection
– is this demonstrating an action / cognition preference?
In 2010 the Department of Health launched a
new initiative which changed the delivery of
educational programmes aimed at supporting
scientific careers in the NHS (Modernising
Scientific Careers)
Before Modernising Scientific Careers
 Students employed by NHS Trusts
 Attended University on block release
(8 to 10 weeks per year)
 Student ‘belonged’ to NHS Trust
Now
 Students HEFCE funded
 Attend work-based placements
(50 weeks over 3 years)
 Student ‘belongs' to HEI
Implications?
 Less exposure to clinical environment
 Shift of focus towards academic knowledge?
 Reflection on experience – more important??
 Can we scaffold students’ reflections so that
they are more effectively ‘prepared’ for
independent practice?
Thematic analysis of students reflective reports
produced during undergraduate programme.
Reports scrutinised to determine any emerging
themes surrounding the focus for reflection.
Reflective frameworks applied to consider in more
depth the nature of the reflection demonstrated
Focus for reflection
Patient centred action / behaviour
How to improve patient experience
Negative / judgemental with regard to own
behaviour
Did not include / recognise
Positives – what had gone well
Own professional development
Colleague / wider service related issues
Relationship between academic / theoretical
knowledge and practice
Department of Health, 2010. Modernising Scientific Careers: the UK way forward, London: Department of Health.
Gibbs, G., 1988. Learning by doing: A guide to teaching and learning methods. London: Further Education Unit.
Johns, C., 2010. Guided Reflection: a narrative approach to advancing professional practice. 2nd ed. Oxford: Wiley-Blackwell.
Kember, D. et al., 1999. Determining the level of reflective thinking from student's written journals using a coding scheme based on Mezirow. International Journal of Lifelong Learning, 1(18-30), p. 18..
Gibbs (1988)
And now…………… Review reports using Johns (2010) framing perspectives, more qualitative / thematic analysis, thematic analysis of reflective reports
within areas identified by framework descriptors