Reflecting on reflections

Three years on from the Optometry Board of Australia’s (OBA) changes to professional development registration standard, Optometry Australia’s Policy & Standards advisor Cassandra Haines reflects on how this change has affected members and how to get the most benefit from the current model.

2020 heralded a series of changes to the OBA’s continuing professional development registration standard, and as part of these changes, optometrists are required to maintain a portfolio that includes reflections on our learning and how we expect it to improve patient outcomes. Similar, and often more rigorous, changes have been implemented across the 15 National Boards covering the health professions in Australia, most recently by the Medical Board of Australia (MBA).

So, in our third year since the changes were implemented, let’s reflect on reflection.

Is reflection effective learning? The evidence on reflective practice

The AHPRA documentation refers to studies commissioned or conducted by AHPRA in 2012, 2015 and 2017¹, which formed the evidence base for the changes to the CPD registration standard for optometrists. However, reflection on practice is not a new concept; it has been embedded in medical education to help students learn from clinical experiences, curricula content and community interaction for over a century. Outlined in John Dewey’s 1910 book “How We Think”,² reflection is summarised as a ‘meaning-making process that moves a learner from one experience into the next with deeper understanding….requir[ing] attitudes that value the personal and intellectual growth of oneself’.³

Teaching, or content, alone is simply a catalyst for learning; the learner must engage to make meaningful gains towards intended learning objectives. Webinars framed in an approachable way for clinical practice, for instance, can provide an excellent source of information delivery, but without active engagement from the learner, the learning potential is limited. Reflecting on how the information can be ingrained into one’s daily practices bridges the theory-practice gap and enables the learner to change and develop professionally.⁴

David Kolb published theories of effective self-guided learning models in 1984, of which reflection is a key component. He proposes that reflection allows us to grasp abstract concepts and truly consider how we are going to incorporate new information into everyday practice.⁶ The abstract thinking can become concrete as we experiment with new elements of our practice, such as try a new treatment, look for signs or symptoms of a condition, or change the way we take a history.

Ann Webber discusses in the OBA 2020 video on changes to CPD that reflection ‘is a time to think about what you’ve learned, and how that can be applied to your clinical practice’, and this is key. With an increase in the availability of remote learning options, such as webinars, it’s easy to feel distracted or disengaged and only just scratch the surface of an engaging or effective learning practice. Without participating in a reflective learning-cycle process, those important updates to treatments or improvements in your skills won’t be carried forward to your patient encounters.

So, what should I include in my reflection to make the most of my learning experience?

I feel Darryl Guest answered this question best in an Optometry Australia 2022 article on “Tools and Resources to Support your Learning“: ‘Reflections are important because they demonstrate whether the CPD activity has in fact changed practice behaviour for the better. When you can evaluate and answer this question, you show a level of sophistication. Reflections don’t have to be pages and pages; it’s the insightfulness that matters, not the length.’

The OBA has provided question prompts that can assist you in structuring a reflection and what to include (see table 1), but these are just prompts, not mandatory questions to answer.

I personally find that post-, or even during, webinars, I like to think of things I have learned, and consider how I might then be able to incorporate this into the next time I see a patient with that condition.

Keeping up with the requirements of the CPD registration standard in addition to all of life’s other pressures can be tricky, but it’s a requirement of my practice, so I try to engage to make my learning time as meaningful as possible. With medical advances and new technology rapidly changing the way we practice, something clearly observable even for me even as an early career optometrist, I fear the minute I think I have nothing left to learn I will surely be an ineffective practitioner.

Do I have to reflect?

Reflection is strictly defined in our AHPRA registration as a key element of our competency to practice as optometrists. Optometry Australia’s learning plan tools and resources allow you to record your CPD activities and reflections. These reflections are solely to support your learning and are not routinely read by Optometry Australia; if audited, you can download a report of your CPD activities, including your reflections, and submit that to the OBA. If the process of being audited seems daunting, my colleagues on the optometry advisor help desk can walk any members through the process.

Written by Cassandra Haines, Policy & Standards Advisor, Optometry Australia

 

References

1. Optometry Board of Australia. Summary of research to inform registration standards reviews [internet]. Canberra (AU): AHPRA; 2019 [updated 2019; cited 2023 April 16]. Avaialble from https://www.optometryboard.gov.au/Policies-Codes-Guidelines.aspx .
2. Dewey J. How We Think: Dover Publications; 1997.
3. Rodgers C. Defining Reflection: Another Look at John Dewey and Reflective Thinking. Teachers College Record – TEACH COLL REC. 2002;104:842-66.
4. Kaufman DM, Mann KV. Teaching and Learning in Medical Education: How Theory can Inform Practice. Understanding Medical Education2010. p. 16-36.
5. Mukhalalati BA, Taylor A. Adult Learning Theories in Context: A Quick Guide for Healthcare Professional Educators. J Med Educ Curric Dev. 2019;6:2382120519840332.
6. Hong L, Lei J, Shu-hong G, Bruce C. The Relationship of Kolb Learning Styles, Online Learning Behaviors and Learning Outcomes. Journal of Educational Technology & Society. 2007;10(4):187-96.
7. Chan LK, Pawlina W. Teaching Anatomy A Practical Guide: A Practical Guide 2020.