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Critically Reflective Practice, Brookfield, Stephen. J Continuing Education in the Health Professions 1998; 18: 197-205 Reviewed by Larrie Greenberg, George Washington University


Critically Reflective Practice, Brookfield, Stephen. J Continuing Education in the Health Professions 1998; 18: 197-205

Reviewed by Larrie Greenberg, George Washington University

As practitioners, we often lose sight of one of the major purposes of CME; namely, to translate cognition into practice. This change process results in better care for our patients and better education for our learners. The article I chose to review has done just that for me; i.e., it has given me a more organized overview of my educational efforts. That is why I chose to share this article with my COMSEP colleagues.

Brookfield defines critically reflective practice as ‘the process of inquiry involving practitioners in trying to discover, and research, the assumptions that frame how they work.' Reflective practitioners review these assumptions by seeing practice through 4 lenses: 1) those of their own anecdotal, rich life experiences; 2) those of their learners; 3) those of their colleagues; and 4) those of the literature. Assessing practice without considering all four lenses is incomplete, in my estimation. Viewing what we do through these lenses allows us to assess who we are and how we come across to others.

Let me briefly summarize each of the lenses. The first, one's autobiography, allows us to reflect how it was for us as learners and to use that information as we engage learners. Our memories as learners of what didn't go well for us are most likely going to lead to better connections with learners whom we engage.

The second, the lenses of our learners, allows us to view the world like we haven't viewed it previously. If our learners are honest, we can learn a great deal about ourselves. This only happens in a trusting environment.

The lens reflecting our colleagues' experiences helps us learn others' perceptions of why things happen the way they do. Talking about problems in common with suggested solutions is what COMSEP is all about; i.e., a collaborative and not competitive environment so that all of our students benefit.

Finally, the fourth lens is the ‘best practice' or evidence-based literature. When we combine the other lenses with what is documented in the literature, we gain added credibility with our colleagues who are skeptical about medical education.

As a way to evaluate critical reflection, Brookfield suggests asking 5 questions to our learners:

  • At what moment in this learning experience were you most engaged as a learner?

  • At what moment in this learning experience were you most distanced as a learner?

  • What action that anyone on the team took was most affirming or helpful?

  • What action that anyone on the team took was most confusing?

  • What surprised you most about the class (or rounds, clinic experience) this week (month, day)?

(These 5 questions could really help improve our teaching, I wonder if this would be a better form to have learner's fill out - to provide feedback to teachers. Would you use these 5 questions in an evaluation/feedback form for teachers? Steve Miller, MD)

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