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CIPPET Study Support: Reflective models and language

This guide will help you find resources, understand academic and reflective writing and help you prepare for your coursework and exams

Introduction

Reflective thinking is essential for success in unpredictable and complex situations such as working in healthcare.  Reflective thinking helps you to:

  • Develop a questioning attitude and new perspectives
  • Identify areas for change and improvement
  • Respond effectively to new challenges
  • Generalise and apply what you have learned from one situation to other situations

You will be asked to think reflectively when completing assignments that draw on your experience in the workplace, or when considering your own skills and experience and where you might need to develop.  Being able to think reflectively is an important transferrable skill that will help you to showcase your learning to the programme team, but also provide the skill of being a reflective healthcare practitioner.

Reflective writing involves an exploration and explanation of an event. It may feel particularly difficult and more challenging than other forms of academic writing as it involves thinking and writing about anxieties and errors as well as successes in your interactions with an individual or when carrying out a practical task. Try to stand back from the situation and be as objective as possible. Although you are writing about your own experiences and feelings, you need to be as rigorous and thorough as you would be for any other assignment.

Follow the guidelines for your module. There is likely to be a word limit: you cannot write about everything, so select what will illustrate your discussion best. Remember that most of the marks awarded for your work are likely to be for the reflective insights and not for the description of events, so keep your descriptions brief and to the point.

Reflective writing

CIPPET and assessed reflection

Reflective writing will take many forms throughout the CIPPET modules and programmes.  You should refer to the assessment criteria for the piece of coursework to identify the expectations.  Some coursework will be a specific reflective essay or you might need to reflect on a topic/event/experience as a much smaller part of a piece of coursework.  Do not forget in professional exams you will also be required to reflect verbally on your learning, experiences and/or performance.

Approaching reflective writing

It is a common misconception that reflective writing is describing an event, it requires much more depth and largely focusses on the analysis of the event/experience/learning/topic.  There are some tips in the box on the right about the questions you can ask yourself which encourage reflective thinking.  Being about to reflect on your own practice is a key skill as a competent healthcare professional - analysing how you react to situations and the impact they have had on your learning and development are the key aims.  When done well, reflective writing can help develop a better understanding of your strengths and weaknesses, challenge your own assumptions and biases to provide better patient care, deal with you own anxieties, support a learning plan and allow you to understand your own values and beliefs.

Topics for reflective writing

There are too many topics to list here, but almost any healthcare related experience can be used for reflective writing.  Common examples include:

  • Analysis of experiences in your workplace with a patient and/or another healthcare professional
  • Retrospective analysis of an incident in which you were involved
  • Analysis of a past experience that relates to your current situation studying for this module
  • Analysis of learning you have undertaken related to the module

Reflective model

Gibbs' reflective cycle

This model was developed in the 1980's by Graham Gibbs and is widely used because of the clear framework and depth of reflection are well suited to coursework tasks.  It has six stages:

  1. Description - 
  2. Feelings - 
  3. Evaluation - 
  4. Analysis - 
  5. Conclusion - 
  6. Action plan -

You can find more information about this model here: https://libguides.reading.ac.uk/ld.php?content_id=32969395

However, this model has some disadvantages in that it is introspective and tends to focus on the writer. In some postgraduate study it it necessary to demonstrate critical analysis and reflexive skills in your reflective essay writing. You need to show how you are developing new perspectives and to do this you will need to refer to the available literature. So we have adapted Gibbs by using the work of Atkins and Murphy (1993) to ensure you take a robust academic approach: 

  1. Description - a simple description of the incident or case
  2. Feelings - use reflexivity to consider how you felt about the situation 
  3. Evaluation - use criticality to decide the main focus points and identify the main concepts to be analysed (with reference to the future) 
  4. Analysis - analyse each concept using the relevant literature.  (e.g. Why did the problem arise ? What wider systems were involved? What are the main concepts to be considered? What does the evidence tell us about the impact of such systems problems and concepts? 
  5. Conclusion - this is where new perspectives can be consolidated. 
  6. Action plan - what will need to happen now? This plan will need to specify your actions in the change process. .

Make sure that you read the assignment brief carefully and check with the course handbook to understand what is expected for each individual assignment. If you are unsure, please ask your tutor. . 

Getting the language right

How to write reflectively

  • This will be one of the only assessments in which you can use the first person, critiquing your own practice cannot be done in the third person - this does not mean it should be written informally
  • You may find that you write your account in a mixture of tenses, again this is unusual for coursework but describing the situation in the past tense and analysing it in the present tense will allow the writing to flow more structurally
  • Where you describe future events think about how you use the words couldwould, might and will - what is the tense and how does that affect your hypothetical arguments?
  • If you are writing a fully reflective account, rather than part of a bigger piece of work, ensure your description is less than a third of the total length - you should concisely describe the situation for context but this is not a case study where each small detail is important
  • Do not be judgemental - you must remain professional in how you describe and analyse events

Getting the language right

As a large proportion of your reflective account is based on your own experience, it is normally appropriate to use the first person ('I'). However, most assignments containing reflective writing will also include academic writing. You are therefore likely to need to write both in the first person ("I felt…") and in the third person ("Smith (2009) proposes that …"). Identify which parts of your experience you are being asked to reflect on and use this as a guide to when to use the first person.

You will produce a balance by weaving together sections of 'I thought… 'I felt,…' and the relevant evidence in the same section or paragraph. This is more effective than having a section which deals with the evidence and a separate section dealing with your experiences.

Try to avoid emotive or subjective terms. Even though you are drawing on your experiences (and they may well have been emotional), you are trying to communicate these to your reader in an academic style. This means using descriptions that everyone would understand in the same way. So rather than writing, "The patient was very unhappy at the start of the session", it might be better to write, "The patient was visibly distressed", or "The patient reported that he was very unhappy". This shows that you are aware that the patient's understanding of 'unhappiness' may be quite different from yours or your reader's.  

When writing about your reflections use the past tense as you are referring to a particular moment (I felt…). When referring to theory use the present tense as the ideas are still current (Smith proposes that...).

Understanding description, analysis, criticism and critique

‚ÄčTry to move beyond being critical and think about being analytical - use your feelings to ask questions and challenge assumptions, where you can then draw in evidence from the module this will move towards excellence in reflection

Read the example statements below and think about how they demonstrate moving from descriptive to analytical to self-reflective:

Example 1: I identified a prescribing error and asked the doctor to re-prescribe it.  They stated I was wrong and the prescription was correct.  I checked the BNF and they were right as the BNF I had was out of date.  The literature states that 50% of these errors are due to incorrect resources (Author, 0000).

Example 2: I identified a prescribing error but when I asked the doctor to re-prescribe the medicine,it transpired I was wrong and the original prescription was correct.  I was embarrassed that I had not correctly reviewed the prescription and need to remember to use the most up to date reference sources in my practice.  I have looked at the literature on prescribing errors and was surprised that 50% of errors are due to incorrect resources (Author, 0000)

Example 3: I identified a prescribing error but when I asked the doctor to re-prescribe the medicine, it transpired I was wrong and the original prescription was correct.  I was embarrassed that I had made such an error and the doctor appeared frustrated that I had wasted their time.  It is important that all prescriptions are checked before administration and it is key in my role to do so thoroughly.  I have spent a lot of time building a relationship with the multi-disciplinary team to show my advancing knowledge and I feel this has set back their confidence in me.  It is my responsibility to ensure I have the correct resources to do my job well and on this occasion I felt under pressure to give a quick answer.  This made me reflect on how external factors can influence the quality of patient care.  In analysing prescribing errors I was surprised that 50% of errors were due to incorrect references but following this experience, I understand how they occur and I must safeguard my practice to prevent it recurring (Author, 0000).

Example 4I identified a prescribing error but when I asked the doctor to re-prescribe the medicine, it transpired I was wrong and the original prescription was correct.  I was embarrassed that I had made such an error and the doctor appeared frustrated that I had wasted their time. It is important that all prescriptions are checked before administration and it is key in my role to do so thoroughly. I have spent a lot of time building a relationship with the multi-disciplinary team to show my advancing knowledge and I feel this has set back their confidence in me. This made me think about prescribing errors and how 50% of errors are due to incorrect or out of date information sources (Author, 0000). However, although I recognise that it was part of my role responsibility to ensure I use up to date resources (Author, 0000), I began to reflect on team relationships and how they impact team function and support. Author (0000) explored the hierarchy of MDT membership and discovered that certain professions tend to regard their positions as more senior to others within any MDT. This impacted the ability of team members to questions the actions of other team members. This positional hierarchy seemed to be based on perceived value of qualification; medical qualification being most often seen as the most valuable. The concept of professional value is seen in the work of Author (0000) who found that historical professional power had a significant impact on decision making within MDTs, with particular regard to accepting questions on clinical decisions from other team members. I realised that my own position within the team could be perceived, by some, as being less valuable in a prescribing setting. I have decided to speak to my manager and ask her to consider two things: firstly how we can make sure all the team have access to the most up to date information and secondly, how we offer and react to constructive criticism in the clinical setting (Author, 0000).