Reflective Practice in Physical Therapy
Reflective Practice in Physical Therapy
Challenging the status quo to present better options for professional practice
Reflective practice should be an integral part of the physical therapy profession. Reflective practice not only allows for clinicians to evaluate the efficacy of the treatment interventions relative to set goals and outcomes, but it also forces them to question current practices in order to generate alternatives that are both effective and efficient.
Reflective Practice Defined
Wilkinson (1996) defines reflective practice as an "... active process whereby the professional can gain an understanding of how historical, social, cultural, cognitive and personal experiences have contributed to professional knowledge acquisition and practice. An examination of such factors yields an opportunity to identify new potentials within practice, thus challenging the constraints of habituated thoughts and practices." This definition highlights the importance of reflective practice as an active process, where practitioners consistently look at the factors influencing knowledge and practice. It also highlights the importance of practitioners challenging the status quo in order to present better options for professional practice.
Simplifying the concept of reflective practice, McCarthy (1994) encourages reflective practitioners to ask themselves, "What am I doing?" "Why am I doing it like that?" and "How can I improve it?" These three questions not only spur practitioners to establish the justification for and reasons behind their current practices, but also stimulate them to generate more effective and efficient practices.
Reflection-in-Action and on-Action
Schon (1987) describes two types of thinking relevant to reflective practice: reflection-in-action and reflection-on-action. The former refers to the ability to "think on one's feet" when quick thinking and split-second decisions are required, whereas the latter refers to a practitioner's retrospective look at his work in an effort to determine what practices were successful and which areas required improvement.
Physical therapy practitioners utilize both types of reflective thinking in clinical practice. The obvious use of reflection-in-practice occurs everyday when clinicians are put in situations that demand quick action and almost immediate response. Most patient evaluations and treatments occur in such a manner where assessments of patient response to treatment and progress toward goals are determined.
On the other hand, the use of reflection-on-practice is less obvious and, oftentimes, difficult to ascertain. Reevaluations of patient progress after a number of treatment sessions would probably be as close to reflection-on-practice as a clinician can get. And even with this exercise, the time spent on reflection leaves much to be desired. For one, constraints in time, finances and other resources may cause the clinician to view the patient's progress or need for therapy services in a myopic and self-limiting manner. In addition, the physical therapist's lack of contact with the patient due to shifts in the delivery of care to the PT assistant or PT student during the implementation of patient care adds to the complexity of the situation. Finally, physical therapy clinicians may be blind to their own weaknesses, perhaps because they are satisfied with their manner and method of practice thereby seeing themselves as not needing to develop themselves professionally.
Knowledge Generation and Acquisition
For the reflective practitioner, the essence of reflective practice lies in its intimacy with the generation and acquisition of knowledge. According to Schon (1983), knowledge may come from either experience and expertise (tacit knowledge), or scientific study (technical rationality). Tacit knowledge is usually anecdotal, highly personal, and may arise from a practitioner's critical evaluation of his personal practice. Needless to say, the acquisition and generation of knowledge in this respect is highly specific to the person and not generalizable to the profession.
On the other hand, technical rationality is based on objective findings that are subjected to the rigors of scientific inquiry. Thus, the results of the inquiry oftentimes carry strong scientific evidence that is generalizable to the profession and beneficial to professional practice. With today's growing emphasis on evidence-based practice, is it no wonder that the practitioners acknowledge the use of empirical evidence to justify the use of interventions that yield the best outcomes in clinical practice? Evidence-based practice requires the critical examination of evidence from clinical research and the evaluation of clinically relevant outcomes (Duncan, 1996).
Both tacit and technical knowledge have their place in clinical practice. Whereas one is subjective and personal, the other is objective and generalizable. The reflective practitioner needs to determine how best to apply these differences as it relates to clinical practice.
Reflective Practice Model
Reflective practice is essential in the generation and acquisition of tacit and technical knowledge. The generation of tacit and technical knowledge respectively leads to personal and professional development. As a practitioner continues with reflective practice, the cycle continues in an upward spiral that contributes to the development of both the person and the profession.
Duncan, P. (Dec. 1996). Evidence-based practice. PT Magazine.
McCarthy, M. (1994). Teaching an English novel to first year students. In J. McNiff and U. Collins. (Eds.). A new approach to in-career development for teachers in Ireland. Bournemouth: Hyde Publications, pp. 33-40, 39-53.
Schon, D. (1987). Educating the reflective practitioner: How professionals think in action. London: Jossey Bass.
Schon, D. (1983). The reflective practitioner. London: Temple Smith.
Shields, E. (1995). Reflection and learning in student nurses. Nurse Education Today, 15, 452-458.
Wilkinson, J., & Wilkinson, C. (1996). Group discussions in nursing education: A learning process. Nursing Standard, 10, 44, 46-47.
Wong, F. et al. (1995). Assessing the level of student reflection from reflective journals. Journal of Advanced Nursing, 22, 48-57.
Ronald V. Barredo has been a physical therapist for more than a decade. He serves as the program director for the physical therapist assistant program at Kaskaskia College in Centralia, IL, and is a geriatric consultant with Covenant HealthCare Alliance in Tennessee. Reach him at (618) 545-3308 (phone); (618) 532-1990 (fax); or e-mail at: rdbarredo @kc.cc.il.us