Abstract:

Purpose/Hypothesis:
Reflective practice is widely utilized within healthcare education to cultivate critical thinking abilities in students. It appears in many forms, most notably through journaling and portfolios. However, peer reflection, by which students engage in dialectic conversations, has been shown to be a useful and popular alternative to more traditional methods. Though the theoretical bases of peer reflection are well established, implementations into practice are less so, with varied methods utilized. In light of this, an action research study was conducted to assess best practice approaches to peer reflection in a healthcare education program. The nature of action research is iterative, and it was expected that findings from each cycle of peer reflection implementation would reveal insights into best practices.

Subjects:
Ninety-three third-year physical therapy (PT) students from three sequential cohorts participated in peer-reflective discussions and submitted post-discussion reflective assignments as part of the requirements of a doctor of physical therapy program. Forty-five students consented to data from their reflective assignments to be used for this study.

Methods and Materials:
An action research approach was utilized to incorporate peer reflection into a doctor of physical therapy curriculum. Third-year PT students engaged in reflective discussions with peers in self-selected groups. Students discussed critical incidents they had encountered during the PT program and developed action plans to address future similar incidents. Post-discussion assignments prompted students to answer questions regarding their perception of the discussions, outcomes consequent to their action planning, and suggestions for format improvement. Thematic analysis of assignments was conducted. Suggestions for process improvement, gleaned from thematic analysis, were incorporated into subsequent iterations of peer discussions implemented into the PT curriculum.

Results:
Thematic analysis revealed specific recommendations for future iterations of peer reflective discussions. These include:
• Limit group size to 3-4 students
• Schedule longer discussions
• Schedule more frequent discussions
• Implement reflective discussions in the first year of the program
• Schedule reflective discussions prior to and following full-time clinical education experiences
• Provide guidelines for discussion topics

Conclusions:
Peer reflection has been shown to be an effective approach to foster critical thinking among PT students. Notwithstanding positive student feedback and support of its utilization in the professional literature, implementation – particularly during early iterations – warranted improvements, as noted by the students themselves. Students sought changes that would allow them to draw upon longer periods of experience (earlier implementation), align reflection with contextually meaningful experiences (scheduled around clinical internships), engage more vigorously with peers (smaller groups and longer and more frequent discussions), and possess a clearer understanding of contextualized reflective practice (guidance for discussion topics). These recommendations have guided planning for future peer reflection, which, in maintaining the spirit of action research, will be subsequently analyzed.

Keywords:

Reflective practice, peer reflection, action research, healthcare education, physical therapy, physiotherapy.