Occupational Therapy Student’s Conceptions of and Relationship With Self-Reflection: A Phenomenographic Approach

BACKGROUND AND PURPOSE: Self-reflection (SR) is paramount to the development of professionalism and serves as the foundation of adult education and lifelong learning. Health care demands and complexity have made it essential for new graduates to demonstrate the clinical reasoning skills necessary to become a reflective practitioner. Pedagogical approaches in health sciences programs that promote SR are growing in popularity. But is SR actually creating autonomous, qualified, and self-directed professionals who can meet the challenges of today’s health care climate? Research in nursing, physical therapy, and medicine is insufficient on the subject, and conflicting evidence exists on whether SR practices are effective methods for promoting academic and clinical success.

Evidence on occupational therapy students’ beliefs and understanding of the concept of SR is also limited. Therefore, the purpose of this study was to explore occupational therapy students’ conceptions of and relationship with SR. These research aims were examined using the following research questions: What do occupational therapy students conceive of as SR? How do occupational therapy students understand and relate to SR?

METHOD: A qualitative design and phenomenographic approach were used. Twenty-one recently graduated occupational therapy students from the University of New Mexico were conveniently recruited via email for individual, in-depth, open-ended, semistructured interviews. The principal investigator conducted 19 in-person interviews and 2 phone interviews. Interviews were completed after graduation to avoid any coercion and explored the what and how aspects of the phenomenon of SR: when students talked about SR, what they talked about, and how they talked about it.

Interviews were numbered, audio recorded, and transcribed verbatim by the research team. Transcripts were imported into the qualitative analysis software NVivo 10 (QSR International, Melbourne, Australia). Categories were created using a coding structure based on interview questions. Study reliability was ensured through coder and dialogic checking. Two research team members independently reviewed and coded each transcript, and then the team met to discuss. A third member independently coded about 30% of the same transcripts, and the team met again to determine agreement. As new themes and codes emerged, the coding team met and revised coding structure as needed. On completion of coding, salient quotes were chosen and refined within each theme. Code summaries were created to express the study findings.

After the initial analysis, the research team invited five to eight participants to contribute to the focus group discussion. This member checking method helped determine whether the results supported the participants’ conceptions of SR.

RESULTS: The majority of participants endorsed the findings. Main results revealed SR as an individualized, introspective, multidimensional process. Participants conceived of SR as a way to evaluate strengths and weaknesses and critically analyze a situation. Participants suggested that SR promoted personal growth and expansion of clinical skills. They also valued other professionals’ insights to clarify thoughts and actions. Overall, participants understood the intricacies of SR. They expressed awareness of SR’s effects (both positive and negative) on work–life balance and the importance of letting some things go.

CONCLUSION: New ways of understanding SR expand the possibilities of occupational therapy students having a broader repertoire of action in learning and clinical situations. This research may facilitate the creation of new SR approaches in education to better prepare occupational therapy students for the health care workforce. Understanding how students self-reflect allows practitioners and instructors to develop effective SR interventions to improve the SR capacity of health sciences students during educational and clinical programming, thus influencing their growth as occupational therapy practitioners.

References

Adam, K., Peters, S., & Chipchase, L. (2013). Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: A systematic review. Australian Occupational Therapy Journal, 60, 76–84. https://doi.org/10.1111/1440-1630.120006

Andonian, L. (2013). Emotional intelligence, self-efficacy, and occupational therapy students’ fieldwork performance. Occupational Therapy in Health Care, 27, 201–215. https://doi.org/10.3109/07380577.2012.763199

Mann, K., Gordon, J., & Macleod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14, 595–621. https://doi.org/10.1007/s10459-007-9090-2

Marton, F. (1986). Phenomenography: A research approach to investigating different understandings of reality. Journal of Thought, 21(3), 28–49.