“Learning clinical reasoning is like riding a bike…but there is one major difference….you can SEE the bike! “ (Kingdon & Neufeld, 1999)
“Mindful practitioners attend…to their own physical and mental processes during ordinary, everyday tasks. This critical self-reflection enables physicians to listen attentively to patients’ distress, recognize their own errors, refine their technical skills, make evidence-based decisions, and clarify their values so that they can act with compassion, technical competence, presence and insight. Although mindfulness cannot be taught explicitly, it can be modeled by mentors and cultivated in learners.” (Epstein, 1999).
Ideas for the Clinical Educator:
- model reflective practice/clinical reasoning/mindfulness by explicitly talking through your thought process as you assess and treat clients:
• why did you select particular goals, teaching strategies, test etc.?
• what was successful about your session & why?
• what will you change for the next time & why?
- tell client stories (past and present, successful /unsuccessful) and your decision-making process
- ask students to tell you their thinking process as you plan sessions together
- ask students how you can help their learning as you observe their sessions(e.g., what objective data would the student like you to record?)
- following sessions, ask students to reflect on what succeeded and why,what they would change and why, what professional skills have improved as a result of this session and why, how they will use these reflections in planning future sessions. Allow students TIME to reflect, for example: give the student 15 minutes after the sessions to write notes or questions about the session to then bring to the post-session discussion, encourage the student to keep a journal and / or to keep a list of things learned
- continue to provide students opportunities to observe you (and other clinicians) throughout the placement and continue to share your reflections of your own work with the student
- create a Clinical Reasoning Interest Group in your agency (Strock, A. and Sullivan, T., 2001)
What strategies do you find work well ? Let us know
Epstein, R.M. (1999). Mindful practice, JAMA, 282(9), p. 833-839.
Kingdon, L. and Neufeld, J. (1999). Clinical Reasoning…What is it and why should I care? (unpublished).
Schon, D. (1987). Educating the Reflective Practitioner.San Francisco: Jossey-Bass Pub.
Strock, A. and Sullivan, T.M., (2001). Developing Clinical/Professional Reasoning in your Student Clinician. College of Heatlh Disciplines Workshop, UBC.
Weiss, E.M. & Weiss, S. Doing reflective supervision with student teachers in a professional development school culture. Reflective Practice, Vol. 2, No.2, 2001, 125-154.