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T1 - On critical reflection

T2 - A review of Mezirow’s theory and its operationalization

AU - Lundgren, H.

AU - Poell, R.F.

N2 - In this article, we review empirical studies that research critical reflection based on Mezirow’s definition. The concepts of content, process, and premise reflection have often been cited, and operationalizing Mezirow’s high-level transformative learning theory and its components has been the endeavor of adult education and human resource development (HRD) researchers. By conducting a literature review, we distill 12 research studies on critical reflection that we dissect, analyze, and compare. Discovering different approaches, assessment processes, and outcomes leads us to the conclusion that there is little agreement on how to operationalize reflection. We suggest four improvements: (a) integrating different critical reflection traditions, (b) using multiple data collection pathways, (c) opting for thematic embedding, and (d) attending to feelings. By implementing these improvements, we hope to stimulate closer alignment of approaches in critical reflection research across adult education and HRD researchers.Keywords: critical reflection, levels of reflection, Mezirow, transformative learning, operationalization, adult education theory, literature review

AB - In this article, we review empirical studies that research critical reflection based on Mezirow’s definition. The concepts of content, process, and premise reflection have often been cited, and operationalizing Mezirow’s high-level transformative learning theory and its components has been the endeavor of adult education and human resource development (HRD) researchers. By conducting a literature review, we distill 12 research studies on critical reflection that we dissect, analyze, and compare. Discovering different approaches, assessment processes, and outcomes leads us to the conclusion that there is little agreement on how to operationalize reflection. We suggest four improvements: (a) integrating different critical reflection traditions, (b) using multiple data collection pathways, (c) opting for thematic embedding, and (d) attending to feelings. By implementing these improvements, we hope to stimulate closer alignment of approaches in critical reflection research across adult education and HRD researchers.Keywords: critical reflection, levels of reflection, Mezirow, transformative learning, operationalization, adult education theory, literature review

U2 - 10.1177/1534484315622735

DO - 10.1177/1534484315622735

M3 - Article

SN - 1534-4843

JO - Human Resource Development Review

JF - Human Resource Development Review

Critical Reflection

• First Online: 03 July 2018

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• Larry Purnell Ph.D., R.N., FAAN 4 , 5 , 6  

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Critical reflection, sometimes referred to as cultural self-awareness, is a purposeful, vital, careful evaluation of one’s own values, beliefs, and cultural heritage in order to have an awareness of how these qualities can influence patient care. However, critical reflection goes beyond solely awareness by examining and critiquing the assumptions of one’s values and beliefs. It includes an examination of one’s own cultural values that have the potential to be in conflict with the values of others and, as a result, hinder therapeutic relationships and effective patient care outcomes. A number of models related to critical thinking are reviewed and include Dewey’s model of reflective learning, Habermas’s model of critical reflection, Kolb’s model of experiential learning, and feminist theory. In addition, recommendations for clinical practice, administration, education and training, and research are addressed. Tools to help practitioners assess their views and values related to bias are included as appendices.

Guideline : Nurses shall engage in critical reflection of their own values, beliefs, and cultural heritage in order to have an awareness of how these qualities and issues can impact culturally congruent care . Douglas et al. ( 2014 : 110)

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Akers M, Grover P (2017) What is emotional intelligence? Psych Central. https://psychcentral.com/lib/what-is-emotional-intelligence-eq/ . Accessed 2 June 2017

American Association of Colleges of Nursing (2006) Essentials of doctoral education in advanced practice nursing. http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf . Accessed 5 June 2017

American Nurses Association (2015) Code of ethics for nurses with interpretive statements. Author, Silver Spring

Google Scholar  

Andrews MM, Boyle JS (eds) (2016) Transcultural concepts and nursing care, 7th edn. Wolters Kluwer, Philadelphia

Calvillo E, Clark L, Purnell L, Pacquiao D, Ballantyne J, Villaruel S (2009) Cultural competencies in health care: emerging changes in baccalaureate nursing education. J Transcult Nurs 20(2):137–145

Article   PubMed   Google Scholar  

Canadian Nurses Association (2010) Position statement: promoting cultural competence in nursing. https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/ps114_cultural_competence_2010_e.pdf?la=en . Accessed 2 June 2017

Carper BA (1978) Fundamental patterns of knowing in nursing. Adv Nurs Sci 1(1):13–23

Article   CAS   Google Scholar  

Chinn P (2018) Critical theory and emancipatory knowing. In: Butts JB, Rich KL (eds) Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning

Chinn PL, Kramer MK (2015) Knowledge development in nursing theory and process, 9th edn. Elsevier, St. Louis

Cholle FP (2011) What is intuition, and how do we use it? https://www.psychologytoday.com/blog/the-intuitive-compass/201108/what-is-intuition-and-how-do-we-use-it . Accessed 2 June 2017

Cuellar N (2017) Unconscious bias. What is yours? J Transcult Nurs 28(4):333

Dewey J (1933) How we think: a restatement on the relation of reflective thinking to the educative process. D.C. Health, New York

Douglas M, Rosenketter M, Pacquiao D, Clark Callister L et al (2014) Guidelines for implementing culturally competent nursing care. J Transcult Nurs 25(2):109–221

Faith as a Way of Knowing. http://www.agakhanacademies.org/sites/default/files/AKA%20Faith%20Booklet%20for%20IB%20TOK.pdf . Accessed 3 June 2017

Ghoshal RA, Lippard C, Ribas V, Muir K (2013) Beyond bigotry: teaching about unconscious prejudice. Teach Sociol 41(2):130–143. http://vlib.excelsior.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=86187613&site=eds-live&scope=site . Accessed 11 July 2017

Article   Google Scholar  

Goleman D (2005) Emotional intelligence: why it can matter more than IQ. Bloomsbury Publishing, London

Hickson H (2011) Critical reflection: reflecting on learning to be reflective. Reflect Pract Interprof Multidiscip Perspect 12(6):829–839

How We Think: John Dewey on the Art of Reflection and Fruitful Curiosity in an Age of Instant Opinions and Information Overload (n.d.) https://www.brainpickings.org/2014/08/18/how-we-think-john-dewey/. Accessed 2 June 2017

ICN Code of Ethics for Nurses (2012) http://www.icn.ch/who-we-are/code-of-ethics-for-nurses/ . Accessed 2 June 2017

Johns C (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. J Adv Nurs 22:226–234

Article   CAS   PubMed   Google Scholar  

Kolb AY, Kolb DA (2005) Kolb learning style inventory. Experience Based Learning Systems, Inc. https://search.yahoo.com/yhs/search;_ylt=A0LEViOkBIFYzecABzonnIlQ;_ylu=X3oDMTEwcTc4aWkwBGNvbG8DYmYxBHBvcwMxBHZ0aWQDBHNlYwNxc3MtcXJ3?ei=UTF-8&hspart=mozilla&hsimp=yhs-002&fr=yhs-mozilla-002&p=Kolb%2C+%26+Kolb%2C+D.A.+%282005%29.+Kolb+Learning+Style+Inventory.+Experience+Based+Learning+Systems%2C+Inc.&fr2=12642 . Accessed 2 June 2017

Mezirow J (1990) Fostering critical reflection in adulthood. Jossey-Bass, San Francisco

Miettinen R (2000) The concept of experiential learning and John Dewey’s theory of reflective thought and action. Int J Lifelong Educ 19(1):54–72. https://doi.org/10.1080/026013700293458 . Accessed 7 June 2017

Purnell L, Salmond S (2013) Individual cultural competence and evidence-based practice. In: Purnell L (ed) Transcultural health care: a culturally competent approach, 4th edn. F.A. Davis, Philadelphia

Rogers C (2002) Dewey’s model of reflective learning. Teach Coll Rec 104(4):842–866. file:///D:/dewey.pdf. Accessed 2 June 2017

Schon DA (2014) The theory of inquiry: Dewey’s legacy to education. Curric Inq 22(2):119–139. http://www.tandfonline.com/doi/abs/10.1080/03626784.1992.11076093?src=recsys . Accessed 2 June 2017

Sullivan-Marx EM (2013) The bear and the canyon: toward an understanding of personal leadership. Nurs Sci Q 26(4):373–375

The Critical Theory of Jurgen Habermas (n.d.) http://physicsed.buffalostate.edu/danowner/habcritthy.html . Accessed 4 June 2017

Theory of Nursing Knowldege. http://www.theoryofknowledge.net/ . Accessed March 10, 2018

Timmins F (2006) Critical practice in nursing care: analysis, action and reflexivity. Nurs Stand 20:49–54

Tong R (2018) Feminist ethics: some applicable thought for advance practice nurses. In: Butts JB, Rich KL (eds) Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning

Ways of Knowing: Faith (2017) http://sohowdoweknow.weebly.com/faith.html . Accessed 3 June 2017

Ways of Knowing: Theory of Knowledge.net (2017) http://www.theoryofknowledge.net/ways-of-knowing/ . Accessed 2 June 2017

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Appendix 1: Promoting Cultural and Linguistic Competency

1.1 self-assessment checklist for personnel providing primary healthcare services.

Please select A, B, or C for each item listed below.

A = Things I do frequently, or statement applies to me to a great degree

B = Things I do occasionally, or statement applies to me to a moderate degree

C = Things I do rarely or never, or statement applies to me to minimal degree or not at all

1.1.1 Physical Environment, Materials, and Resources

_____ 1. I display pictures, posters, artworks, and other decors that reflect the cultures and ethnic backgrounds of clients served by my program or agency.

_____ 2. I ensure that magazines, brochures, and other printed materials in reception areas are of interest to and reflect the different cultures and languages of individuals and families served by my program or agency.

_____ 3. When using videos, films, or other media resources for health education, treatment, or other interventions, I ensure that they reflect the culture and ethnic backgrounds of individuals and families served by my program or agency.

_____ 4. I ensure that printed information disseminated by my agency or program takes into consideration accuracy and without bias.

1.1.2 Communication Styles

_____ 5. When interacting with individuals and families who have limited English proficiency, I always keep in mind that:

* Limitations in English proficiency are in no way a reflection of their level of intellectual functioning.

* Their limited ability to speak the language of the dominant culture has no bearing on their ability to communicate effectively in their language of origin.

* They may neither be literate in their language of origin nor in English.

______ 6. I use bilingual/bicultural or multilingual/multicultural staff and/or personnel and volunteers who are skilled or certified in the provision of medical interpretation services during treatment, interventions, meetings, or other events for individuals and families who need or prefer this level of assistance.

______ 7. For individuals and families who speak languages or dialects other than English, I attempt to learn and use key words so that I am better able to communicate with them during assessment, treatment, or other interventions.

______ 8. I attempt to determine any familial colloquialisms used by individuals or families that may impact on assessment, treatment, health promotion and education, or other interventions.

______ 9. For those who request or need this service, I ensure that all notices and communiqués to individuals and families are written in their language of origin.

_____ 10. I understand that it may be necessary to use alternatives to written communications for some individuals and families, as word of mouth may be a preferred method of receiving information.

_____ 11. I understand the principles and practices of linguistic competency and:

* Apply them within my program or agency

* Advocate for them within my program or agency

_____ 12. I understand the implications of health literacy within the context of my roles and responsibilities.

_____ 13. I use alternative formats and varied approaches to communicate and share information with individuals and/or their family members who experience disability.

1.1.3 Values and Attitudes

_____ 14. I avoid imposing values that may conflict or be inconsistent with those of cultures or ethnic groups other than my own.

_____ 15. I screen books, movies, and other media resources for negative cultural, ethnic, or racial stereotypes before sharing them with individuals and families served by my program or agency.

_____ 16. I intervene in an appropriate manner when I observe other staff or clients within my program or agency engaging in behaviors that show cultural insensitivity, racial biases, and prejudice.

_____ 17. I recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture.

_____ 18. I understand and accept that family is defined differently by different cultures (e.g., extended family members, fictive kin, godparents).

_____ 19. I accept and respect that male-female roles may vary significantly among different cultures (e.g., who makes major decisions for the family).

_____ 20. I understand that age and life cycle factors must be considered in interactions with individuals and families (e.g., high value placed on the decision of elders, the role of eldest male or female in families, or roles and expectation of children within the family).

_____ 21. Even though my professional or moral viewpoints may differ, I accept individuals and families as the ultimate decision-makers for services and supports impacting their lives.

_____ 22. I recognize that the meaning or value of medical treatment and health education may vary greatly among cultures.

_____ 23. I accept that religion and other beliefs may influence how individuals and families respond to illnesses, disease, and death.

_____ 24. I understand that the perception of health, wellness, and preventive health services has different meanings to different cultural groups.

_____ 25. I recognize and understand that beliefs and concepts of emotional well-being vary significantly from culture to culture.

_____ 26. I understand that beliefs about mental illness and emotional disability are culturally based. I accept that responses to these conditions and related treatments/interventions are heavily influenced by culture.

_____ 27. I recognize and accept that folk and religious beliefs may influence an individual’s or family’s reaction and approach to a child born with a disability or later diagnosed with a disability, genetic disorder, or special healthcare needs.

_____ 28. I understand that grief and bereavement are influenced by culture.

_____ 29. I accept and respect that customs and beliefs about food, its value, preparation, and use are different from culture to culture.

_____ 30. I seek information from individuals, families, or other key community informants that will assist in service adaptation to respond to the needs and preferences of culturally and ethnically diverse groups served by my program or agency.

_____ 31. Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs, and expectations that are unique to the culturally diverse groups served by my program or agency.

_____ 32. I keep abreast of the major health and mental health concerns and issues for ethnically and racially diverse client populations residing in the geographic locale served by my program or agency.

_____ 33. I am aware of specific health and mental health disparities and their prevalence within the communities served by my program or agency.

_____ 34. I am aware of the socioeconomic and environmental risk factors that contribute to health and mental health disparities or other major health problems of culturally and linguistically diverse populations served by my program or agency.

_____ 35. I am well versed in the most current and proven practices, treatments, and interventions for the delivery of health and mental healthcare to specific racial, ethnic, cultural, and linguistic groups within the geographic locale served by my agency or program.

_____ 36. I avail myself to professional development and training to enhance my knowledge and skills in the provision of services and supports to culturally and linguistically diverse groups.

_____ 37. I advocate for the review of my program’s or agency’s mission statement, goals, policies, and procedures to ensure that they incorporate principles and practices that promote cultural and linguistic competence.

Reprinted with Permission: Tawara D. Goode • National Center for Cultural Competence • Georgetown University Center for Child & Human Development • University Center for Excellence in Developmental Disabilities, Education, Research & Service • Adapted Promoting Cultural Competence and Cultural Diversity for Personnel Providing Services and Supports to Children with Special Health Care Needs and their Families • June 1989 (Revised 2009).

SCORING: This checklist is intended to heighten the awareness and sensitivity of personnel to the importance of cultural and linguistic cultural competence in health, mental health, and human service settings. It provides concrete examples of the kinds of beliefs, attitudes, values, and practices which foster cultural and linguistic competence at the individual or practitioner level. There is no answer key with correct responses. However, if you frequently responded “C,” you may not necessarily demonstrate beliefs, attitudes, values, and practices that promote cultural and linguistic competence within health and mental healthcare delivery programs.

Appendix 2: Promoting Cultural and Linguistic Competency

1.1 self-assessment checklist for personnel providing services and supports in early intervention and early childhood settings.

Directions : Please select A, B, or C for each item listed below.

______ 1. I display pictures, posters, and other materials that reflect the cultures and ethnic backgrounds of children and families served in my early childhood program or setting.

______ 2. I select props for the dramatic play/housekeeping area that are culturally diverse (e.g., dolls, clothing, cooking utensils, household articles, furniture).

______ 3. I ensure that the book/literacy area has pictures and storybooks that reflect the different cultures of children and families served in my early childhood program or setting.

______ 4. I ensure that tabletop toys and other play accessories (that depict people) are representative of the various cultural and ethnic groups both within my community and the society in general.

______ 5. I read a variety of books exposing children in my early childhood program or setting to various life experiences of cultures and ethnic groups other than their own.

______ 6. When such books are not available, I provide opportunities for children and their families to create their own books and include them among the resources and materials in my early childhood program or setting.

______ 7. I adapt the above referenced approaches when providing services, supports, and other interventions in the home setting.

______ 8. I encourage and provide opportunities for children and their families to share experiences through storytelling, puppets, marionettes, or other props to support the “oral tradition” common among many cultures.

______ 9. I plan trips and community outings to places where children and their families can learn about their own cultural or ethnic history as well as the history of others.

_____ 10. I select videos, films, or other media resources reflective of diverse cultures to share with children and families served in my early childhood program or setting.

_____ 11. I play a variety of music and introduce musical instruments from many cultures.

_____ 12. I ensure that meals provided include foods that are unique to the cultural and ethnic backgrounds of children and families served in my early childhood program or setting.

_____ 13. I provide opportunities for children to cook or sample a variety of foods typically served by different cultural and ethnic groups other than their own.

_____ 14. If my early childhood program or setting consists entirely of children and families from the same cultural or ethnic group, I feel it is important to plan an environment and implement activities that reflect the cultural diversity within the society at large.

_____ 15. I am cognizant of and ensure that curricula I use include traditional holidays celebrated by the majority culture, as well as those holidays that are unique to the culturally diverse children and families served in my early childhood program or setting.

_____ 16. For children who speak languages or dialects other than English, I attempt to learn and use key words in their language so that I am better able to communicate with them.

_____ 17. I attempt to determine any familial colloquialisms used by children and families that will assist and/or enhance the delivery of services and supports.

_____ 18. I use visual aids, gestures, and physical prompts in my interactions with children who have limited English proficiency.

_____ 19. When interacting with parents and other family members who have limited English proficiency, I always keep in mind that:

____ (a) Limitation in English proficiency is in no way a reflection of their level of intellectual functioning.

____ (b) Their limited ability to speak the language of the dominant culture has no bearing on their ability to communicate effectively in their language of origin.

____ (c) They may neither be literate in their language of original English.

_____ 20. I ensure that all notices and communiqués to parents are written in their language of origin.

_____ 21. I understand that it may be necessary to use alternatives to written communications for some families, as word of mouth may be a preferred method of receiving information.

_____ 22. I understand the principles and practices of linguistic competency and:

(a) Apply them within my early childhood program or setting

(b) Advocate for them within my program or agency

_____ 23. I use bilingual or multilingual staff and/or trained/certified foreign language interpreters for meetings, conferences, or other events for parents and family members who may require this level of assistance.

_____ 24. I encourage and invite parents and family members to volunteer and assist with activities regardless of their ability to speak English.

_____ 25. I use alternative formats and varied approaches to communicate with children and/or their family members who experience disability.

_____ 26. I arrange accommodations for parents and family members who may require communication assistance to ensure their full participation in all aspects of the early childhood program (e.g., hearing impaired, physical disability, visually impaired, not literate or low literacy, etc.).

_____ 27. I accept and recognize that there are often differences between language used in early childhood/early intervention settings, or at “school,” and in the home setting.

_____ 28. I avoid imposing values that may conflict or be inconsistent with those of cultures or ethnic groups other than my own.

_____ 29. I discourage children from using racial and ethnic slurs by helping them understand that certain words can hurt others.

_____ 30. I screen books, movies, and other media resources for negative cultural, ethnic, racial, or religious stereotypes before sharing them with children and their families served in my early childhood program or setting.

_____ 31. I provide activities to help children learn about and accept the differences and similarities in all people as an ongoing component of program curricula.

_____ 32. I intervene in an appropriate manner when I observe other staff or parents within my program or agency engaging in behaviors that show cultural insensitivity, bias, or prejudice.

_____ 33. I recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture.

_____ 34. I understand and accept that family is defined differently by different cultures (e.g., extended family members, fictive kin, godparents).

_____ 35. I accept and respect that male-female roles in families may vary significantly among different cultures (e.g., who makes major decisions for the family, play and social interactions expected of male and female children).

_____ 36. I understand that age and life cycle factors must be considered in interactions with families (e.g., high value placed on the decisions or child-rearing practices of elders or the role of the eldest female in the family).

_____ 37. Even though my professional or moral viewpoints may differ, I accept the family/parents as the ultimate decision-makers for services and supports for their children.

_____ 38. I accept that religion, spirituality, and other beliefs may influence how families respond to illness, disease, and death.

_____ 39. I recognize and understand that beliefs and concepts of mental health or emotional well-being, particularly for infants and young children, vary significantly from culture to culture.

_____ 40. I recognize and accept that familial folklore, religious, or spiritual beliefs may influence a family’s reaction and approach to a child born with a disability or later diagnosed with a disability or special healthcare needs.

_____ 41. I understand that beliefs about mental illness and emotional disability are culturally based. I accept that responses to these conditions and related treatments/interventions are heavily influenced by culture.

_____ 42. I understand that the healthcare practices of families served in my early childhood program or setting may be rooted in cultural traditions.

_____ 43. I recognize that the meaning or value of early childhood education or early intervention may vary greatly among cultures.

_____ 44. I understand that traditional approaches to disciplining children are influenced by culture.

_____ 45. I understand that families from different cultures will have different expectations of their children for acquiring toileting, dressing, feeding, and other self-help skills.

_____ 46. I accept and respect that customs and beliefs about food, its value, preparation, and use are different from culture to culture.

_____ 47. Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs, and expectations that are unique to families of specific cultural groups served in my early childhood program or setting.

_____ 48. I advocate for the review of my program’s or agency’s mission statement, goals, policies, and procedures to ensure that they incorporate principles and practices that promote cultural diversity, cultural competence, and linguistic competence.

_____ 49. I seek information from family members or other key community informants that will assist me to respond effectively to the needs and preferences of culturally and linguistically diverse children and families served in my early childhood program or setting.

Reprinted with Permission: Tawara D. Goode • National Center for Cultural Competence • Georgetown University Center for Child & Human Development • University Center for Excellence in Developmental Disabilities, Education, Research & Service • Adapted Promoting Cultural Competence and Cultural Diversity for Personnel Providing Services and Supports to Children with Special Health Care Needs and their Families • June 1989 (Revised 2009).

SCORING: This checklist is intended to heighten the awareness and sensitivity of personnel to the importance of cultural diversity, cultural competence, and linguistic competence in early childhood settings. It provides concrete examples of the kinds of practices that foster such an environment. There is no answer key with correct responses. However, if you frequently responded “C,” you may not necessarily demonstrate practices that promote a culturally diverse and culturally competent learning environment for children and families within your classroom, program, or agency.

Appendix 3: Personal Self-Assessment of Antibias Behavior

Directions : Using the rating scale of NEVER to ALWAYS, assess yourself for each item by placing an “X” on the appropriate place along each continuum. When you have completed the checklist, review your responses to identify areas in need of improvement. Create specific goals to address the areas in which you would like to improve.

I educate myself about the culture and experiences of other racial, religious, ethnic and socioeconomic groups by reading and attending classes, workshops, cultural events, etc.

Never ________________________ Always

I spend time reflecting on my own upbringing and childhood to better understand my own biases and the ways I may have internalized the prejudicial messages I received.

I look at my own attitudes and behaviors as an adult to determine the ways they may be contributing to or combating prejudice in society.

I evaluate my use of language to avoid terms or phrases that may be degrading or hurtful to other groups.

I avoid stereotyping and generalizing other people based on their group identity.

Never __________________________ Always

I value cultural differences and avoid statements such as “I never think of you as______________,” which discredits differences.

Never _________________________ Always

I am comfortable discussing issues of racism, anti-Semitism and other forms of prejudice with others.

I am open to other people’s feedback about ways in which my behavior may be culturally insensitive or offensive to others.

I give equal attention to other people regardless of race, religion, gender, socioeconomic class or other difference.

I am comfortable giving constructive feedback to someone of another race, gender, age or physical ability.

The value of diversity is reflected in my work, which includes a wide range of racial, religious, ethnic and socioeconomic groups, even when these groups are not personally represented in my community.

I work intentionally to develop inclusive practices, such as considering how the time, location and cost of scheduled meetings and programs might inadvertently exclude certain groups.

I work to increase my awareness of biased content in television programs, newspapers and advertising.

I take time to notice the environment of my home, office, house of worship and children’s school, to ensure that visual media represent diverse groups, and I advocate for the addition of such materials if they are lacking.

When other people use biased language and behavior, I feel comfortable speaking up, asking them to refrain and stating my reasons.

I contribute to my organization’s achievement of its diversity goals through programming and by advocating for hiring practices that contribute to a diverse workforce.

I demonstrate my commitment to social justice in my personal life by engaging in activities to achieve equity.

This activity was adapted from “Commitment to Combat Racism” by Dr. Beverly Tatum & Andrea Ayvazian in White Awareness: Handbook for Anti-Racism Training by Judy H. Katz. ©1978 by the University of Oklahoma Press, Norman. Reprinted by permission of the publisher. All rights reserved.

Permission was also granted from the Anti-Defamation League, Education Division, A WORLD OF DIFFERENCE ® Institute © 2007 Anti-Defamation League: www.adl.org/education ; email: [email protected].

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Purnell, L. (2018). Critical Reflection. In: Douglas, M., Pacquiao, D., Purnell, L. (eds) Global Applications of Culturally Competent Health Care: Guidelines for Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-69332-3_10

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What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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17 strong academic phrases to write your literature review (+ real examples)

A well-written academic literature review not only builds upon existing knowledge and publications but also involves critical reflection, comparison, contrast, and identifying research gaps. The following 17 strong academic key phrases can assist you in writing a critical and reflective literature review.

Disclosure: This post may contain affiliate links, which means I may earn a small commission if you make a purchase using the links below at no additional cost to you . I only recommend products or services that I truly believe can benefit my audience. As always, my opinions are my own.

Academic key phrases to present existing knowledge in a literature review

Academic key phrases to contrast and compare findings in a literature review, academic key phrases to highlight research gaps in a literature review, the topic has received significant interest within the wider literature..

Example: “ The topic of big data and its integration with AI has received significant interest within the wider literature .” ( Dwivedi et al. 2021, p. 4 )

The topic gained considerable attention in the academic literature in…

Example:  “ The relationship between BITs and FDI gained considerable attention in the academic literature in the last two decades .” ( Amendolagine and Prota, 2021, p. 173 )

Studies have identified…

Example: “ Studies have identified the complexities of implementing AI based systems within government and the public sector .” ( Dwivedi et al. 2021, p. 6 )

Researchers have discussed…

Example: “ Researchers have discussed the ethical dimensions of AI and implications for greater use of the technology. ” ( Dwivedi et al. 2021, p. 6)

Recent work demonstrated that…

Example: “Recent work demonstrated that dune grasses with similar morphological traits can build contrasting landscapes due to differences in their spatial shoot organization.” ( Van de Ven, 2022 et al., p. 1339 )

Existing research frequently attributes…

Example:  “Existing research frequently attributes these challenges to AI’s technical complexity, demand for data, and unpredictable interactions.” ( Yang et al., 2020, p. 174 )

Prior research has hypothesized that…

Example:  “Prior research has hypothesized that racial and ethnic disparities may be mitigated if the patient and provider share the same race due to improved communication and increased trust” ( Otte, 2022, p. 1 )

Prior studies have found that…

Example:  “ Prior studies have found that court-referred individuals are more likely to complete relationship violence intervention programs (RVIP) than self-referred individuals. ” ( Evans et al. 2022, p. 1 )

You may also like: 26 powerful academic phrases to write your introduction (+ real examples)

While some scholars…, others…

Example: “On the sustainable development of microcredit, some scholars emphasize the effect of its poverty alleviation, while some scholars emphasize the factors such as institutional innovation and government support.” ( Huang et al., 2021, p. 2117 )

The findings of Scholar A showcase that… . Scholar B , on the other hand, found…

Example: “ The findings of Arinto (2016) call for administrators concerning the design of faculty development programs, provision of faculty support, and strategic planning for online distance learning implementation across the institution. Francisco and Nuqui (2020) on the other hand found that the new normal leadership is an adaptive one while staying strong on their commitment. ” ( Asio and Bayucca, 2021, p. 20 )

Interestingly, all the arguments refer to…

Example:  “Interestingly, all the arguments above refer to daily role transitions—more specifically: role transitions on teleworking days—as an important explanatory mechanism for both the possible conflict-reducing effect and the potential conflict enhancing effects of telework.”  ( Delanoeije et al., 2019, p. 1845 )

This argument is similar to…

Example: “The third argument against physician involvement in lethal injection is that physicians are prohibited from deliberately harming patients or the argument from nonmaleficence. This argument is similar to the argument from healing but has different implications and must therefore be considered independently.” ( Sawicki, 2022, p. 22 )

If you are looking to elevate your writing and editing skills, I highly recommend enrolling in the course “ Good with Words: Writing and Editing Specialization “, which is a 4 course series offered by the University of Michigan. This comprehensive program is conveniently available as an online course on Coursera, allowing you to learn at your own pace. Plus, upon successful completion, you’ll have the opportunity to earn a valuable certificate to showcase your newfound expertise!

Yet, it remains unknown how…

Example: “Yet, it remains unknown how findings from aeolian landscapes translate to aquatic systems and how young clonally expanding plants in hydrodynamically exposed conditions overcome these establishment thresholds by optimizing shoot placement.” ( Van de Ven, 2022 et al., p. 1339 )

There is, however, still little research on…

Example:  “There is, however, still little research on what integrated STEM approaches require from schools and teachers, and on the potential obstacles that may prevent teachers from running this kind of teaching.”  ( Bungum and Mogstad, 2022, p. 2 )

Existing studies have failed to address…

Example: “ University–industry relations (UIR) are usually analysed by the knowledge transfer channels, but existing studies have failed to address what knowledge content is being transferred – impacting the technology output aimed by the partnership.”  (Dalmarco et al. 2019, p. 1314 )

Several scholars have recommended to move away…

Example: “Several scholars have recommended to move away from such a stable-level approach (i.e. using a global judgment of work-home conflict) to a dynamic episodes approach ” ( Delanoeije et al., 2019, p. 1847 )

New approaches are needed to address…

Example:  “ Accurate computational approaches are needed to address this gap and to enable large-scale structural bioinformatics. ” ( Jumper et al. 2021,p. 583 )

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Critical Reflection

A Critical Reflection (also called a reflective essay) is a process of identifying, questioning, and assessing our deeply-held assumptions – about our knowledge, the way we perceive events and issues, our beliefs, feelings, and actions. When you reflect critically, you use course material (lectures, readings, discussions, etc.) to examine our biases, compare theories with current actions, search for causes and triggers, and identify problems at their core.   Critical reflection is   not   a reading assignment, a summary of an activity, or an emotional outlet.   Rather,   the goal is   to change your thinking about a subject, and thus change your behaviour.

Tip: Critical reflections are common in coursework across all disciplines, but they can take very different forms. Your instructor may ask you to develop a formal essay, produce weekly blog entries, or provide short paragraph answers to a set of questions. Read the assignment guidelines before you begin.

How to Critically Reflect

Writing a critical reflection happens in two phases.

• Analyze:   In the first phase, analyze the issue and your role by asking critical questions. Use free writing as a way to develop good ideas. Don’t worry about organized paragraphs or good grammar at this stage.
• Articulate:   In the second phase, use your analysis to develop a clear argument about what you learned. Organize your ideas so they are clear for your reader.

First phase: Analyze

A popular method for analyzing is the three stage model: What? So What? Now what?

In the  What?  stage, describe the issue, including your role, observations, and reactions. The   what?   stage helps you make initial observations about what you feel and think. At this point, there’s no need to look at your course notes or readings.

Use the questions below to guide your writing during this stage.

• What happened?
• What did you do?
• What did you expect?
• What was different?
• What was your reaction?
• What did you learn?

In the second  So What?   stage, try to understand on a deeper level why the issue is significant or relevant. Use information from your first stage, your course materials (readings, lectures, discussions) -- as well as previous experience and knowledge to help you think through the issue from a variety of perspectives.

Tip:  Since you’ll be using more course resources in this step, review your readings and course notes before you begin writing.

Below are three perspectives you can consider:

• Academic perspective: How did the experience enhance your understanding of a concept/theory/skill? Did the experience confirm your understanding or challenge it? Did you identify strengths or gaps in your knowledge?
• Personal perspective:   Why does the experience matter? What are the consequences? Were your previous expectations/assumptions confirmed or refuted? What surprised you and why?
• Systems perspective:   What were the sources of power and who benefited/who was harmed? What changes would you suggest? How does this experience help you understand the organization or system?

In the third   Now what?   stage, explore how the experience will shape your future thinking and behaviour.

Use the following questions to guide your thinking and writing:

• What are you going to do as a result of your experiences?
• What will you do differently?
• How will you apply what you learned?

Second phase: Articulate

After completing the analysis stage, you probably have a lot of writing, but it is not yet organized into a coherent story. You need to build an organized and clear argument about what you learned and how you changed. To do so,   develop a thesis statement , make an   outline ,   write , and   revise.

Develop a thesis statement

Develop a clear argument to help your reader understand what you learned. This argument should pull together different themes from your analysis into a main idea. You can see an example of a thesis statement in the sample reflection essay at the end of this resource.

Tip: For more help on developing thesis statements, see our   Thesis statements  resource

Make an outline

Once you have a clear thesis statement for your essay, build an outline. Below is a straightforward method to organize your essay.

• Background/Context of reflection
• Thesis statement
• Introduce theme A
• Writer's past position/thinking
• Moment of learning/change
• Writer's current/new position
• Introduce theme B
• Introduce theme C
• Summarize learning
• Discuss significance of learning for self and others
• Discuss future actions/behaviour

Write and revise

Time to get writing! Work from your outline and give yourself enough time for a first draft and revisions.

Even though you are writing about your personal experience and learning, your audience may still be an academic one. Consult the assignment guidelines or ask your instructor to find out whether your writing should be formal or informal.

Sample Critical Reflection

Below are sample annotated paragraphs from one student’s critical reflection for a course on society and privilege.

Introduction

Background/context of reflection : I became aware of privileged positions in society only in recent years. I was lucky enough, privileged enough, to be ignorant of such phenomena, but for some, privilege is a daily lesson of how they do not fit into mainstream culture. In the past, I defined oppression as only that which is obvious and intentional. I never realized the part I played. However, during a class field study to investigate privileged positions in everyday environments, I learned otherwise.   Thesis:   Without meaning to, I caused harm by participating in a system where I gained from others’ subtle oppression. In one of these spaces, the local mall, everything from advertisements to food to products, to the locations of doorways, bathrooms and other public necessities, made clear my privilege as a white, heterosexual male.

Body paragraph

Topic sentence : Peggy McIntosh describes privilege as an invisible knapsack of tools and advantages. This description crystalized for me when I shopped for a greeting card at the stationary store. There, as a white, heterosexual male, I felt comfortable and empowered to roam about the store as I pleased. I freely asked the clerk about a mother’s day card.   Writer’s past position:   Previously, I never considered that a store did anything but sell products. However, when I asked the sales clerk for same sex greeting cards, she paused for a few seconds and gave me a look that made me feel instantly uncomfortable. Some customers stopped to look at me. I felt a heat move over my face. I felt, for a moment, wrong for being in that store.  I quickly clarified that I was only doing a report for school, implying that I was not in fact homosexual.   Writer’s current position:   The clerk’s demeanor changed. I was free to check, she said.  It was the only time during the field study that I had felt the need to explain what I was doing to anyone. I could get out of the situation with a simple clarification. But what if I really was a member of the homosexual community? The looks and the silence taught me that I should be feared.  I realized that, along with its products, the store was selling an image of normal. But my “normality” was another person’s “abnormality.”  After I walked out of the store I felt guilty for having denied being homosexual.

Summary of learning:   At the mall I realized how much we indirectly shame nonprivileged groups, even in seemingly welcoming spaces. That shame is supported every time I or any other privileged individual fails to question our advantage. And it leads to a different kind of shame carried by privileged individuals, too.   Value for self and others:   All of this, as Brown (2003) documents, is exacerbated by silence. Thus, the next step for me is to not only question privilege internally, but to publicly question covert bias and oppression. If I do, I may very well be shamed for speaking out. But my actions might just encourage other people to speak up as well.

Sample paragraphs adapted from James C. Olsen's Teaching Portfolio from Georgetown University .

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Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Sven p. c. schaepkens.

1 Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands

A. de la Croix

2 Faculty of Medicine, Vrije Universiteit Amsterdam, Postbus 7057, 1007 MB Amsterdam, The Netherlands

Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, ‘how can research approach the conceptual indeterminacy of reflection to produce knowledge?’. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.

Introduction

The concept of reflection entered medical education based on new insights about what matters for becoming a competent professional (Sandars, 2009 ). Many undergraduate and specialty medical education programs include reflection to help medical trainees develop into competent professionals. Additionally, various theories about learning integrate reflection in their models, of which Kolb’s experiential learning is a prominent example (Caty et al., 2015 ; Coffield et al., 2004 ; Roessger, 2014 ). The main purpose of research on reflection in medical education is to support practice and its practitioners. Nonetheless, there is tension between theory and practice (van Enk & Regehr, 2018 ).

The reflective path towards professionalism is slippery like soap. Reflection is a complex phenomenon that lacks a theoretically unified concept. Empirical research on reflection shows a wide variety of methodological approaches (Fragkos, 2016 ; Mann et al., 2007 ). Some suggest that this is “due to the complexity of reflection itself, lack of consensus, and variability in educators’ understanding of the reflective process” (Uygur et al., 2019 , p. 13). The multitude of definitions and models of reflection that currently exist contribute “to the accrual of multiple meanings of reflection” (Nguyen et al., 2014 , p. 1184; Chaffey et al., 2012 ; Koole et al., 2011 ; Marshall, 2019 ; Roessger, 2014 ).

The underlying scientific problem can be captured in an analogy. If we ask adults to define soap, they might reply that soap consists of oil, lye, water and fragrance. If we ask a child the same question, she could say that it is a slippery thing that cleans dirty hands. A third reply might be poetic, like Francis Ponge’s Soap , that it behaves like a frog and a fish (Ponge, 2015 ). A chemist replies with C17H35COO- plus Na + or K + (Brenntag, 2021 ). Which of these descriptions captures the essence of soap? Is the chemist’s definition more fundamental than the child’s? Or should we combine them all? In short, what formulation unifies our understanding of soap?

Medical education research often strives for the scientific ideal of producing theory that can predict accurately and has ‘conceptual elegance’ (van Enk & Regehr, 2018 ). However, if reflection is a complex practice and behaves like soap, it might support a wide range of descriptions. Its very nature might resist the ideal of scientific rigor that equates to predictability and conceptual elegance (Heidegger, 2002 ). When a concept like reflection is important for medical education, it does not automatically follow that we can scientifically measure or assess it (Veen & Cianciolo, 2020 ). What does this imply for research on reflection in medical education?

A skeptic could argue that researching reflection requires modesty because it is so fundamental to being human. The concept is “just too big, that is, too general and vague, for effective, real world application” (Cornford, 2002 , p. 226). Contrary to such skeptics, we argue that medical education research on reflection is sensible, provided we understand how different ways of operationalizing the concept affect the research. This requires us to take a step back, and clarify how medical education research can do justice to reflective practice without losing its conceptual and methodological integrity.

In this study, we conduct a philosophical analysis of the scholarly debate on reflection, which is challenged by its heterogeneous understanding of the concept of reflection itself. We aim to provide suggestions on how future conceptual development can take shape (Grant & Booth, 2009 ). Therefore, we address the questions, ‘what are the possible scientific approaches to conceptualizing and operationalizing reflection, and how do these influence knowledge production on reflection in practice?’.

Study design

We conducted a critical narrative umbrella review of research on reflection (Ng et al., 2015 ). This was a review of reviews, and included an analysis to ‘take stock’ and evaluate the previous body of work (Grant & Booth, 2009 ). We opted for this non-systematic review since many systematic reviews have already been performed without resulting in conceptual consensus.

Data collection

We analyzed reviews of research on reflection in the broadest sense, ranging from systematic to narrative reviews in English. SS conducted a search with the search string (‘REFLECTION’ OR ‘REFLEXIVE’) AND (‘REVIEW’), and (‘REFLECTION’ OR ‘REFLEXIVE’) AND (‘SYSTEMATIC REVIEW’ OR ‘LITERATURE REVIEW’ OR ‘NARRATIVE REVIEW’ OR ‘CRITICAL REVIEW’) from 2000 until 6 July 2020 in the following databases: EMBASE, PubMed, Scopus, and Web of Science. Reviews eligible for inclusion in this study either had to report empirical research on (certain aspects of) reflection in medical education and/or medical health professions, or alternatively, regardless of their disciplinary focus, provide a substantial theoretical discussion on the concept of reflection (Brown et al., 2019 ). We included reviews from fields other than medical education, such as the teacher education field, when they dealt with cross-disciplinary theoretical discussions on reflection. We excluded studies that solely dealt with empirical research on reflection in non-medical education contexts. These in- and exclusion criteria resulted in 47 articles that we analyzed (cf. references with *).

Often, the purpose of reviews is to pool and assess empirical data, or synthesize literature about a phenomenon in a model or theoretical framework. For our study, however, the assessment of research and synthesized frameworks in the reviews themselves were the object of philosophical analysis. Philosophy is a broad field, but we understand it as “an academic discipline specialized in analyzing and understanding the wider processes of the constructing of theories, questioning their hidden background premises, and revealing and examining the values affecting (…) human practices” (Ruitenberg, 2009 , p. 325; Holma, 2009 ). Philosophy can help identify different theoretical orientations on reflection, and “act as a broker or negotiator” between them, because it is not immediately obvious which approach is appropriate (Veen & Cianciolo, 2020 , p. 5).

We analyzed literature reviews on reflection research by contrasting the foundational philosophical work that underpins the reviews with their assessments of reflection research. In this study, we do not describe what the trends are, but analyze how research produces scientific knowledge on reflection in alignment with reflection’s theoretical underpinnings. Using the foundational literature in this study functions like a ‘subjectivist lens’ (Varpio et al., 2020 ). The lens helps us recognize the field’s main tendencies that are valuable for analytical juxtaposition to highlight conceptual problems (Biesta, 2009 ; Davis, 2009 ).

We now present the results of our analysis by first describing the two distinct approaches to reflection research. We then describe each approach in more detail, discuss how they relate to each other based on our analytical lens, and provide further recommendations.

Two approaches

We distinguished two main approaches to studying the ‘fuzzy concept’ of reflection. The first approach aims to dissolve conceptual ambiguity (Nguyen et al., 2014 ). This approach portrays a pressing need for unified conceptual ground between theories and empirical studies on reflection (Koole et al., 2011 ; Kuiper & Pesut, 2004 ; Kurt, 2018 ; Marshall, 2019 ; Nguyen et al., 2014 ). The second approach, in contrast, does not aim at dissolving ambiguity with an all-encompassing concept of reflection; instead, it incorporates the heterogeneous understanding of reflection as a vital quality in research on reflection (Mantzoukas, 2008 ; Ng, 2012 ; Ng et al., 2015 ; Norrie et al., 2012 ; Platt, 2014 ; van Beveren et al., 2018 ).

The reviewed studies mention various scholars such as Habermas or Kolb as influential in this field, but a clear majority refer to the work of Dewey and/or Schön as foundational (Erlandson & Beach, 2008 ; Fendler, 2003 ; Fragkos, 2016 ; Koole et al., 2011 ; Miraglia, 2015 ; Ng et al., 2015 ; Richard et al., 2019 ; van Beveren et al., 2018 ). Dewey’s and Schön’s work underpin both approaches to studying reflection. Although Schön responds critically to Dewey, there is a distinct commonality between them. With their study of reflection, they rethink the relation between theory and practice, and grant practice center stage (Erlandson & Beach, 2008 ; Farrell, 2012 ). Some studies question how far Dewey and Schön succeed; nevertheless, their work on reflection marks a pivotal point in this discussion (Hébert, 2015 ; Newman, 1999 ). Our ‘move’ in the philosophical analysis was, therefore, to adopt Dewey’s and Schön’s ideas as our analytical lens. From their work, we drew the qualities of a technicist and a dynamic rationale, that tie in with the theory–practice debate. We applied these two rationales to the contemporary scientific knowledge production on reflection.

Our use of the term technicist stems from what Schön describes as ‘Technical Rationality’ (Kinsella, 2007 ; Schön, 1983 ). Technicist indicates that professional problems are clearly demarcated and then solved by rigorously applying (scientific) theory and techniques in practice. ‘Applying’ implies a normative hierarchy, wherein “general principles occupy the highest level and concrete problem solving the lowest” (Schön, 1983 , p. 24; Garrison et al., 2012 ). Theory and practice are mostly perceived as separated from each other, wherein theory is the systematic instrument bringing order to reality’s chaos (Kinsella, 2007 ). Both Dewey and Schön challenge this dualism between rationality and practice (Garrison et al., 2012 ).

Our use of the term dynamic originates with the description that Dewey and Schön give of experience and practice. They are dynamic, in the sense that problems in practice are not clear-cut but interconnected. Practice is messy, turbulent, filled with normative tensions, disorder, and conflict which make practice indeterminate (Kinsella, 2007 ; Ng et al., 2020 ; Schön, 1983). Furthermore, “rationality emerges over time in experience” (Garrison et al., 2012 , p. 42). Whereas logic is unchanging and indifferent to context, “thinking is a process” that continuously changes because thinking always “has reference to some context” (Dewey, 1933 , p. 72). In the next section, we will discuss the two approaches in detail.

The technicist approach to reflection

Scholarship across the field of medical education research emphasizes that reflection is a complex phenomenon. Reflection is not seen as monolithic and one-dimensional like a switch that trainees can turn on or off. Instead, reflection moves along a continuum that happens over time (Koole et al., 2011 ; Marshall, 2019 ; Nguyen et al., 2014 ; Uygur et al., 2019 ). Such interpretations align well with a dynamic interpretation of reflection because it acknowledges that reflective practice has no clear-cut order. Nonetheless, upon closer scrutiny, studies that claim reflection is complex can still uphold technicist presuppositions that lead to particular technicist research problems and methodological solutions.

Many reviews conclude that the wide range of methodologies used to study reflection is problematic. They claim that effects of reflection are difficult to quantify and measure because multiple frameworks are in use. Cross-comparing research outcomes to harvest strong evidence yields limited results (Anderson et al., 2019 ; Bjerkvik & Hilli, 2019 ; Buckley et al., 2009 ; Chen & Forbes, 2014 ; Choperena et al., 2019 ; Contreras et al., 2020 ; Mann et al., 2007 ; McGillivray et al, 2015 ; Roessger, 2014 ; Uygur et al., 2019 ; Winkel et al., 2017 ). Ongoing theoretical disagreement over the definition of reflection is perceived as detrimental to validity and evidence-based practice (Marshall, 2019 ). The lack of consensus is seen as perpetuating “considerable uncertainty about how to best foster [reflection]” (Koole et al., 2011 , p. 7), or prevents us from knowing if reflection is effective (Roessger, 2014 ; Winkel et al., 2017 ). Therefore, “a more defined construct of reflection, with clear outcomes, could lead to the development of benchmarks useful in tracking student progress and as research outcome measures” (Chaffey et al., 2012 , p. 202).

To address the methodological challenges, studies with a technicist orientation synthesize common traits of reflection in models and definitions. They aim for “a comprehensive yet precise understanding of reflection” to accrue consensus that validates the concept (Marshall, 2019 , p. 397; Koole et al., 2011 ; Kuiper & Pesut, 2004 ; Nguyen et al., 2014 ). Research tends to define reflection in generic terms to make the concept self-contained and untied to extrinsic elements for easier operationalization. “Reflection thus remains universally applicable and understandable independent of context” (Nguyen et al., 2014 , p. 1185). Various reviews welcome such pursuits of systematized, de-contextualized models that clearly demarcate boundaries to mitigate conceptual ambivalence (Uygur et al., 2019 ).

Reviews with a technicist orientation stress the educational need for conceptual clarity and homogeneity. First, it caters to curriculum leaders who seek practical guidelines and validated assessment and feedback instruments. Such tools show whether trainees obtained the required skills, knowledge and attitudes and allow for more focused, structured and effective feedback (Chaffey et al., 2012 ; Koole et al., 2011 ; Nguyen et al., 2014 ). Moreover, standardized models and instruments help educators assess reflection outcomes uniformly and thus fairly. Second, this approach helps trainees gain a procedural understanding of reflection as a process that goes through certain phases with different dimensions that can be mastered.

The aforementioned benefits to practice are significant. However, up to this point, the field itself acknowledges its systematic failure to accurately measure effects or validly cross-compare studies to produce generalizable evidence. From the technical perspective, the solution lies with conceptual homogeneity and consensus that allows scientific standardization. Thus, the problem of reflection is complex, but in time its complexity can be instrumentally tamed because “there is nothing as practical as good theory” (Nguyen et al., 2014 , p. 1187). Despite setbacks, the truth of reflection is ultimately perceived as testable in reference to the facts based on methodological rigor, accurate models and strict definitions (Schön, 1983).

The dynamic approach to reflection

Like technicist oriented studies, those that adopt a dynamic approach to studying reflection also emphasize its complexity. Contrary to techniscist studies, however, they place theoretical emphasis on the messy nature of practice, and prioritize this over conceptual consensus and a universal definition. “Practice is characterized by uncertainty, instability, uniqueness, and value conflict, and (…) this is where the important questions of practice are negotiated” (Kinsella, 2009 , p. 6; Mantzoukas, 2008 ; Ng et al., 2015 ). Reflective practice is thus “not as a fixed trait, but, rather, a dynamic state arising out of personal experience and sources of knowledge” (Ng et al., 2020 , p. 6). This view supports the argument that reflection is not only complex, but more importantly, open. “Different practices and forms of thinking are considered reflective and the teaching of reflection is attributed to a broad diversity of educational values and purposes” (van Beveren et al., 2018 , p. 7; Beauchamp, 2015 ). Developing a nuanced view on reflective practice rejects “a one-sized solution for facilitating ‘real’ (…) reflection” (Platt, 2014 , p. 50).

Divergent views on reflection are empirically identifiable across the field. In their review, Norrie et al. ( 2012 ) conclude that there are significant variations in understanding reflection between healthcare professions. “In the medical context, the focus is on improving professional practice (…). In contrast, in other professions [e.g. nursing], reflective practice is approached more as a way of asserting each group’s autonomous professional identity” (Norrie et al., 2012 , p. 573). Research in the medical field tends to favor a realist and pragmatic approach that is outcome oriented, with an emphasis on assessment and skill acquisition. Nursing adopts a more constructivist approach that is value-oriented. This varied production of reflection literature “is related to the history and traditions within the professions as well as to evolving national debates and policy imperatives” (Norrie et al., 2012 , p. 574). Thus, the point of dynamic approaches is not synthesizing widely adopted reflective theories into one overarching, objective concept; rather, the meaning of reflection is entrenched in professional values stemming from practice with its own traditions and history. The concept of reflection is not universal, but open and socially contingent (Beauchamp, 2015 ).

Dynamic approaches suggest a revaluation of generalizable evidence. For instance, Mantzoukas (Mantzoukas, 2008 ) argues that the gold standard in Evidence Based Practice for reflection is not always a Randomized Control Trial. On the contrary, nurses “come to realize that reflection can provide not only valid evidences for practice, but possibly [allows them to be] positioned in a better place to provide more practical, useful and effective evidences” (Mantzoukas, 2008 , p. 221). Rolfe argues that “what is required is not a science of large numbers, but a science of the unique. (…) [N]ursing science requires theories about individual persons,” that can also come from individual practitioners (Rolfe, 2006 , p. 40).

The central message of scholarship that adopts a dynamic view of reflection is that “the field must broaden its conceptualization and deepen its understanding of what reflection is, from what philosophical contexts it derives, and what its purposes in the current socio-political context of medical education can be” (Ng et al., 2015 , p. 469). Instead of diminishing reflection’s openness with precise models, scholarship should embrace openness that is infused by divergent practices. Furthermore, addressing context-specific socio-political dimensions incites debate, instigating “multiple ways of thinking about complex challenges in medical education” (Ng et al., 2015 , p. 469).

Thus far, we have organized the research on reflection in a narrative, perceived through the lens of technicist and dynamic approaches. These approaches embody two different ways of tackling reflection’s complexity. A technicist approach to studying reflection has merit for practice, for instance by offering generalized and validated guidelines for education developers, trainees and practitioners. However, this merit is based on a consensus on the concept of reflection in order to subject it to solid empirical testing. From the dynamic perspective, this consensus still remains an ideal (Williams et al., 2019 )–or rather, an impossibility. To further our understanding of both positions, we juxtapose the technicist and dynamic approaches.

We can see researchers of reflection struggle with a reciprocal tension between practice and theory, especially when research wants concepts to function anywhere, at any time and any place. From a technicist perspective, self-contained concepts that reduce reflection to its essence can be applied in any context. From a dynamic perspective, such reductionist definitions can end up in a ‘double bind’ (Ng et al., 2015 ): a self-contained concept that necessarily generalizes key components of the phenomenon to exclude alternatives, but in the process compromises the complexity which it wishes to convey (Kinsella, 2009 ). The disadvantage is that “many things that actually occur are debarred from use” (Sacks, 1985 , p. 25). Conversely, reality rarely fully corresponds with abstracted prescriptions (Nofke & Brennan, 2005 ).

Generally, complex concepts show tensions between theory and practice. Tensions become tangible when research extrapolates the research object, like reflection, in a void as a self-contained concept. Borrowing from Wittgenstein’s work, concepts gain substance and significance in their situated use (Newman, 1999 ; Wittgenstein, 1958 ). For example, ‘soap’ gains concrete meaning within the context of washing your hands. To speak with the poet Ponge, soap is like no other stone found in nature. It gifts itself to you almost inexhaustibly after you marry it with water (Ponge, 2015 ). From a purely chemical context, soap is hydrophilic and hydrophobic; it can be ‘water-loving’ or ‘water-fearing’. In short, any phenomenon appears differently in distinct practices that show some overlap, but they are never completely identical. Likewise, each instance of reflection “resemble[s] others in many different ways, like the faces of people belonging to the same family,” but defining the vital essence between them is nigh impossible (Pears, 1970 , p. 108; Wittgenstein, 1958 ). Meaning of complex concepts is in “the fine grain of events and processes” (Davis, 2009 , p. 372).

To preserve the complexity and richness of reflection while trying to capture it in an all-encompassing concept provides research with a paradox . Each time we think of concepts, we deduce and reconstitute their meaning from their specific application in everyday use. Conversely, it is impossible to bring all varied uses to mind (Newman, 1999 ). A concept that needs to encompass all varied uses as much as possible will become too broad and will lose its power in the process (nearly everything can be called reflection). Simultaneously, the concept can become too narrow and precise, and cut away things that can also be seen as reflection. This paradox explains why scholars claim that reflection is notoriously difficult to define. Nonetheless, “without a context, the life of a concept is left without oxygen” (Nauta, 1984 , p. 364; Boud & Walker, 1998 ; Flyvbjerg, 2006 ). This raises the question: why can the paradox manifest itself so prevalently in research on reflection?

Reflection as a thick concept

We suggest that the paradox of formulating concepts too narrowly and too broadly, can be unpacked by thinking of reflection as a thick concept (Kirchin, 2013 ; Kroes & Meijers, 2016 ). On the one hand, thin concepts have an evaluative dimension. The barest examples are the words ‘pro’ and ‘con’, that indicate the simplest form of favoring or disfavoring something. On the other hand, thick concepts also have this evaluative function, but in addition they tell us something about a phenomenon. For instance, something is reflection when it has features of < a, b, c > , and is not reflection when < d, and e > . “The key problem here is whether we can be certain that we will ever capture all of [the phenomenon’s] instances” (Kirchin, 2013 , p. 9). The thicker the concept the more local it becomes. ‘Pro’ and ‘con’ can be used almost universally, and can be transported beyond a distinct web of practices and meanings (Harcourt & Thomas, 2013 , p. 24). Thicker concepts, however, are inherently bound to practice that thrives on some form of agreement in action among its participants (Medina, 2004 ). The crux of the matter is that socially complex phenomena are under constant interpretation because they involve countless interrelated elements; their meaning “cannot be simply ‘read off’ by direct observation” (Davis, 2017 , p. 293).

We should not forget that reflection in medical education is not there for its own sake. There is always a purpose or point to reflection, but reflective practice is never fully stable because it needs (normative) interpretation. The point hinges on traditions and evolves from its socio-cultural history and ongoing debates (Norrie et al., 2012 ). For example, in the case of reflection in practice, there are broadly speaking two opposing points. On the one hand, reflection could imply alignment with new situations, and the point is ongoing socialization. This type of reflection could be, up to some degree, measured and assessed. ‘Effective and skilled reflection’ on the part of the trainee entails that potential gaps of knowledge are identified, for example, in reflective portfolios and subsequently addressed as learning goals. Successful identification of knowledge gaps indicates that reflection was effective. On the other hand, one could argue that reflection instigates deviation from institutional norms by becoming explicitly critical of current practice. Measuring and assessing critical reflection is nonsensical, because assessment safeguards the very institutional ideals that critical reflection is supposed to question (Hodges, 2015 ; Ng et al., 2020 ; Procee, 2006 ). Other points of contention are: should reflection be about emotions, or if it should be rational, debar from emoting (Birden & Usherwood, 2013 ; Nguyen et al., 2014 ; Wald, 2015 ), is reflection a solitary or interpersonal activity (Kotzee, 2012 ), can reflection lead to harmful rumination (Lengelle et al., 2016 ), and can we measure reflection (Aukes et al., 2007 ; de la Croix & Veen, 2018 ; Veen et al., 2020 )? With each of these and other contested areas, the point of reflective practice is always at stake. Various points are incongruent and prevent a universal description of reflection from materializing. Thicker concepts place more demands on explaining the social situation they function in than thin concepts, while any concept equips the user with reasons for doing things (Harcourt & Thomas, 2013 ). Each conceptualization and application of reflection in practice is a temporary depiction of the normative debate in academia and educational institutes (Gu-Ze'ev et al., 2001 ; Norrie et al., 2012 ). This leaves research with the challenge: how can we study a debated concept like reflection?

How can we study reflection?

Given the contested state of reflection, how should we study it? The key limitation of our approach is that we interpret the philosophical underpinnings as coherently and consistently as possible, but that no conclusive interpretation exists. Nonetheless, medical education often proffers to be an interdisciplinary field, but the reality is that most medical education research is still done from the perspective of medical research (Albert et al., 2020 ). Perhaps we can achieve a ‘multidisciplinary edge effect’ (Varpio & MacLeod, 2020 ) through fruitful dialogue between technicist and dynamic approaches.

Researchers who adopt a technicist approach should be aware that their outlook on science is more in alignment with the epistemic culture from medical research, and mostly methodologically deductive in nature (Varpio & MacLeod, 2020 ). This means that reflection is usually conceptualized upfront and tested in diverse circumstances. The value of this approach is in checking if the chosen variables appear as outcomes in specific practices by using datasets like questionnaires, portfolios, rubrics or (statistical) analyses of learning outcomes. In general, this approach accepts that only features of reflection in practice that are adopted in the initial conceptualization will necessarily appear in the outcomes–‘you will find what you formulate upfront’. Those features that have not been conceptualized upfront will likewise not appear in the results (Sacks, 1985 ; Uygur et al., 2019 ). The research is mostly prescriptive . First, research is prescriptive in a normative sense, because the conceptualization prescribes what should happen in practice (van Enk & Regehr, 2018 ). Simplified, if one were to conceptualize reflection as a purely ‘rational dissection of events,’ then emotional moments are not flagged as reflective. Second, and in line with Dewey, research is prescriptive in a methodological sense because all inquiry is concept-laden. Concepts direct observation and demarcate relevant from irrelevant information (Garrison et al., 2012 ). This need not be a problem, if we keep in mind that the selection of a (thick) concept is temporary and limited. Concepts are contingent and subject to continuous reconstruction. Claiming conceptual universality by aggregating all available theories will remain, in our view, idealistic.

Technical approaches aim for self-contained concepts in generic wording to facilitate operationalization, “unlike, for example, Schön’s model, which is not easy to grasp without lengthy exploration of his writing” (Nguyen et al., 2014 , p. 1185; Koole et al., 2011 ). For example, Marshall’s concept of reflection, after synthesizing theories across different professional contexts, reads as follows: “Reflection is a careful examination and bringing together of ideas to create new insight through ongoing cycles of expression and re/evaluation” (Marshall, 2019 , p. 411). This concept is theoretically ‘correct’ and helps research gain a first footing, but from a dynamic and Wittgensteinian perspective, it remains abstract, up to the point that it means very little. What do ‘careful examination,’ ‘bringing together ideas,’ ‘ongoing cycles of expression’ and ‘re/evaluation’ look like? How do practitioners go about accomplishing such feats? What do they do, say or remain silent on? The concept still needs to come alive by aligning it closely with practice.

From the dynamic approach, we take the value of (single) case studies (Flyvbjerg, 2006 ; Newman, 1999 ; Rolfe, 2002 , 2006 ). Case studies give abstract concepts oxygen. From the dynamic perspective, case studies are not designed to mean the same thing to all people. The case study should be sufficiently rich with so many facets, mimicking practice itself, that “different readers may be attracted, or repelled, by different things in the case. Readers are not pointed down any one theoretical path or given the impression that truth might lie at the end” (Flyvbjerg, 2006 , p. 238). The case studies reject “the certainty of any one meaning implied by the single term ‘reflective practice’” (Newman, 1999 , p. 160). In the current research field, we see that researching reflective practice in situ to provide more dynamism to technicist abstractions is still underrepresented. Studies that examine reflection ‘as it occurs in practice,’ for instance with conversation analysis of reflection group sessions (van Braak et al., 2018 ; Veen & de la Croix, 2016 ), or phenomenological approaches (Rietmeijer et al., 2021 ) can provide additional dynamism.

We asked what the possible scientific approaches to conceptualizing and operationalizing reflection are, and how these influence knowledge production on reflection in practice. Our analysis of medical educational literature on reflection showed that there are two main responses to reflection’s conceptual indeterminacy. The technicist and dynamic approaches both agree that reflection is complex, but technicists attempt to tame its complexity by seeking conceptual consensus on reflection. Consensus is beneficial to standardize and cross-compare research and understand how reflection is effective. Conversely, the dynamic approach embraces reflection’s conceptual openness, and emphasizes the importance of local practice. Practices are historically contingent and evolving, and thus reflection is theoretically variable. We interpreted reflection as a thick concept, and argued that research is bound to the paradox that any conceptualization is either too broad or too narrow. Contingent practice limits the reach of any theory, and universal formulations of reflection have strong limitations. Furthermore, the two approaches can be complementary; generalized technicist theory can come alive by providing (single) case study evidence of practice.

Finally, we come back to our poet friend, Ponge, who tried to describe soap, but there was so much to say that he returned it to its saucer. It appears as if Ponge is defeated. However, we feel that his poem’s last words on the matter are of key importance: “… it is necessary to return it to its saucer, to its strict appearance, its austere oval, its dry patience, and its power to serve again” (Ponge, 2015 ). Like an effort to understand and describe soap, the key to conceptualizing reflection lies in its use and purpose that inspires any description. Taking into account that a child’s definition of soap is different from that of a chemist is crucial. Each definition of soap or reflection will do different work. Combining all occurrences to find that definitive, universal definition will remain, for us, idealistic. However, reflection, like soap, will serve again if we return to its practice, which should not be underestimated.

Acknowledgements

The authors wish to thank Michelle Verheijden for providing feedback on an early draft of this article.

Biographies

is PhD student at the Department of General Practice, Erasmus University Medical Center Rotterdam, The Netherlands.

is project manager educational research at the Department of General Practice, Erasmus University Medical Center Rotterdam, The Netherlands.

Anne de la Croix

is assistant professor in the Research in Education team at the Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, The Netherlands.

Author contributions

All authors contributed to the study conception and design. The literature search was performed by Sven Schaepkens. The first draft of the manuscript was written by Sven Schaepkens. Mario Veen and Anne de la Croix commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding/support

No funding was received for conducting this study.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Albert M, Rowland P, Friesen F, Laberge S. Interdisciplinarity in medical education research: Myth and reality. Advances in Health Sciences Education. 2020; 25 :1243–1253. doi: 10.1007/s10459-020-09977-8. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Anderson E, Sandars J, Kinnair D. The nature and benefits of team-based reflection on a patient death by healthcare professionals: A scoping review. Journal of Interprofessional Care. 2019; 33 (1):15–25. doi: 10.1080/13561820.2018.1513462. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Aukes LC, Geertsma J, Cohen-Schotanus J, Zwierstra RP, Slaets JPJ. The development of a scale to measure personal reflection in medical practice and education. Medical Teacher. 2007; 29 (2–3):177–182. doi: 10.1080/01421590701299272. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barbagallo MS. Completing reflective practice post undergraduate nursing clinical placements: A literature review. Teaching and Learning in Nursing. 2019; 14 (3):160–165. doi: 10.1016/j.teln.2019.02.001. [ CrossRef ] [ Google Scholar ]
• Beauchamp C. Reflection in teacher education: Issues emerging from a review of current literature. Reflective Practice. 2015; 16 (1):123–141. doi: 10.1080/14623943.2014.982525. [ CrossRef ] [ Google Scholar ]
• Bernard AW, Gorgas D, Greenberger S, Jacques A, Khandelwal S. The use of reflection in emergency medicine education. Academic Emergency Medicine. 2012; 19 (8):978–982. doi: 10.1111/j.1553-2712.2012.01407.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Biesta G. Witnessing deconstruction in education: why quasi-transcendentalism matters. Journal of Philosophy of Education. 2009; 43 (3):391–404. doi: 10.1111/j.1467-9752.2009.00705.x. [ CrossRef ] [ Google Scholar ]
• Birden HH, Usherwood T. “They liked it if you said you cried”: How medical students perceive the teaching of professionalism. Medical Journal of Australia. 2013; 199 (6):406–409. doi: 10.5694/mja12.11827. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bjerkvik LK, Hilli Y. Reflective writing in undergraduate clinical nursing education: A literature review. Nurse Education in Practice. 2019; 35 :32–41. doi: 10.1016/j.nepr.2018.11.013. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Boud D, Walker D. Promoting reflection in professional courses: The challenge of context. Studies in Higher Education. 1998; 23 (2):191–206. doi: 10.1080/03075079812331380384. [ CrossRef ] [ Google Scholar ]
• Brenntag. (2021). Caustic chemicals used in soap making. Retrieved from https://www.brenntag.com/en-us/industries/household-industrial-institutional/chemicals-in-liquid-soap/
• Brown J, Bearman M, Kirby C, Molloy E, Colville D, Nestel D. Theory, a lost character? As presented in general practice education research papers. Medical Education. 2019; 53 (5):443–457. doi: 10.1111/medu.13793. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Buckley S, Coleman J, Davison I, Khan KS, Zamora J, Malick S, Sayers J. The educational effects of portfolios on undergraduate student learning: A best evidence medical education (BEME) systematic review. BEME Guide No. 11. Medical Teacher. 2009; 31 (4):282–298. doi: 10.1080/01421590902889897. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Caty M-È, Kinsella EA, Doyle PC. Reflective practice in speech-language pathology: A scoping review. International Journal of Speech-Language Pathology. 2015; 17 (4):411–420. doi: 10.3109/17549507.2014.979870. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chaffey L, de Leeuw EJ, Finnigan G. Facilitating students' reflective practice in a medical course: Literature review. Education for Health. 2012; 25 (3):198–203. doi: 10.4103/1357-6283.109787. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chen I, Forbes C. Reflective writing and its impact on empathy in medical education: Systematic review. Journal of Educational Evaluation for Health Professions. 2014; 11 :20–20. doi: 10.3352/jeehp.2014.11.20. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Choperena A, Oroviogoicoechea C, Zaragoza Salcedo A, Olza Moreno I, Jones D. Nursing narratives and reflective practice: A theoretical review. Journal of Advanced Nursing. 2019; 75 (8):1637–1647. doi: 10.1111/jan.13955. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Coffield F, Moseley D, Hall E, Ecclestone K, editors. Learning styles and pedagogy in post-16 learning. A systematic and critical review. Cromwell Press Ltd.; 2004. [ Google Scholar ]
• Contreras JA, Edwards-Maddox S, Hall A, Lee MA. Effects of reflective practice on baccalaureate nursing students’ stress, anxiety and competency: An integrative review. Worldviews on Evidence-Based Nursing. 2020; 17 (3):239–245. doi: 10.1111/wvn.12438. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cornford IR. Reflective teaching: Empirical research findings and some implications for teacher education. Journal for Vocational Education and Training. 2002; 54 (2):219–236. doi: 10.1080/13636820200200196. [ CrossRef ] [ Google Scholar ]
• Crowe MT, O'Malley J. Teaching critical reflection skills for advanced mental health nursing practice: A deconstructive–reconstructive approach. Journal of Advanced Nursing. 2006; 56 (1):79–87. doi: 10.1111/j.1365-2648.2006.03982.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• D’Cruz H, Gillingham P, Melendez S. Reflexivity, its meanings and relevance for social work: A critical review of the literature. The British Journal of Social Work. 2006; 37 (1):73–90. doi: 10.1093/bjsw/bcl001. [ CrossRef ] [ Google Scholar ]
• Davis A. Examples as method? My attempts to understand assessment and fairness (in the Spirit of the Later Wittgenstein) Journal of Philosophy of Education. 2009; 43 (3):371–389. doi: 10.1111/j.1467-9752.2009.00699.x. [ CrossRef ] [ Google Scholar ]
• Davis A. It worked. there Will it work here? Researching Teaching Methods. Ethics and Education. 2017; 12 (3):289–303. doi: 10.1080/17449642.2017.1361267. [ CrossRef ] [ Google Scholar ]
• de la Croix A, Veen M. The reflective zombie: Problematizing the conceptual framework of reflection in medical education. Perspectives on Medical Education. 2018; 7 (6):394–400. doi: 10.1007/s40037-018-0479-9. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dewey J. How we think. A restatement of the relation of reflective thinking to the educative process. D. C. Heath and Company; 1933. [ Google Scholar ]
• Epp S. The value of reflective journaling in undergraduate nursing education: A literature review. International Journal of Nursing Studies. 2008; 45 (9):1379–1388. doi: 10.1016/j.ijnurstu.2008.01.006. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Erlandson P, Beach D. The ambivalence of reflection – rereading Schön. Reflective Practice. 2008; 9 (4):409–421. doi: 10.1080/14623940802475843. [ CrossRef ] [ Google Scholar ]
• Farrell TSC. Reflecting on reflective practice: (Re)Visiting Dewey and Schön. TESOL Journal. 2012; 3 (1):7–16. doi: 10.1002/tesj.10. [ CrossRef ] [ Google Scholar ]
• Fendler L. Teacher reflection in a hall of mirrors: Historical influences and political reverberations. Educational Researcher. 2003; 32 (3):16–25. doi: 10.3102/0013189x032003016. [ CrossRef ] [ Google Scholar ]
• Flyvbjerg B. Five misunderstandings about case-study research. Qualitative Inquiry. 2006; 12 (2):219–245. doi: 10.1177/1077800405284363. [ CrossRef ] [ Google Scholar ]
• Fragkos KC. Reflective practice in healthcare education: An umbrella review. Education Sciences. 2016; 6 (3):1–16. doi: 10.1080/10401334.2017.1392864. [ CrossRef ] [ Google Scholar ]
• Garrison J, Neubart S, Reich K, editors. John Dewey's philosophy of education. An introduction and recontextualization for our times. Pelgrave Macmillan; 2012. [ Google Scholar ]
• Grant MJ, Booth A. A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal. 2009; 26 (2):91–108. doi: 10.1111/j.1471-1842.2009.00848.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gu-Ze'ev I, Masschelein J, Blake N. Reflectivity, reflection, and counter-education. Studies in Philosophy and Education. 2001; 20 (2):93–106. doi: 10.1023/a:1010303001871. [ CrossRef ] [ Google Scholar ]
• Hamel C, Viau-Guay A. Using video to support teachers’ reflective practice : A literature review. Cogent Education. 2019; 6 (1):1673689. doi: 10.1080/2331186x.2019.1673689. [ CrossRef ] [ Google Scholar ]
• Harcourt E, Thomas A. Thick Concepts, Analysis and Reductionism. In: Kirchin S, editor. Thick Concepts. Oxford: Oxford University Press; 2013. pp. 20–43. [ Google Scholar ]
• Hébert C. Knowing and/or experiencing: A critical examination of the reflective models of John Dewey and Donald Schön. Reflective Practice. 2015; 16 (3):361–371. doi: 10.1080/14623943.2015.1023281. [ CrossRef ] [ Google Scholar ]
• Heidegger M. Off the beaten track (J. Young &amp; K. Haynes, Trans.) Cambridge University Press; 2002. [ Google Scholar ]
• Hodges BD. Sea monsters & whirlpools: Navigating between examination and reflection in medical education. Medical Teacher. 2015; 37 (3):261–266. doi: 10.3109/0142159x.2014.993601. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Holma K. The strict analysis and the open discussion. Journal of Philosophy of Education. 2009; 43 (3):325–338. doi: 10.1111/j.1467-9752.2009.00696.x. [ CrossRef ] [ Google Scholar ]
• Jayatilleke N, Mackie A. Reflection as part of continuous professional development for public health professionals: A literature review. Journal of Public Health. 2012; 35 (2):308–312. doi: 10.1093/pubmed/fds083. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kinsella EA. Technical rationality in Schön’s reflective practice: Dichotomous or non-dualistic epistemological position. Nursing Philosophy. 2007; 8 (2):102–113. doi: 10.1111/j.1466-769X.2007.00304.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kinsella EA. Professional knowledge and the epistemology of reflective practice. Nursing Philosophy. 2009; 11 (1):3–14. doi: 10.1111/j.1466-769X.2009.00428.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kirchin S. Introduction: Thick and Thin Concepts. In: Kirchin S, editor. Thick Concepts. Oxford: Oxford University Press; 2013. pp. 1–19. [ Google Scholar ]
• Koole S, Dornan T, Aper L, Scherpbier A, Valcke M, Cohen-Schotanus J, Derese A. Factors confounding the assessment of reflection: A critical review. BMC Medical Education. 2011; 11 :104–104. doi: 10.1186/1472-6920-11-104. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kotzee B. Private practice: Exploring the missing social dimension in ‘reflective practice’ Studies in Continuing Education. 2012; 34 (1):5–16. doi: 10.1080/0158037x.2012.660521. [ CrossRef ] [ Google Scholar ]
• Kroes P, Meijers AWM. Toward an axiological turn in the philosophy of technology. In: Franssen M, Vermaas PE, Kroes P, Meijers AWM, editors. Philosophy of Technology after the Empirical Turn. Switzerland: Springer International Publishing; 2016. pp. 11–30. [ Google Scholar ]
• Kuiper RA, Pesut DJ. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: Self-regulated learning theory. Journal of Advanced Nursing. 2004; 45 (4):381–391. doi: 10.1046/j.1365-2648.2003.02921.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kurt M. Quality in reflective thinking: Elicitation and classification of reflective acts. Quality & Quantity. 2018; 52 (1):247–259. doi: 10.1007/s11135-017-0609-1. [ CrossRef ] [ Google Scholar ]
• Lengelle R, Luken T, Meijers F. Is self-reflection dangerous? Preventing rumination in career learning. Australian Journal of Career Development. 2016; 25 (3):99–109. doi: 10.1177/1038416216670675. [ CrossRef ] [ Google Scholar ]
• Lethbridge K, Andrusyszyn MA, Iwasiw C, Laschinger HK, Fernando R. Structural and psychological empowerment and reflective thinking: Is there a link? The Journal of Nursing Education. 2011; 50 (11):636–645. doi: 10.3928/01484834-20110817-02. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education. 2007; 14 (4):595–621. doi: 10.1007/s10459-007-9090-2. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mantzoukas S. A review of evidence-based practice, nursing research and reflection: Levelling the hierarchy. Journal of Clinical Nursing. 2008; 17 (2):214–223. doi: 10.1111/j.1365-2702.2006.01912.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Marshall T. The concept of reflection: A systematic review and thematic synthesis across professional contexts. Reflective Practice. 2019; 20 (3):396–415. doi: 10.1080/14623943.2019.1622520. [ CrossRef ] [ Google Scholar ]
• McGillivray J, Gurtman C, Boganin C, Sheen J. Self-practice and self-reflection in training of psychological interventions and therapist skills development: A qualitative meta-synthesis review. Australian Psychologist. 2015; 50 (6):434–444. doi: 10.1111/ap.12158. [ CrossRef ] [ Google Scholar ]
• Medina J. In defense of pragmatic contextualism: Wittgenstein and Dewey on meaning and agreement. The Philosophical Forum. 2004; 35 (3):341–369. doi: 10.1111/j.1467-9191.2004.00177.x. [ CrossRef ] [ Google Scholar ]
• Nauta LW. Historical roots of the concept of autonomy in Western philosophy. Praxis International. 1984; 4 :363–377. [ Google Scholar ]
• Newman SJ. Constructing and critiquing reflective practice 1. Educational Action Research. 1999; 7 (1):145–163. doi: 10.1080/09650799900200081. [ CrossRef ] [ Google Scholar ]
• Ng SL. Reflection and reflective practice: Creating knowledge through experience. Seminars in Hearing. 2012; 33 (02):117–134. doi: 10.1055/s-0032-1311673. [ CrossRef ] [ Google Scholar ]
• Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: A critical narrative review. Medical Education. 2015; 49 (5):461–475. doi: 10.1111/medu.12680. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ng SL, Mylopoulos M, Kangasjarvi E, Boyd VA, Teles S, Orsino A, Phelan S. Critically reflective practice and its sources: A qualitative exploration. Medical Education. 2020; 54 (4):312–319. doi: 10.1111/medu.14032. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nguyen QD, Fernandez N, Karsenti T, Charlin B. What is reflection? A conceptual analysis of major definitions and a proposal of a five-component model. Medical Education. 2014; 48 (12):1176–1189. doi: 10.1111/medu.12583. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nofke S, Brennan M. The dimensions of reflection: A conceptual and contextual analysis. International Journal of Progressive Education. 2005; 1 (3):44–63. [ Google Scholar ]
• Norrie C, Hammond J, D’Avray L, Collington V, Fook J. Doing it differently? A review of literature on teaching reflective practice across health and social care professions. Reflective Practice. 2012; 13 (4):565–578. doi: 10.1080/14623943.2012.670628. [ CrossRef ] [ Google Scholar ]
• Pears DF. Ludwig Wittgenstein. Viking Press; 1970. [ Google Scholar ]
• Platt L. The 'wicked problem' of reflective practice: a critical literature review. Innovations in Practice. 2014; 9 (1):44–53. doi: 10.24377/LJMU.iip.vol9iss1article108. [ CrossRef ] [ Google Scholar ]
• Ponge, F. (2015). Soap. Retrieved September, 18, 2020, from The Paris Review Foundation theparisreview.org/blog/2015/03/27/soap
• Prakash S, Sladek RM, Schuwirth L. Interventions to improve diagnostic decision making: A systematic review and meta-analysis on reflective strategies. Medical Teacher. 2019; 41 (5):517–524. doi: 10.1080/0142159x.2018.1497786. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Prasko J, Mozny P, Novotny M, Slepecky M, Vyskocilova J. Self-reflection in cognitive behavioural therapy and supervision. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2012; 156 (4):377–384. doi: 10.5507/bp.2012.027. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Procee H. Reflection in education: A Kantian epistemology. Educational Theory. 2006; 56 (3):237–253. doi: 10.1111/j.1741-5446.2006.00225.x. [ CrossRef ] [ Google Scholar ]
• Richard A, Gagnon M, Careau E. Using reflective practice in interprofessional education and practice: A realist review of its characteristics and effectiveness. Journal of Interprofessional Care. 2019; 33 (5):424–436. doi: 10.1080/13561820.2018.1551867. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rietmeijer CBT, Deves M, van Esch SCM, van der Horst HE, Blankenstein AH, Veen M, Teunissen PW. A phenomenological investigation of patients’ experiences during direct observation in residency: Busting the myth of the fly on the wall. Advances in Health Sciences Education. 2021 doi: 10.1007/s10459-021-10044-z. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Robbin M, Asselin M. Reflection as an educational strategy in nursing professional development. Journal for Nurses in Professional Development. 2015; 31 (2):62–72. doi: 10.1097/NND.0000000000000151. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Roessger KM. The effect of reflective activities on instrumental learning in adult work-related education: A critical review of the empirical research. Educational Research Review. 2014; 13 :17–34. doi: 10.1016/j.edurev.2014.06.002. [ CrossRef ] [ Google Scholar ]
• Rolfe G. Reflective practice: Where now? Nurse Education in Practice. 2002; 2 (1):21–29. doi: 10.1054/nepr.2002.0047. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rolfe G. Nursing Praxis and the science of the unique. Nursing Science Quarterly. 2006; 19 (1):39–43. doi: 10.1177/0894318405284128. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rønning SB, Bjørkly S. The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education: An integrative review. Advances in Medical Education and Practice. 2019; 10 :415–425. doi: 10.2147/amep.S202115. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ruitenberg C. Introduction: The question of method in philosophy of education. Journal of Philosophy of Education. 2009; 43 (3):315–323. doi: 10.1111/j.1467-9752.2009.00712.x. [ CrossRef ] [ Google Scholar ]
• Ruth-Sahd LA. Reflective practice: A critical analysis of data-based studies and implications for nursing education. The Journal of Nursing Education. 2003; 42 (11):488–497. doi: 10.3928/0148-4834-20031101-07. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sacks, H. (1985). Notes on methodology. In M. J. Atkinson (Ed.), Structures of Social Action. Studies in Emotion and Social Interaction (pp. 21–27). Cambridge: Cambridge University Press. (Reprinted from: 2010)
• Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Medical Teacher. 2009; 31 (8):685–695. doi: 10.1080/01421590903050374. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schön DA. The reflective practitioner. How Professionals think in action. Basic Books; 1983. [ Google Scholar ]
• Steven A, Wilson G, Turunen H, Vizcaya-Moreno MF, Azimirad M, Kakurel J, Porras J, Tella S, Pérez-Cañaveras R, Sasso L, Aleo G, Myhre K, Ringstad Ø, Sara-Aho A, Scott M, Pearson P. Critical incident techniques and reflection in nursing and health professions education: Systematic narrative review. Nurse Educator (in press); 2020. [ PubMed ] [ Google Scholar ]
• Torres JT, Higheagle Strong Z, Adesope OO. Reflection through assessment: A systematic narrative review of teacher feedback and student self-perception. Studies in Educational Evaluation. 2020; 64 :100814. doi: 10.1016/j.stueduc.2019.100814. [ CrossRef ] [ Google Scholar ]
• Tretheway R, Taylor J, O'Hara L, Percival N. A missing ethical competency? A review of critical reflection in health promotion. Health Promotion Journal of Australia. 2015; 26 (3):216–221. doi: 10.1071/he15047. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Uygur J, Stuart E, De Paor M, Wallace E, Duffy S, O’Shea M, Pawlikowska T. A best evidence in medical education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51. Medical Teacher. 2019; 41 (1):3–16. doi: 10.1080/0142159x.2018.1505037. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• van Beveren L, Roets G, Buysse A, Rutten K. We all reflect, but why? A systematic review of the purposes of reflection in higher education in social and behavioral sciences. Educational Research Review. 2018; 24 :1–9. doi: 10.1016/j.edurev.2018.01.002. [ CrossRef ] [ Google Scholar ]
• van Braak M, de Groot E, Veen M, Welink L, Giroldi E. Eliciting tacit knowledge: The potential of a reflective approach to video-stimulated interviewing. Perspectives on Medical Education. 2018; 7 (6):386–393. doi: 10.1007/s40037-018-0487-9. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• van Enk A, Regehr G. HPE as a Field: implications for the production of compelling knowledge. Teaching and Learning in Medicine. 2018; 30 (3):337–344. doi: 10.1080/10401334.2017.1392864. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Varpio L, MacLeod A. Philosophy of science series: Harnessing the multidisciplinary edge effect by exploring paradigms, ontologies, epistemologies, axiologies, and methodologies. Academic Medicine. 2020; 95 (5):686–698. doi: 10.1097/ACM0000000000003142. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Varpio L, Paradis E, Uijtdehaage S, Young M. The distinctions between theory, theoretical framework, and conceptual framework. Academic Medicine. 2020; 95 (7):989–994. doi: 10.1097/ACM.0000000000003075. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Veen M, Cianciolo AT. Problems no one looked for: Philosophical expeditions into medical education. Teaching and Learning in Medicine. 2020; 32 (3):337–344. doi: 10.1080/10401334.2020.1748634. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Veen M, de la Croix A. Collaborative reflection under the microscope: Using conversation analysis to study the transition from case presentation to discussion in GP residents' experience sharing sessions. Teaching and Learning in Medicine. 2016; 28 (1):3–14. doi: 10.1080/10401334.2015.1107486. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Veen M, Skelton J, de la Croix A. Knowledge, skills and beetles: Respecting the privacy of private experiences in medical education. Perspectives on Medical Education. 2020; 9 (2):111–116. doi: 10.1007/s40037-020-00565-5. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wald HS. Refining a definition of reflection for the being as well as doing the work of a physician. Medical Teacher. 2015; 37 (7):696–699. doi: 10.3109/0142159x.2015.1029897. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Williams B. Developing critical reflection for professional practice through problem-based learning. Journal of Advanced Nursing. 2000; 34 (1):27–34. doi: 10.1046/j.1365-2648.2001.3411737.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Williams JC, Ireland T, Warman S, Cake MA, Dymock D, Fowler E, Baillie S. Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care. European Journal of Dental Education. 2019; 23 (4):389–404. doi: 10.1111/eje.12445. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Winkel AF, Yingling S, Jones A-A, Nicholson J. Reflection as a learning tool in graduate medical education: A systematic review. Journal of Graduate Medical Education. 2017; 9 (4):430–439. doi: 10.4300/jgme-d-16-00500.1. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wittgenstein L. Philosophical investigations. In: Anscombe GEM, editor. Trans. 3. Oxford: Basil Blackwell Ltd; 1958. [ Google Scholar ]
• Ziebart C, MacDermid JC. Reflective practice in physical therapy: A scoping review. Physical Therapy. 2019; 99 (8):1056–1068. doi: 10.1093/ptj/pzz049. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Should we retransplant a patient who is non-adherent? A literature review and critical reflection

Affiliation.

• 1 Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium. [email protected]
• PMID: 22248250
• DOI: 10.1111/j.1399-3046.2011.01633.x

The majority of transplant centers around the world face an ethical debate whether to retransplant a young non-adherent patient. Non-adherence to lifelong immunosuppressants presents a significant risk for graft loss, yet rates remain consistently high. Despite a number of these patients presenting for retransplantation, there is little evidence to guide professionals in their decision-making. This paper aims to provide such guidance, by systematically reviewing the existing outcome data for retransplantation in patients who are known to be non-adherent to their immunosuppressants. This review searched for original papers that addressed retransplantation of a solid organ and included quantitative data on adherence or graft function. Only one original research paper was found to meet the inclusion criteria. This paper is reviewed, and details of the protocol to determine eligibility for retransplantation are summarized. The findings are discussed within the ethical context that transplant professionals work within, and the arguments for and against retransplantation are considered. The need for effective integration of adherence management into routine practice is highlighted, with an emphasis on reliable measurement of adherence throughout the patient's life. Examples of good practice are discussed, favoring prevention over cure.

© 2012 John Wiley & Sons A/S.

Publication types

• Ethics, Medical
• Graft Survival
• Immunosuppression Therapy / methods
• Immunosuppressive Agents / pharmacology
• Patient Compliance*
• Patient Education as Topic
• Postoperative Complications / surgery
• Reoperation / methods*
• Resource Allocation
• Tissue and Organ Procurement
• Transplantation / methods*
• Immunosuppressive Agents

Grants and funding

• MR/J006742/1/MRC_/Medical Research Council/United Kingdom

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Computer Science > Social and Information Networks

Title: computational propaganda theory and bot detection system: critical literature review.

Abstract: According to the classical definition, propaganda is the management of collective attitudes by manipulation of significant symbols. However this definition has changed to computational propaganda, the way manipulation takes place in digital medium. Computational propaganda is the use of algorithms, automation and human curation to purposefully distribute misleading information over social media networks to manipulate public opinion, for political polarization etc. Digital media platforms have introduced new modalities of propaganda such as the use of social bots and state-organized 'troll armies' for social astroturfing to simulate public support or opposition towards a particular topic. Along with this digital media has blurred the line between different forms of propaganda. Hence existing conceptual and epistemological frameworks in propaganda studies need a revision. One of the methods to detect the computational propaganda is to identify automation and bots. Many supervised machine learning based frameworks have been proposed for bot detection but these systems can only identify single accounts, not the coordinated activities of botnets and also these systems depend on the data structure provided by the social media platforms. Similarly, current systems have not included the image features in their detection system. Most of the systems are mainly built for Twitter while there are still uncharted areas of research in other social media platforms. Therefore, there are many unexplored research questions and methods in bot detection systems.

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