Cultivating Neuroplasticity through Reflection?
I recently had the opportunity to present about reflection as a skill for developing expert practice.
As a student, new clinician, and a clinical instructor I’ve had the opportunity to complete structured reflections on my clinical practice. Often these were guided questions about a patient case or interaction. Although I felt these tools for reflection were helpful, I also found them tedious. There was a marked drudgery about returning to a case scenario after already performing and documenting the interaction. It felt like I was rehashing something for the 3rd time. Although I was aware I learned something by the end of the reflection, I often questioned, was it really worth the time lost that I could learn something new?
This internal struggle lasted throughout graduate school and through my first few years of practice. My first 2 years of practice felt like a constant loop of reflection. I saw the patient, write the clinical note, wrote weekly case summaries for team conferences (with OT, SLP, rehab psychology, case management, and physiatrist), presented the patient case in team conference, and finally triaged plan of care decision for the patient case in team conference. Deviling into, “yet another” reflective perspective on the same patient case scenario felt tortious. “What more can I learn here,” was often the thought roaming through my head.
Given the feeling of drudgery I felt of diving so deep into case scenarios, it was ironic, when I began studying for my board specialization in neurologic PT, that one of the first articles I started reading was “A Tool for Clinical Reasoning and Reflection Using the International Classification of Functioning, Disability, and Health (ICF) Framework and Patient Management Model”, published by the journal of physical therapy in 2011. This article was recommended by my mentor and she asked me to choose 1 pt case, JUST ONE, and complete the reflective questions. Several (seriously, several) hours and deep thought later a light bulb went off. Despite all the documentation, all the team conferences, all the dialogue, and triage, I was only scratching the surface. Going through the first case in such depth truly blew me away. I learned more from that one reflection practice than I did in my first 2 years of practice and hundreds of patients interactions. This level of reflection helped me to truly think about my thinking. I challenged my biases, my perceptions, my hypothesis, and even my positive outcomes. That one, in-depth, dive changed my entire view of my clinical practice. I began approaching each and every case with a new lens of not just learning at the moment, but “thinking about my thinking” of a given experience.
I begin introducing this clinical reflection tool with all of my students during these last 2 weeks or so of clinical rotation. I wanted them to dive deeper, by challenging their reasoning on a new level. As I often felt in school, at first I received a lot of grumbles when requesting this of them, in those last 2 weeks. Just when they felt they were finally getting a handle of the caseload, I threw a curveball. But after completing a section, each and every student was so grateful for gaining this perspective.
Since that time, I have approached each patient case from this lens of reflection, but I had not reflected on reflection as a skill or learned practice until recently. While preparing for this presentation. I dusted off an old textbook of mine, “Teaching and Learning in Physical Therapy: from Classroom to Clinic” by Margaret Plack and Maryanne Driscoll. This was another textbook I acquired on my journey to my NCS. At the time, I’d only skimmed it, but now it was time to really break in the binding and really grasp the author's perspective of teaching, reflection, and even the neuroplastic nature of learning. I was fascinated!
Through exploring the skill of learning and reflection, I was able to begin to connect my love for learning, my excitement with neuroplasticity, and a new interest in mindfulness as a possible opportunity for improving reflection.
I believe what I was lacking in my reflections in graduate school or in those first 2 years of practice, was guided attention to the present moment. I simply did not know what I did not know, so I didn’t have to tools to ask myself the right questions in the moment or after the experience.
Some of the tools that I will begin exploring over the next few weeks will discuss ways to cultivate neuroplasticity through a reflection in both your personal and professional life.
