Learner Reflection Exercises

Evidence across multiple studies support reflective practice as a moderator for learners’ uncertainty tolerance development. Without guidance however, some learners may focus on describing the scenarios in which they experienced uncertainty, without critical reflection as to how the uncertain related to their learning and future professional role.  Each of these elements is an important factor in the impact of reflective practice in this context. The following recommendations (adapted from Stephens et al., 2024) can be used to guide learners on how to reflect on uncertainty, as well as considerations for educators when implementing reflective learning activities.

1. Ask learners to describe a scenario in which they or others experienced uncertainty

Educator Tip:  Health professions learners typically experience substantive uncertainties relating to the learning, professional development and the practice of their future profession (e.g., uncertainties inherent in clinical practice). Some learners may be able to identify uncertain scenarios without prompting. However, example scenarios may be helpful to develop learners’ skills for managing uncertainties in learning and clinical care, and could include:

1. Expert management of uncertainty. Describe a time when you observed a supervising clinician responding to uncertainty. What were they uncertain about, and how did they respond to and manage the uncertainty?
2. Communication of uncertainty. Describe a time when you or someone else communicated uncertainty (e.g., to a patient, fellow learner, supervisor, etc.). What was the uncertainty about (e.g., clinical care, learning, professionalism, etc.), and how did those involved in the conversation express and respond to the uncertainty?
3. Clinical care uncertainty. Describe a time when you recognised uncertainty in clinical care (e.g., diagnosis, management, prognosis, etc.). Why was this scenario uncertain and how did you recognise this?

2. Provide prompts for how to engage in critical reflection on uncertainty to build skills for adaptively managing uncertainty

Educator Tip: These prompts are designed to elicit how learners respond to the uncertainty described in step 1, and what can be learnt from the scenario for future experiences when faced with uncertainty. This recommendation utilises a common framework for reflection, the ‘What, So What, Now What’ approach (Academy of Medical Royal Colleges, et al., n.d.), but is adapted to integrate the elements of uncertainty tolerance models:

1. What were your responses to the observations and/or experiences of uncertainty across your thoughts, feelings and actions?
2. Given the context of the uncertainty, how effective were your actions (or those of the person you observed) in managing uncertainty and why?
3. What did you learn from this scenario about managing uncertainty, and what might you do differently when managing a similar uncertain scenario in the future?

3. Consider how educators and institutions can optimise reflection on uncertainty

1. Provide feedback from trusted educators or mentors. This may include individualised feedback where feasible, or aggregated feedback where key learning points relevant to the wider cohort are provided.
2. Ensure repeated opportunities for reflection and feedback. Ideally, multiple opportunities for reflection on uncertainty are provided across the duration of a unit or course or study. Learners could even return to earlier reflections and reflect how they may have changed their approaches to managing uncertainty in light of learning, experience and feedback.
3. Consider learner psychological safety. Reflective learning should focus on learner development, and hence summative reflections should typically be avoided as these may lead to learners presenting idealised versions of events. To facilitate discussion of challenging or contentious topics, allowing for anonymised reflections and feedback may be appropriate.
4. Allow flexibility in the format of reflections. Types of reflections include written, typed, audio recorded or visual arts-based approaches. The key is the chosen format facilitates the learner critically engaging with the uncertainty they experienced, as the format to best engage may differ between learners.

References

Academy of Medical Royal Colleges, UK Conference of Postgraduate Medical Deans, General Medical Council, & Medical Schools Council. (n.d.). The reflective practitioner: Guidance for doctors and medical students. General Medical Council. https://www.gmc-uk.org/-/media/documents/dc11703-pol-w-the-reflective-practioner-guidance-20210112_pdf-78479611.pdf

Stephens, G. C., Sarkar, M., & Lazarus, M. D. (2024). ‘I was uncertain, but I was acting on it’: A longitudinal qualitative study of medical students’ responses to uncertainty. Medical Education, 58(7), 869-879. https://doi.org/10.1111/medu.15269