Intended for healthcare professionals

Practice Teaching Rounds

The self critical doctor: helping students become more reflective

BMJ 2008; 336 doi: (Published 10 April 2008) Cite this as: BMJ 2008;336:827
  1. Erik Driessen, assistant professor1,
  2. Jan van Tartwijk, associate professor2,
  3. Tim Dornan, professor3
  1. 1Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
  2. 2ICLON Graduate School of Teaching, Leiden University, Leiden, the Netherlands
  3. 3University of Manchester and Salford Royal Hospitals, Hope Hospital, Salford M6 8HD
  1. Correspondence to: E Driessen e.driessen{at}

    Reflection underpins learning from experience, so how do you foster reflection in your students? This article explores the best ways to do this

    Key points

    • Reflection is vital for learning from clinical experiences

    • Students do not generally adopt reflective learning habits spontaneously, so teachers must help them

    • Clinical teachers can stimulate students to assess and analyse their actions and devise alternative actions

    • To do so, they must provide a challenging but safe learning environment, give feedback, and ask the right questions

    • The skill of the clinical teacher is to listen well and ask open questions

    Defining reflection

    Reflection means letting future behaviour be guided by a systematic and critical analysis of past actions and their consequences

    Whether or not “experience” means “making the same mistakes with increasing confidence over an impressive number of years”1 depends on how self analytical and critical you are. When you speak of your students needing to be “more reflective” you mean they should let their future behaviour be guided by systematic and critical evaluation and analysis of actions and beliefs and the assumptions that underlie them.2 All UK doctors are now expected to make reflection a critical foundation of their lifelong learning3 on the assumption that patients will benefit.4 This emphasis on reflective learning in medical education is relatively new, and certainly no hard evidence exists yet that patients benefit directly from doctors’ reflective learning.5

    However, evidence suggests that reflection could help students to learn from their experiences. A study in postgraduate medical education found that reflection plays a vital role in helping junior doctors to learn from clinical experiences.6 Acquiring reflective learning skills helped undergraduate medical students to identify their learning needs and stimulated learning that focused on comprehension and understanding.7 Research in the fields of expertise development,8 nurse training, …

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