Skip to main content

Advertisement

Log in

Using reflective learning to improve the impact of continuing education in the context of work rehabilitation

  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

Abstract

Reflective learning has been described as a promising approach for ameliorating the impact of continuing education (CE) programs. However, there are still very few studies that have investigated how occupational therapists use reflection to improve the integration of CE program content in their decision-making processes. The study objectives were to describe how these professionals, working in the sector of work rehabilitation, used reflective learning to integrate research evidence into their clinical decision-making process and to identify the factors that influenced the reflective learning process. A collaborative research study was conducted. Eight occupational therapists were recruited to participate to the group that was convened for 12 meetings and held during a 15-month period. The strategies used were critical analysis of ill-structured and authentic clinical situations, peer support, reflective journal writing and complementary reading. The group facilitator acted as a research evidence mentor and guided the group process. The data collected was analyzed using the grounded theory method. The reflective learning process, used by the participants, enabled them to change their perspective at six different stages in their decision-making process. The participants developed their ability to use different types of reflective thinking: introspection, concept attainment, self-attribution, problem solving, action planning and reorganization. The factors that most influenced learning were: ease in sharing experience, normative beliefs, coping with negative emotions, perceived self-efficacy, social support and risk taking. Results led to the development of the Model of Research Utilization Grounded in Critical Reflection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology, 42, 665–683.

    Article  Google Scholar 

  • Andersen, L. T. (2000). Occupational therapy practitioners’ perceptions of the impact of continuing education activities in continuing competency. American Journal of Occupational Therapy, 55, 449–454.

    Article  Google Scholar 

  • Bandura, A. (1977). Social learning theory. New York: General Learning Press.

    Google Scholar 

  • Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press.

    Google Scholar 

  • Boud, D. (2001). Using journal writing to enhance reflective practice. New Directions for Adult and Continuing Education, 90, 9–17.

    Article  Google Scholar 

  • Boyd, E. M., & Fales, A. W. (1983). Reflective learning: Key to learning from experience. Journal of Humanistic Psychology, 23, 99–117.

    Article  Google Scholar 

  • Brookfield, S. (1991). Using critical incidents to explore learners’ assumptions. In J. Mezirow (Ed.), Fostering critical reflection in adulthood (pp. 177–193). San Francisco: Jossey-Bass.

    Google Scholar 

  • Bruner, J. (1996). The culture of education. Cambridge: Harvard University Press.

    Google Scholar 

  • Canadian Association of Occupational Therapy. (2006). CAOT position statement:Continuing professional education. Retrieved March 10, 2009, from http://www.caot.ca/default.asp?ChangeID=163&pageID=153.

  • Craik, J., & Rappolt, S. (2003). Theory of research utilization enhancement: A model for occupational therapy. Canadian Journal of Occupational Therapy, 70, 266–275.

    Google Scholar 

  • Desgagné, S., Bednarz, N., Couture, C., Poirier, L., & Lebuis, P. (2001). L’approche collaborative de recherche en éducation: Un rapport nouveau à établir entre recherche et formation. Revue des sciences de l’éducation, 27, 33–64.

    Google Scholar 

  • Dewey, J. (1933). How we think: A restatement of the relation of reflective thinking to the education process. Boston: Heath.

    Google Scholar 

  • Duffy, A. (2007). A concept analysis of reflective practice: Determining its value to nurses. British Journal of Nursing, 16, 1400–1407.

    Google Scholar 

  • Duggan, R. (2005). Reflection as a means to foster client-centred practice. Canadian Journal of Occupational Therapy, 72, 103–112.

    Google Scholar 

  • Duncan, E. A. S. (2006). The cognitive behavioral fram of reference. In E. A. S. Duncan (Ed.), Fondations for practice in occupational therapy (pp. 217–232). London: Elsevier Churchill Livingstone.

  • Dunstan, D. A., & Covic, T. (2006). Compensable work disability management: A literature review of biopsychosocial perspectives. Australian Journal of Occupational Therapy, 53, 67–77.

    Google Scholar 

  • Durand, M. J., & Loisel, P. (2001). Therapeutic return to work: Rehabilitation in the workplace. Work, 17, 57–63.

    Google Scholar 

  • Durand, M. J., Loisel, P., Hong, Q. N., & Charpentier, N. (2002). Helping clinicians in work disability prevention: The work disability diagnosis interview. Journal of Occupational Rehabilitation, 12, 191–204.

    Article  Google Scholar 

  • Durand, M. J., Vachon, B., Loisel, P., & Berthelette, D. (2003). Constructing the program impact theory for an evidence-based work rehabilitation program for workers with low back pain. Work, 21, 233–242.

    Google Scholar 

  • Eccles, M., Grimshaw, J., Walker, A., Johnston, M., & Pitts, N. (2005). Changing the behavior of healthcare professionals: The use of theory in promoting the uptake of research findings. Journal of Clinical Epidemiology, 58, 107–112.

    Article  Google Scholar 

  • Epstein, R. M. (1999). Mindful practice. Journal of the American Medical Association, 282, 833–839.

    Article  Google Scholar 

  • Errington, E., & Roberson, L. (1998). Promoting staff development in occupational therapy. British Journal of Occupational Therapy, 61, 497–503.

    Google Scholar 

  • Feaver, S., & Edmans, J. (2006). Theoretical approaches to motor control and cognitive-perceptual function. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (4th ed., pp. 277–294). London: Elsevier Churchill Livingstone.

    Google Scholar 

  • Fish, D., & Coles, C. (1998). Developing professional judgement in health care. Oxford: Butterworth Heinemann.

    Google Scholar 

  • Gatchel, R. J., & Turk, D. C. (2008). Criticisms of the biopsychosocial model in spine care: Creating and then attacking a straw person. Spine, 33, 2831–2836.

    Article  Google Scholar 

  • Godin, G., Bélanger-Gravel, A., Eccles, M., & Grimshaw, J. (2008). Healthcare professionals’ intentions and behaviours: A systematic review of studies based on social cognitive theories. Implementation Science, 3, 36.

    Article  Google Scholar 

  • Greenwood, J. (1998). The role of reflection in single and double loop learning. Journal of Advanced Nursing, 27, 1048–1053.

    Article  Google Scholar 

  • Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. Medical Journal of Australia, 180, S57–S60.

    Google Scholar 

  • Guba, E., & Lincoln, Y. (1989). Fourth generation evaluation. Newbury Park: Sage.

    Google Scholar 

  • Hagedorn, R. (2000). Introduction to therapeutic use of self. In R. Hagedorn (Ed.), Tools for practice in occupational therapy: A structured approach to core skills and processes. Amsterdam: Elsevier Health Sciences.

    Google Scholar 

  • Illeris, K. (2004). Transformative learning in the perspective of a comprehensive learning theory. Journal of Transformative Education, 2, 79–89.

    Article  Google Scholar 

  • Joyce, B., Calhoun, E., & Hopkins, D. (2002). Models of learning—tools for teaching (2nd ed.). Buckingham: Open University Press.

    Google Scholar 

  • Kember, D. (2001). Reflective teaching and learning in the health professions. Oxford: Blackwell Science.

    Book  Google Scholar 

  • Kember, D., Jones, A., Loke, A., Mckay, J., Sinclair, K., Tse, H., et al. (1999). Determining the level of reflective thinking from students’ written journals using a coding scheme based on the work of Mezirow. International Journal of Lifelong Education, 18, 18–30.

    Article  Google Scholar 

  • Kemmis, S., & McTaggart, R. (2000). Participatory action research. In N. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research. Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  • Kinsella, E. A. (2000). Professional development and reflective practice: Strategies for learning through professional experience. Ottawa: CAOT Publications ACE.

    Google Scholar 

  • Klein, H. J. (1989). An integrated control theory model of work motivation. Academy of Management Review, 14, 150–172.

    Article  Google Scholar 

  • Kontosh, L. G. (2000). Ethical rehabilitation counseling in a managed-care environment. Journal of Rehabilitation, 66, 9–14.

    Google Scholar 

  • Leeuw, M., Goossens, M. E., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30, 77–94.

    Article  Google Scholar 

  • Loisel, P., Buchbinder, R., Hazard, R., Keller, R., Scheel, I., van Tulder, M., et al. (2005). Prevention of work disability due to musculoskeletal disorders: The challenge of implementing evidence. Journal of Occupational Rehabilitation, 15, 507–524.

    Article  Google Scholar 

  • Loisel, P., Durand, M. J., Berthelette, D., Vezina, N., Baril, R., Gagnon, D., et al. (2001). Disability prevention—new paradigm for the management of occupational back pain. Disease Management & Health Outcomes, 9, 351–360.

    Article  Google Scholar 

  • Loisel, P., Durand, M. J., Diallo, B., Vachon, B., Charpentier, N., & Labelle, J. (2003). From evidence to community practice in work rehabilitation: The Quebec experience. Clinical Journal of Pain, 19, 105–113.

    Article  Google Scholar 

  • Lowe, M., Rappolt, S., Jaglal, S., & Macdonald, G. (2007). The role of reflection in implementing learning from continuing education into practice. Journal of Continuing Education in the Health Professions, 27, 143–148.

    Article  Google Scholar 

  • Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14(4), 595–621. doi:10.1007/s10459-007-9090-2.

  • McMillan, I. R. (2006). Assumptions underpinning a biomechanical frame of reference in occupational therapy. In E. S. Duncan (Ed.), Foundations for practice in occupational therapy (4th ed., pp. 255–275). London: Elsevier Churchill Livingstone.

    Google Scholar 

  • McWilliam, C. L. (2007). Continuing education at the cutting edge: Promoting transformative knowledge translation. Journal of Continuing Education in the Health Professions, 27, 72–79.

    Article  Google Scholar 

  • Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: The Guildford.

    Google Scholar 

  • Moon, J. (2004). Using reflective learning to improve the impact of short courses and workshops. Journal of Continuing Education in the Health Professions, 24, 4–11.

    Article  Google Scholar 

  • Mosey, A. (1986). Psychosocial components of occupational therapy. New Psychosocial components of occupational therapy. New York: Raven.

    Google Scholar 

  • Novak, J. D. & Cañas, A. J. (2006). The theory underlying concept maps and how to construct and use them. Retrieved April 13, 2009, from http://cmap.ihmc.us/Publications/ResearchPapers/TheoryUnderlyingConceptMaps.pdf.

  • Orbell, S., & Sheeran, P. (2000). Motivational and volitional processes in action initiation: A field study of the role of implementation intentions. Journal of Applied Social Psychology, 30, 780–797.

    Article  Google Scholar 

  • Ordre des ergothérapeutes du Québec. (2003). Formation continue de l’ergothérapeute: Lignes directrices. Montreal: Ordre des ergothérapeutes du Québec.

    Google Scholar 

  • Paget, T. (2001). Reflective practice and clinical outcomes: Practitioners’ views on how reflective practice has influenced their clinical practice. Journal of Clinical Nursing, 10, 204–214.

    Article  Google Scholar 

  • Paillé, P. (1994). L’analyse par théorisation ancrée. Cahier de recherche sociologique, 23, 204–238.

    Google Scholar 

  • Peden-McAlpine, C., Tomlinson, P. S., Forneris, S. G., Genck, G., & Meiers, S. J. (2005). Evaluation of a reflective practice intervention to enhance family care. Journal of Advanced Nursing, 49, 494–501.

    Article  Google Scholar 

  • Piaget, J. (1995). Sociological studies. New York: Routledge.

    Google Scholar 

  • Pierce, D., & Gunn, J. (2007). Using problem solving therapy in general practice. Australian Family Physician, 36, 230–233.

    Google Scholar 

  • Reason, P. (1999). Integrating action and reflection through co-operative inquiry. Management Learning, 30, 207–226.

    Article  Google Scholar 

  • Roberts, A. E. K. (2002). Advancing practice through continuing professional education: The case for reflection. British Journal of Occupational Therapy, 65, 237–241.

    Google Scholar 

  • Robertson, L. J. (1996). Clinical reasoning, part. 1: The nature of problem solving, a literature review. British Journal of Occupational Therapy, 59, 178–182.

    Google Scholar 

  • Robertson, M. K., Umble, K. E., & Cervero, R. M. (2003). Impact studies in continuing education for health professions: Update. Journal of Continuing Education in the Health Professions, 23, 146–156.

    Article  Google Scholar 

  • Robinson, G. (2002). Do general practitioners’ risk-taking propensities and learning styles influence their continuing medical education preferences? Medical Teacher, 24, 71–78.

    Article  Google Scholar 

  • Rodgers, C. (2002). Defining reflection: Another look at John Dewey and reflective thinking. Teachers College Record, 104, 842–866.

    Article  Google Scholar 

  • Sackett, D. L., Strauss, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM. London: Churchill Livingstone.

    Google Scholar 

  • Sargeant, J., Mann, K., Sinclair, D., Van der Vleuten, C., & Metsemakers, J. (2008). Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Advances in Health Sciences Education, 13, 275–288.

    Article  Google Scholar 

  • Satterfield, J. M., & Hughes, E. (2007). Emotion skills training for medical students: A systematic review. Medical Education, 41, 935–941.

    Article  Google Scholar 

  • Schell, J. W., & Boyt Schell, B. A. (2008a). Communities of practice: A curricular model that promotes professional reasoning. In B. A. Boyt Schell & J. W. Schell (Eds.), Clinical and professional reasoning in occupational therapy (pp. 289–310). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

    Google Scholar 

  • Schell, J. W., & Boyt Schell, B. A. (2008b). Teaching for expert practice. In B. A. Boyt Schell & J. W. Schell (Eds.), Clinical and professional reasoning in occupational therapy (pp. 258–288). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

    Google Scholar 

  • Schön, D. A. (1983). The reflective practitioner. New York: Basic Books.

    Google Scholar 

  • Shaw, W. S., Linton, S. J., & Pransky, G. (2006). Reducing sickness absence from work due to low back pain: How well do intervention strategies match modifiable risk factors? Journal of Occupational Rehabilitation, 16, 591–605.

    Article  Google Scholar 

  • Siemonsma, P. C., Schroder, C. D., Dekker, J. H., & Lettinga, A. T. (2008). The benefits of theory for clinical practice: Cognitive treatment for chronic low back pain patients as an illustrative example. Disability & Rehabilitation, 30, 1309–1317.

    Article  Google Scholar 

  • Sniehotta, F. F., Schwarzer, R., Scholz, U., & Schuz, B. (2005). Action planning and coping planning for long-term lifestyle change: Theory and assessment. European Journal of Social Psychology, 35, 565–576.

    Article  Google Scholar 

  • Stergiou-Kita, M. (2006). Client-centred decision making in return to work: A systematic approach informed by reflection. Occupational Therapy Now, 8, 5–7.

    Google Scholar 

  • Strauss, A. L., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks: Sage.

    Google Scholar 

  • Strong, S., Baptiste, S., & Salvatori, P. (2003). Learning from today’s clinicians in vocational practice to educate tomorrow’s therapists. Canadian Journal of Occupational Therapy, 70, 11–20.

    Google Scholar 

  • Sullivan, M. J., Ward, L. C., Tripp, D., French, D. J., Adams, H., & Stanish, W. D. (2005). Secondary prevention of work disability: Community-based psychosocial intervention for musculoskeletal disorders. Journal of Occupational Rehabilitation, 15, 377–392.

    Article  Google Scholar 

  • Taylor, K. L., & Care, W. D. (1999). Nursing education as cognitive apprenticeship. A framework for clinical education. Nurse Educator, 24, 31–36.

    Article  Google Scholar 

  • Thomson O’Brien, M. A., Freemantle, N., Oxman, A. D., Wolf, F., Davis, D. A., & Herrin, J. (2001). Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (in press). doi:10.1002/14651858.CD003030.

  • Thorne, S., Kirkham, S. R., & O’Flynn-Magee, K. (2004). The analytic challenge in interpretative description. International Journal of Qualitative Methods, 3, 11–21.

    Google Scholar 

  • Tripp, D. (1993). Critical incidents in teaching: Developing professional judgement. London: Routledge.

    Google Scholar 

  • Vachon, B., Durand, M.-J., & LeBlanc, J. (2009). Empowering occupational therapists to become evidence-based work rehabilitation practitioners. Work: A Journal of Prevention, Assessment and Rehabilitation (in press).

  • Waddell, G. (2006). Preventing incapacity in people with musculoskeletal disorders. British Medical Bulletin, 77–78, 55–69.

    Article  Google Scholar 

  • Watkins, C., Timm, A., Gooberman-Hill, R., Harvey, I., Haines, A., & Donovan, J. (2004). Factors affecting feasibility and acceptability of a practice-based educational intervention to support evidence-based prescribing: A qualitative study. Family Practice, 21, 661–669.

    Article  Google Scholar 

Download references

Acknowledgments

The co-authors of this paper would like to express their sincere gratitude to the eight participants who generously gave their time to this study and who displayed great interest in understanding, changing and improving their practice. Funding for this research was provided by the FRSQ Work Disability Prevention Team. The first author received a Doctoral Training Award from the Fonds de la recherche en santé du Québec (FRSQ) and the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brigitte Vachon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vachon, B., Durand, MJ. & LeBlanc, J. Using reflective learning to improve the impact of continuing education in the context of work rehabilitation. Adv in Health Sci Educ 15, 329–348 (2010). https://doi.org/10.1007/s10459-009-9200-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10459-009-9200-4

Keywords

Navigation