Teaching Reflective Learning in Higher Education : A Systematic Approach Using Pedagogic Patterns

This book is about understanding the nature and application of reflection in higher education. It provides a theoretical model to guide the implementation of reflective learning and reflective practice across multiple disciplines and international contexts in higher education. The book presents research into the ways in which reflection is both considered and implemented in different ways across different professional disciplines, while maintaining a common purpose to transform and improve learning and/or practice. Readers will find this book innovative and new in three key ways. First, in its holistic theorisation of reflection within the pedagogic field of higher education; Secondly, in conceptualising reflection in different modes to achieve specific purposes in different disciplines; and finally, in providing conceptual guidance for embedding reflective learning and reflective practice in a systematic way across whole programmes, faculties or institutions in higher education. The book considers important contextual factors that influence the teaching of forms and methods of reflection. It provides a functional analysis of multiple modes of reflection, including written, oral, visual, auditory, and embodied forms. Empirical chapters analyse the application of these modes across disciplines and at different stages of a programme. The theoretical model accounts for students’ stage of development in the disciplinary field, along with progressive and cyclical levels of higher order thinking, and learning and professional practice that are expected within different disciplines and professional fields. The book provides: • A conceptual model for the application of reflection across disciplines in a variety of contexts. • Empirical examples of different modes and pedagogic patterns for reflection. • Guidance and support for embedding systemic pedagogical and curriculum change.

Introduction: Reflective and Reflexive Approaches in Higher Education : A Warrant for Lifelong Learning?

In our complex and incongruous world, where variety produces more variety, and there is no blueprint for dealing with unprecedented change, it is imperative that individuals develop reflexive approaches to life and learning. Higher education has a role to play in guiding students to be self-analysts, with the ability to examine and mediate self and context for improved outcomes. This chapter elucidates the catchphrase of lifelong learning and its enactment in higher education. Theories of reflexivity and personal epistemology are utilised to provide the conceptual tools to understand the ways in which individuals manage competing influences and deliberate about action in their learning journey. The case is made for the integral role of higher education teachers in developing students’ capacities for reflective thinking and reflexive approaches to learning as a life project.

Teaching and Assessing Reflective Writing in a Large Undergraduate Core Substantive Law Unit

The focus of higher education has shifted towards building students’ skills and self-awareness for future employment, in addition to developing substantive discipline knowledge. This means that there is an increasing need for embedding approaches to teaching and learning which provide a context for skills development and opportunities for students to prepare for the transition from legal education to professional practice. This chapter reports on a large (500-600 students) core undergraduate Equity law unit in an Australian University. ePortfolio has been embedded in Equity as a means of enabling students to document their reflections on their skill development in that unit. Students are taught, practice and are assessed on their teamwork and letter writing skills in the context of writing a letter of advice to a fictional client in response to a real world problem. Following submission of the team letter, students are asked to reflect on their skill development and document their reflections in ePortfolio. A scaffolded approach to teaching reflective writing is adopted using a blended model of delivery which combines face to face lectures and online resources, including an online module, facts sheets designed to guide students through the process of reflection by following the TARL model of reflection, and exemplars of reflective writing. Although students have engaged in the process of reflective writing in Equity for some years, in semester one 2011 assessment criteria were developed and the ePortfolio reflections were summatively assessed for the first time. The model of teaching and assessing reflective practice was evaluated in a range of ways by seeking feedback from students and academic staff responsible for implementing the model and asking them to reflect on their experiences. This chapter describes why skill development and reflective writing were embedded in the undergraduate law unit Equity; identify the teaching and learning approaches which were implemented to teach reflective writing to online and internal Equity students; explain the assessment processes; analyse the empirical evidence from evaluations; document the lessons learnt and discuss planned future improvements to the teaching and assessment strategies.

Reawakening reflective capacity in the psychotherapy of schizophrenia : a case study

Disturbed sense of self has long been identified as a common experience among people suffering with schizophrenia. More recently, metacognitive deficits have been found to be a stable and independent feature of schizophrenia that contributes to disturbed self-experience and impedes recovery. Individual psychotherapy designed to target poor metacognition has been shown to promote a more coherent sense of self and enhanced recovery in people with schizophrenia. We provide a report of a 2-year individual psychotherapy with a patient suffering with chronic schizophrenia. Progress was assessed over the course of treatment using the Metacognition Assessment Scale and the Brief Psychiatric Rating Scale. The patient experienced improved metacognitive capacity and reduced symptom severity over the course of therapy. Implications for clinical practice are discussed.

Analysing reflective text for learning analytics : an approach using anomaly recontextualisation

Reflective writing is an important learning task to help foster reflective practice, but even when assessed it is rarely analysed or critically reviewed due to its subjective and affective nature. We propose a process for capturing subjective and affective analytics based on the identification and recontextualisation of anomalous features within reflective text. We evaluate 2 human supervised trials of the process, and so demonstrate the potential for an automated Anomaly Recontextualisation process for Learning Analytics.

How does the use of a reflective journal enhance students’ critical thinking about complexity?

Introduction to Youth Services is a second year Social Work and Human Services unit. In this unit a reflective writing task was introduced to assess students’ reflections on an ongoing tutorial discussion to which they contributed. The discussion was based on a fictional young person each tutorial group ‘worked with’ across eight weeks of a semester. In developing the process and the criteria for the reflective journal, the ideas raised by the Teaching and Assessing Reflective Learning (TARL) in Higher Education project (see Chap. 2) were utilised, scaffolding the work with resources and submission of a draft. The students were also invited to choose the form of reflective process they used, it could be a written journal but did not need to be. The evidence exemplified that a reflective journal is an effective tool for students to record their developing understanding regarding the concept that issues people experience are complex and compounding. Importantly, it was also a useful vehicle for students to begin to consider the impacts of their own and others’ values and beliefs on their response to the issues raised within the case discussion. The reflective journal also helped participants to consider how this learning contributes to the ongoing development of their professional practice framework.

Effectiveness of an emergency nurse practitioner service for adults presenting to rural hospitals with chest pain : Protocol for a multicentre, longitudinal nested cohort study

Introduction Chest pain is common in emergency department (ED) patients and represents a considerable burden for rural health services. Health services reforms to improve access to care need appropriately skilled and supported clinicians in the delivery of safe and effective care, including the use of emergency nurse practitioners (ENPs). Despite increasing use of ENPs, little is known about the safety and quality of the service in the rural ED context. The aims of this study are (1) to examine the safety and quality of the ENP service model in the provision of care in the rural environment and (2) to evaluate the effectiveness of the service in the management of patients presenting with undifferentiated chest pain. Methods and analysis This is the protocol for a prospective longitudinal nested cohort study to compare the effectiveness of ENP service with that of standard care. Adults presenting to three rural EDs in Queensland, Australia with a primary presenting complaint of atraumatic chest pain will be eligible for enrolment. We will measure (1) clinician's use of evidence-based guidelines (2) diagnostic accuracy of ECG interpretation for the management of patients with suspected or confirmed ACS (3) service indicators of waiting times, length-of-stay and did-not-wait rates and (4) clinician's diagnostic accuracy as measured by rates of unplanned representation within 7 days (5) satisfaction with care, (6) quality-of-life and (7) functional status. To assess these outcomes we will use a combination of measures collected from routinely collected data, medical record review and questionnaires (with 30-day follow-up). Ethics and dissemination Queensland Health Human Research Ethics Committee (HREC) has approved this protocol. The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.

The small business CGT concessions: Evidence from the perspective of the tax practitioner

On 21 September 1999 Division 152 was inserted into the Income Tax Assessment Act (1997) (ITAA 1997). Division 152 contains the small business CGT concessions, which enables eligible small business taxpayers to reduce the amount of tax payable on capital gains arising from certain CGT events that occur after 11:45 am on 21 September 1999. One of the principal objectives of the legislation is to provide a concessionary regime for small business owners who do not have the same ability to access the concessionary superannuation regime generally available to employees. When announcing the introduction of the concessions the then Federal Treasurer, Mr Peter Costello, specifically stated that the objective of Division 152 was to provide ‘small business people with access to funds for retirement or expansion’. The purpose of this article is to: one, assess the extent to which small business taxpayers understand the CGT small business concessions, particularly when considering the sale of their business; two, determine which of the four small business CGT concessions are most commonly adopted and/or recommended by tax practitioners to clients; and three, to determine whether the superannuation changes in relation to the capping of the concessional superannuation thresholds have had an impact on the use of the small business retirement concession.

Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: A qualitative study

Background Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs) in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia. Methods A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1) pharmacists’ role viewed mainly as supplying medications, 2) readiness to accept pharmacists in private GP clinics, 3) willingness to pay for pharmacy services, and 4) concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy information on the use and potential side effects of medications and screening for medication misadventure. The potential increase in costs passed on to consumers and GPs’ reluctance were perceived as barriers to integration. Conclusion This study provides insights into consumers’ perspectives on the roles of pharmacists within private GP clinics in Malaysia. Consumers generally supported pharmacist integration into private primary health care clinics. However, for pharmacists to expand their capacity in providing integrated and collaborative primary care services to consumers, barriers to pharmacist integration need to be addressed.

A randomised controlled trial evaluating outcomes of emergency nurse practitioner service

The emergency nurse practitioner role was developed as an innovative and cost effective approach to meet increasing patient demand for health care. This thesis is the first contemporary study to evaluate clinical outcomes of the role within a complex systems-intervention framework. Emergency nurse practitioner service effectiveness was demonstrated through superior performance in delivery of timely analgesia for emergency department patients. The results validate nurse practitioner service as being able to demonstrate comparable outcomes. This research provides a much-needed evidence base supporting nurse practitioner service and its role in the changing health system and the reform agenda for service innovation.

Enhanced student learning in accounting utilising web-based technology, peer-review feedback and reflective practices: A learning community approach to assessment

Higher education is becoming a major driver of economic competitiveness in an increasingly knowledge-driven global economy. Maintaining the competitive edge has seen an increase in public accountability of higher education institutions through the mechanism of ranking universities based on the quality of their teaching and learning outcomes. As a result, assessment processes are under scrutiny, creating tensions between standardisation and measurability and the development of creative and reflective learners. These tensions are further highlighted in the context of large undergraduate subjects, learner diversity and time-poor academics and students. Research suggests that high level and complex learning is best developed when assessment, combined with effective feedback practices, involves students as partners in these processes. This article reports on a four-phase, cross-institution and cross-discipline project designed to embed peer-review processes as part of the assessment in two large, undergraduate accounting classes. Using a social constructivist view of learning, which emphasises the role of both teacher and learner in the development of complex cognitive understandings, we undertook an iterative process of peer review. Successive phases built upon students’ feedback and achievements and input from language/learning and curriculum experts to improve the teaching and learning outcomes.

Wikis for women's health: Social constructivist analysis of the effectiveness of online collaborative spaces for reflective learning

Public Health undergraduate students studying the unit Women’s Health undertook a teaching and learning exercise which required them to learn to create and use a wiki website for reflective learning purposes. The Women’s Health wiki provided an online shared, collaborative, and creative space wherein the students’ perceptions of women's health issues could be discussed, reflected upon, and debated. We analysed the content developed on the Women’s Health wiki using a social constructivist theoretical framework and provided a theoretical model for how the wiki worked to aid reflective and critical thinking, as well as developing technological and communicative skills amongst students.

Scoping study into wound management nurse practitioner models of practice

Objectives The primary objective of this research was to investigate wound management nurse practitioner (WMNP) models of service for the purposes of identifying parameters of practice and how patient outcomes are measured. Methods A scoping study was conducted with all authorised WMNPs in Australia from October to December 2012 using survey methodology. A questionnaire was developed to obtain data on the role and practice parameters of authorised WMNPs in Australia. The tool comprised seven sections and included a total of 59 questions. The questionnaire was distributed to all members of the WMNP Online Peer Review Group, to which it was anticipated the majority of WMNPs belonged. Results Twenty-one WMNPs responded (response rate 87%), with the results based on a subset of respondents who stated that, at the time of the questionnaire, they were employed as a WMNP, therefore yielding a response rate of 71% (n≤15). Most respondents (93%; n≤14) were employed in the public sector, with an average of 64 occasions of service per month. The typical length of a new case consultation was 60min, with 32min for follow ups. The most frequently performed activity was wound photography (83%; n≤12), patient, family or carer education (75%; n≤12), Doppler ankle-brachial pressure index assessment (58%; n≤12), conservative sharp wound debridement (58%; n≤12) and counselling (50%; n≤12). The most routinely prescribed medications were local anaesthetics (25%; n≤12) and oral antibiotics (25%; n≤12). Data were routinely collected by 91% of respondents on service-related and wound-related parameters to monitor patient outcomes, to justify and improve health services provided. Conclusion This study yielded important baseline information on this professional group, including data on patient problems managed, the types of interventions implemented, the resources used to accomplish outcomes and how outcomes are measured.

Evaluating emergency nurse practitioner service effectiveness on achieving timely analgesia: A pragmatic randomized controlled trial

Objectives The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia. Methods Patients presenting with pain were randomly assigned to receive either standard ED medical care or NP care. Primary investigators were blinded to treatment allocation for data analyses. The primary outcome measure was the proportion of patients receiving analgesia within 30 minutes from being seen by care group. Secondary outcome measures were time to analgesia from presentation and documentation of and changes in pain scores. Results There were 260 patients randomized; 128 received standard care (medical practitioner led), and 130 received NP care. Two patients needed to be excluded due to incomplete consent forms. The proportion of patients who received analgesia within 30 minutes from being seen was 49.2% (n = 64) in the NP group and 29.7% (n = 38) in the standard group, a difference of 19.5% (95% confidence interval [CI] = 7.9% to 31.2%; p = 0.001). Of 165 patients who received analgesia, 64 (84.2%) received analgesia within 30 minutes in the NP group compared to 38 (42.7%) in the standard care group, a difference in proportions of 41.5% (95% CI = 28.3% to 54.7%; p < 0.001). The mean (±SD) time from being seen to analgesia was 25.4 (±39.2) minutes for NP care and 43.0 (±35.5) minutes for standard care, a difference of 17.6 minutes (95% CI = 6.1 to 29.1 minutes; p = 0.003). There was a difference in the median change in pain score of 0.5 between care groups, but this was not statistically significant (p = 0.13). Conclusions Nurse practitioner service effectiveness was demonstrated through superior performance in achieving timely analgesia for ED patients.