Biomedical Engineering Reference
In-Depth Information
current methods of training personnel. Simulation
in a controlled environment offers the advantages
of experiential learning (learning via experiences)
and reflective practice. Reflective practice refers
to one's analysis of his own or others experi-
ences in the attempt to gain a new perspective
of the said events [13]. The goal being to incor-
porated these findings into one's practice for the
betterment of patient care. The epic text by Schön
in 1983,
Educating the Reflective Practitioner
,
discussed how professionals think in action [14].
Learning is viewed as the integration of reflec-
tion and experience. Schön stressed that knowl-
edge, skill and expertise are implicit in practice and
often occur spontaneously by the practitioner. This
has been coined “knowing-in-action” and basically
refers to the practitioner's spontaneous response
and thinking processes (“knowing”) during the act
of delivering, in this case medical care or attending
to a medical emergency (“action”). This is further
delineated by two forms of reflection on “knowing-
in-action” which purports that we should think
about what we are doing or have experienced [14].
First, “reflection-in-action” is typically prompted
by unexpected events that prompt a “reflective
conversation” either internally or externally to
one's self, to discuss the event, its implications,
its etiology, its treatment, the role participants are
playing or should play and avoidance or preventive
strategies in the midst of the event. This type of
reflection “on demand” may be difficult due to its
rapid pace but the experienced and seasoned practi-
tioner may portend an improved ability to “reflect”
during the actual event. Following this instanta-
neous, “real-time” reflection on the said event as
it is happening, the practitioner can develop a
response to what is occurring. Thus, the practi-
tioner is performing “research” or “real-time exper-
imenting at the bedside” during the actual event.
“Reflection-on-action” takes place following the
event and allows for thinking about the prior situ-
ation, causations, implicating factors, its etiology,
etc., in a similar fashion to “reflection-in-action.”
The follow-up analysis should lead to a better
understanding of the event and the deployment
of preventive, avoidance, or treatment strategies.
The individual or members of the team who were
involved in an “event” may debrief themselves
to gain a better understanding of their thoughts
and behaviors. This should prompt improvement
in one's critical thinking, highlight areas of weak-
ness and strengths, and encourage open discus-
sion and analysis to improve one's preparation for
the next event [14]. Highly motivated practitioners
who link their professional position to life-long
learning may be individuals who more actively
“notice” or seek information that can be harnessed
to potentiate their education, hence, they may be
those who actively pursue their own analysis of the
events and solicit feedback and criticism from their
colleagues in a more rigorous manner than those
less inclined [3,14,15]. Once the reflective process
takes place, it is the level of commitment by the
individual (or department, governing body, etc.)
that plays a pivotal role in initiating change one's
own practice. There lies great educational benefit
to reflecting on one's own actions and responses to
routine and emergency care, as we should in nearly
all areas of our personal and professional existence.
We practice “reflection-on-action” in a delayed
fashion when we discuss patient care issues or
cases at the monthly interesting case conference or
morbidity and mortality conference but the built
in delay may allow certain key components of the
“event” to languish and possibly be “lost to follow-
up” [14,15].
It has been recommended that the design of a
curriculum for an educational encounter, in this
case, a simulated medical or surgical crisis, consist
of three phases: preparation of the students for the
“event,” execution of the “event,” and a period
of time to debrief and reflect on the event that
took place. For example, a mock bioterrorism drill
may be developed based on these three guiding
suggestions as outlined in Figure 20.1 [3].
Students not only benefit from the training
session itself, but the instructors should solicit
feedback from the “students” on how to improve
the learning experience as well as repair the
problems and shortcomings that were found within
the “system” during the event. For example, more
time devoted during the preparation phase to
review of equipment, protocols and guidelines
or the limitations noted by personnel donning
