Reflection as Awareness
In research on reflective engagement of emergency medicine teams, Duffy et al. (2014) found that, “ ...the team members and leader exhibited a great deal of metacognitive knowledge while reflecting upon the sources of their difficulties.” (Duffy et al. 2014).
"Medical emergencies (e.g., cardiac arrest) present a challenge for medical professionals because they are demanding in terms of both the medical knowledge needed to plan effective interventions and the regulatory skills required to effectively manage the team" (Duffy, et al. 2014).
Reflective practice begins with awareness of self and the dynamics between educator and learners in the context of the specific educational setting. The concept of effective reflection is that this awareness is accompanied by a willingness to examine practice for error as well as strengths before taking action to change or improve practice.
"Reflection is effective when it leads the teacher to make meaning from the situation in ways that enhance understanding so that she or he comes to see and understand the practice setting from a variety of viewpoints,"-Loughran (2002, 36).
Reflection as Metacognition
Metacognition has been associated with successful learning across many disciplines (Bransford, Brown, & Cocking, 1999), lifelong professional learning (Schön, 1983; also Plack & Santasier, 2004; Clouder, 2000) and in the practice of teaching (Lougran, 2002).
The process of development that Vygotsky (1978) refers to as internalization and self-regulation applies metacognitive strategies to focused awareness, attention and control. Such strategies help learners “to increase awareness of thinking processes” and assist them in examining practice for possible error, assumptions, biases as well as strengths (Thompson & Thompson, p. 249, citing Palinscar & Brown, 1987; also Bransford, Brown & Cocking, 1999).
When preparing learners to problem-solve in situations with unpredictable outcomes, a process integral to medical education, educators should capitalize on reflective teaching to promote reflective learning. One way to promote reflective learning is to provide opportunities for learners for “clarifying the potential goals” and “choosing or inventing an effective metacognitive strategy to achieve a selected goal” (Lin, Schwartz, & Hatano, 2005, p. 253). In other words, asking students to deliberate on HOW they should approach a problem or situation, not only as to WHAT they think of the situation or problem.