46 Chapter 3 This reflection-upon-action as part of reflexive practice is considered a key element in developmental and continuous learning. [13] Reflexive practice, or critical reflexivity, presumes that you “critically [examine] the assumptions underlying [your] actions, the impact of those actions, and from a broader perspective, what passes as good (…) practice”. [14] It includes reflectivity, which is the deliberate and critical questioning of one’s past actions and future possibilities, but also covers actively reflecting on personal views and how those relate to the surrounding world. [14] Reflexivity, therefore, is a social, relational process. [15] The process of critical reflexivity is represented in a framework designed by Norton and Sliep (Figure 1). [16] It consists of a continuous loop, incorporating five important elements in reflexive practice. The loop moves from ‘power’ to ‘values & identity,’ ‘agency & responsibility,’ and ends at ‘performance’. The center of the loop is where reflexive practice is effectuated: the ‘dialogical space.’ The reflexivity framework can be used to apply critical reflexivity in training situations, but also as an instrument to analyze reflexive practice. [16] The present study developed and pilot-tested a tool to structurally collect patient feedback on residents’ SDM and general consultation skills. As part of this pilot, we explored residents’ views on SDM and on patient feedback, exploring the concept of reflexivity and whether patient feedback catalyzes reflexive practice. Figure 1: Critical Reflexivity Framework. Adopted from Norton and Sliep (2018).
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