Reflection Toolkit

The integrated reflective cycle

Barbara Bassot designed her own model of reflection in her book ‘The Reflective Diary’, which takes you through four steps.

Overview

The integrated reflective cycle (Bassot, 2013) is a model of reflection which will guide you through four steps to make sense of and learn from an experience. The model will allow you to explore feelings, assumptions and your own professional practice.

  • The Experience: Describe the experience
  • Reflection on Action: Look at the experience and identify what went well and what could be improved. It is here you explore your thoughts, feelings, and assumptions and ask yourself why.
  • Theory: Think about the experience in larger context of professional literature and your own learning and personal experience.
  • Preparation: Using your reflection to prepare yourself for future experiences.

 

Below is further information on the model – each step is given a fuller description, guiding questions to ask yourself and an example of how this might look in a reflection.

This is just one model of reflection. Test it out and see how it works for you. If you find that only a few of the questions are helpful, focus on those. However, by thinking about each stage you are likely to engage more critically with your learning experience.

The model

A circular diagram showing the four stages of the integrated cycle
The integrated reflective cycle

The model is inspired by Gibbs’ reflective cycle and shares some characteristics with it. In contrast to Gibb’s reflective cycle, the integrated reflective cycle contains fewer steps which may make it simpler to work through, while still being able to bring out the same realisations and learning.

The ‘Reflection on Action’ step contains what some models would break up into feelings, results and evaluation.

A number of helpful questions are outlined below for each of the sections. You don’t have to answer all of them, but they can guide you to what sort of things make sense to include in that section. You might have other questions that work better for you.

An example of using this model is also provided below.  This example is specific to a field, but still demonstrates well how you can use thoughts and theory to make informed decisions about your practice. To make it more relevant, you can ask yourself if there is anything from the example that resonates with you.

 

The Experience

Here you should describe the situation in as much detail as you find necessary. Think about whether it is for yourself or for someone else to read. If it is for someone else, it is important you define the context clearly.

Helpful questions

  • What happened?
  • What were the contributing factors?
  • Who else was there?
  • What did I/others do?

Example of 'The Experience'

Consultation with patient
During a medical placement I was doing my first supervised consultation with a patient. I needed to run a medical interview and learn about their symptoms and signs to potentially come up with a diagnosis and a treatment plan. We have been taught the Calgary-Cambridge framework to run a consultation (Kurtz SM, Silverman JD, Draper J, 1998). While engaging with the patient I kept checking my notes to ensure I got the process right. In the end I got confused and kept asking the same questions and the patient looked uneasy. Then the supervisor stepped in and finished the consultation.

 

Reflection on Action

Here is where you start to make sense of what happened. You should question yourself and your assumptions to understand what led you to your actions – this will allow you to challenge the status quo of your actions and assumptions.

Helpful questions

  • What was I trying to achieve?
  • Why did I act as I did?
  • What assumptions did I make?
  • What were the consequences for me and the other people involved?
  • How did I feel?
  • How did the other people feel and how could I tell?

Example of 'Reflection on Action'

Consultation with patient
I was trying to go through a good patient consultation, making sure that I got the right information and ensuring that I built a relationship and provided structure to the consultation. I think I went through the interview framework too rigidly; I assumed that by asking each question on the list in the order they were displayed I would conduct a good interview. That’s why I kept checking my notes – I felt afraid that I would miss something despite having learned and practised the framework with my course friends. Overall, I was really nervous and afraid of making mistakes. This made me uncertain and that’s why I wanted to stick fully to the template. I could see that the constant checking of my notes made the patient uneasy; they kept looking to the supervisor and would hesitantly answer my questions. In the end, when the supervisor took over I felt a bit ashamed but also relieved. My supervisor then gave me feedback. She told me that while my intention of getting all the questions of the Calgary-Cambridge framework correct was good, I need to treat each consultation as an individual case and use the framework to inform my decisions.

 

Theory

Here you can conclude on your learnings. You can use both your own realisations and theoretical literature to make sense of the experience. It can be useful to discuss how your experience has influenced your understanding of your professional or theoretical knowledge.

Helpful questions

  • What has this experience contributed to my professional or theoretical knowledge?
  • What have I learned that I can apply to a similar situation in the future?
  • What have I learned in general?

Example of 'Theory'

Consultation with patient
I have learned that I need to relax better in new situations. I went into the consultation being extremely nervous, and I realise that it was my nervousness and not my ability that made me stumble over my questions. I will need to work on my nervousness. Secondly, I now see how theory is a tool that should be applied to, but not dictate, every step in practice. Of course, all of my decisions need to be informed by theory, but the theory gives a general overview and it’s my job to apply to the specifics. In this case, I have updated my knowledge of the Calgary-Cambridge model. I know that I need to touch on all the different aspects but it’s not a checklist that I need to complete. I need to apply the parts which are relevant to the individual – building a relationship with the patient and providing structure to the consultation is important to make the patient feel safe and confident before I start asking questions. This will look different for each patient and once I get more confident with the model I am sure this will come more naturally to me.

 

Preparation

Here you can take all of the things that you have discovered in the previous sections to create a plan for how to become better prepared for the future.

Helpful questions

  • What will I do next time in a similar situation?
  • How could I do better next time?
  • What will I now consider for next time?
  • What other strategies could I adopt to move forward?

Example of 'preparation'

Consultation with patient
Next time I will be calmer going into a supervised consultation. I will do this in two ways. Firstly, knowing that my supervisor can always step in and help me, and knowing that I don’t have to use the interview framework exactly as it is written, will allow me to go with the flow of the consultation much better. Secondly, before starting the consultation I will take as many deep breaths as I need to calm down. Moreover, I will ask my supervisor specifically to give me feedback on my use of the model to make sure I am using it in an effective way. I will start out by making sure the patient is comfortable by introducing myself and getting their name from them, rather than the records. While I’m doing the first steps of the initiation, I will not look at my notes, but keep eye contact and use responsive body language.

 

Adapted from

Bassot, B. (2013). The Reflective Journal. Basingstoke: Palgrave