WIL reflective practice strategy
Meredith Kennedy | Nutrition and Dietetics Program (SMAH)
Embedding reflective practice into the nutrition and dietetics work integrated learning (WIL) placement program as the central ingredient of assessment.
My name is Meredith Kennedy, and I'm a senior lecturer in the nutrition and Dietetics program. I have the great privilege of teaching students in their penultimate and final year of the course. There's approximately 60 students in third year and another 60 on final year, which is their placements.
So the reason that I've embedded reflective practice into my subjects is that the ability to reflect on practice in collaboration with peers, supervisors and mentors is a national competency standard for dieticians in Australia. So our students have to be able to demonstrate that competency.
The second reason stems from feedback that we receive from supervisors. So supervisors were asked if they were concerned about a student's progress on placement. What was it that made them concerned? And they identified the inability to reflect on practice as a major red flag.
The way I embed reflection commences the year before placement. So reflective practice is integrated in with learning around clinical skills, communication skills and professionalism skills. During that year, we teach students a range of different theories, such as Rolfe, Kolb, Gibbs, and students are asked to use those models to reflect on their simulated experiences that year.
At the end of the year, they participate in an observed, structured clinical exam and are required to undertake a reflection as a component of assessment.
The second way that we embed reflection is in the final year during placement, so students are asked to keep a weekly evidence form which aligns with Gibbs model of reflective practice. With that evidence form, they are required to write down all the work activities they've undertaken for the week. They write down feedback that they receive from supervisors, from peers, from key stakeholders like clients. They then write down their thoughts and feelings about the work activities and the feedback. They also write down their challenges and achievements.
They make a conclusion from that week and then they develop an action plan for progression. And that written plan is also discussed with their supervisor, every single week. The final embedding of reflection occurs in an exit interview. And with that exit interview, students are required to think about a key learning moment from each of their placements and to reflect on that key learning moment. They then will reflect holistically in regards to their competence as a dietitian at the end of the exit interview.
What I've learned from embedding reflection is that it's received very positively from our placement partners and our key stakeholders. Students are certainly able to demonstrate the competency standard, and supervisors are very happy that they're now seeing reflective practice with the students supervising.
So my advice to anyone who is thinking about embedding reflection is to just give it a go and experiment, just do a small chunk and then evaluate that, reflect on that. And I'm sure that you'll find the students will enjoy that. And it will enhance their learning.
Why?
To reflect on practice in collaboration with supervisors, peers and mentors is a national competency standard for Dietitians in Australia. I have therefore included reflective practice in my placement preparedness subjects (DIET 467/967/468/968) for many years. More recently, after reflecting on the way that the placement subject (DIET 454/954/460) was assessed, I also embedded reflective practice into the nutrition and dietetics placement program as the central ingredient of assessment.
When I decided to make a change to the way that placement was assessed, I reflected on my own experiences in placement assessment through two lenses. First, through my role as the UOW placement subject co-ordinator, I drew on previous feedback received from students and placement supervisors and the literature about placement assessment. Interestingly, research undertaken with dietitian supervisors, identified the inability of a student to reflect on their practice as a red flag for poor progression on placement. Second, I reflected on my own experiences as a dietitian who assesses placement students in the health setting especially thinking about how feedback was understood and actioned by the student.
My conclusion was that the new assessment process had to be student driven and include opportunities for students to demonstrate reflective practice regularly throughout their placement program. Placement supervisors needed the opportunity to observe, assess and provide feedback about the student’s ability to reflect on their practice. The student voice about the feedback they were receiving and how they were using that feedback to progress also needed to be included.
This resulted in the development and implementation of a student driven programmatic approach to assessment through an e-portfolio. This requires students to complete weekly evidence (reflection) forms, supervisors to provide specific feedback about the student’s ability to reflect on practice and an exit interview where students are required to present their key placement learning reflections to a panel at the end of their program.
How?
An outline of how reflective practice is embedded into the subjects taught by Meredith is outlined below.
Note: The pre-placement subjects referred to below are DIET 467/967/468/968
Reflective practice is integrated with the teaching and assessment of clinical knowledge, communication and professionalism skills required for dietetic practice.
For example in DIET 467/967 – Dietetics Care 1
- Students are taught the reflective practice theory of Rolfe (week 3), Kolb (week 4) and Gibbs (week 8) alongside an essential skill required for dietetic practice (taking a food and nutrition history (week 3), dietary counselling (week 4) and small group nutrition facilitation (week 8).
- Students then practice the skill they have learnt on a peer, receive peer feedback and use the reflective practice theory they have learnt about during the workshop to write a reflection about their performance, which they then share with their peer and to the larger class if they wish to.
- So in week 3 for example, the students learn about Rolfe’s theory of reflective practice in the same workshop that they learn how to take a food and nutrition history. They then practice taking a food and nutrition history on a peer and write a reflection about their own performance using Rolfe’s theory of What? So What? Now What?
- This culminates in week 12 with an assessment of their reflective practice alongside their observed structured clinical exam (OSCE) in dietary counselling. Students choose one of the theories they have learnt about that best resonates with their learning and write a written reflection about their OSCE performance. For this reflection, I have experimented with a reflection immediately post-OSCE or a reflection submitted within 24 hours of OSCE completion. Undertaking my own reflective practice about this task, I have concluded that it is important to give students time to reflect as this elucidates a far richer reflection of practice compared to a reflection immediately post OSCE.
Note: The subjects referred to below are DIET 454/954/460
Nutrition and Dietetics students undertake a minimum of 20 weeks of placement in the final year of their program where they are required to complete an e-portfolio containing evidence of how they have met the National Competency Standards (NCS) for Dietitians in Australia.
Reflective practice is embedded into the following components of their placement assessment.
Weekly Evidence (Reflection) Forms
For every week of placement, students write a reflection which best aligns with Gibbs learning by doing model of reflection. This requires students to:-
- List their work activities for the week and the NCS these work activities addressed.
- Summarise the feedback they have received over the week from their supervisors, peers and other stakeholders such as clients.
- Evaluate their achievements, challenges, thoughts and feelings about the week and come to an overall conclusion about their performance for that week.
- Write an action plan for progression for the following week.
- Discuss and review all the above with their placement supervisor on a weekly basis.
Supervisor Feedback and Assessment Forms
Assessment forms are completed by placement supervisors’ midway and at the end of each five -week placement block. Supervisors’ are asked four questions about a student’s progress one of which is to comment about the student’s ability to reflect on their practice and to action the strategies identified.
Panel Exit Interview – showcase, reflect and celebrate placement
The final assessment for students is to present via an exit interview to a panel of UOW academics and placement partners. The theme for the interview is to showcase, reflect and celebrate placement. Students are required to choose at least one key learning moment from each of their five placements and to reflect on why that experience helped them progress in their practice. They then complete the interview with a broad reflection about their current strengths, areas for growth and strategies to progress as they now enter the profession.
Feedback from Placement Supervisors about the exit interviews
"Seeing their reflections at the end of each placement was a highlight for me "
- Placement Supervisor, 2021
"It is always nice to hear students’ reflections on some of the highlights and/or challenges they faced across some of their placements as they then often have achieved both personal and professional growth."
- Placement Supervisor, 2022
Reflection and impact
No students have failed placement since the implementation of the placement assessment process containing weekly reflective practice. Further, the number of students requiring supplementary weeks to pass has decreased.
Why do I think it has worked?
The inclusion of an explicit written weekly reflection involving discussions with their placement supervisor has helped students to develop and refine this skill in the context of clinical practice.
Specifically, the process has enabled students in partnership with their supervisors to identify the student’s strengths, areas to work on and to develop achievable action plans to address any problems influencing their progress in a timely way. This means, that potential problems are identified by students and supervisors quickly thus providing opportunity for them to be remediated before they become a safe practice concern placing the student at risk of not passing their placement.
Feedback from students
"I have the power to reflect on my own practice, to feel included and that I have an important voice in my progress"
- Final year placement student
"I really enjoyed the exit interview. I think it definitely prompted us to self -reflect on what we have achieved throughout the year and especially those important lightbulb learning moments"
- Final year placement student
Feedback from placement supervisors
Note: at the time of writing, students have only completed five weeks of their placement program (March, 2023).
"We just wanted to thank you for sending us such amazing students year after year, your program obviously sets the students up well for success in their clinical placements. Your marking criteria (referring to the weekly reflection and supervisor assessment forms) is also very much preferable for us as supervisors!"
- Placement Supervisor, 2023
"I have found them (students) both to be really good ‘reflectors’, often at first placement students need a bit of prompting on how to reflect and being open about things – but these two are naturals!"
- Placement Supervisor, 2023
Support resources
- Teaching reflective practice | L&T Hub collection
