Aukes Leo C, Cohen-Schotanus Janke, Zwierstra Rein P, Slaets Joris Pj
University of Groningen, Groningen, the Netherlands.
Educ Health (Abingdon). 2009 May;22(1):210. Epub 2009 May 8.
Healthcare students and practitioners need to be able to critically assess themselves and their actions in order to learn from their experiences and improve their care of patients. Students' behaviours can be directly observed and faculty can provide direct feedback on it, when necessary. But 'reflection', a mechanism for assessing one's self, is less visible and often remains an abstract notion that is difficult to understand, use, and assess.
We designed an educational model to help healthcare educators and learners visualize reflection. We posit that it can provide a greater understanding of what reflection is, how it works and how to facilitate its development and use by individuals. As a metaphor we used the angler's (fisherman's) float, which to function properly must stand balanced and steady in the water. Likewise, healthcare practitioners try to maintain an upright balance to be able to learn and work effectively. The visible component of the float, the portion above the water, is the 'behaviour'. The hidden, "mental" components of the float are under water: expert thinking (a combination of 'clinical reasoning' and 'scientific thinking'), 'personal reflection', and 'unconscious thoughts'. Each of these mental components plays a role in maintaining balance in learning and working, varying with the circumstances and context. And of course, without water a float has no meaning. In the float model, the water symbolizes the organisational and cultural context in which each practitioner must learn to function.
We propose that the float model can be used to reveal the interplay among clinicians' mental processes, which occur unseen "underneath the water" but subtly influence the appropriateness of the behaviour witnessed at the surface. We believe the model can help prevent errors in understanding practitioners' behaviours and their causes, such as when they blur scientific thinking and personal reflection, take reflection as a goal in and of itself, and deny the value of the intuitive and unconscious aspects influencing their behaviours.
医学生和从业者需要能够批判性地评估自己及其行为，以便从经验中学习并改善对患者的护理。学生的行为可以直接观察到，必要时教师可以提供直接反馈。但是，“反思”作为一种自我评估机制，不太容易被看到，而且常常仍然是一个难以理解、运用和评估的抽象概念。
我们设计了一种教育模式，以帮助医学教育工作者和学习者将反思可视化。我们认为，它可以让人们更深入地理解反思是什么、它是如何起作用的，以及如何促进个人对反思的发展和运用。我们用钓鱼者的浮漂作比喻，浮漂要正常发挥作用，必须在水中保持平衡和稳定。同样，医疗从业者也试图保持一种正直的平衡，以便能够有效地学习和工作。浮漂露出水面的可见部分是“行为”。浮漂隐藏在水下的“心理”部分包括：专家思维（“临床推理”和“科学思维”的结合）、“个人反思”和“无意识思维”。这些心理成分中的每一个在学习和工作中保持平衡时都发挥着作用，其作用会因情况和背景的不同而有所变化。当然，没有水，浮漂就没有意义。在浮漂模型中，水象征着每个从业者必须学会在其中发挥作用的组织和文化背景。
我们认为，浮漂模型可用于揭示临床医生心理过程之间的相互作用，这些心理过程在“水下”无形地发生，但会微妙地影响表面上所观察到行为的恰当性。我们相信，该模型有助于防止在理解从业者行为及其原因时出现错误，比如当他们混淆科学思维和个人反思、将反思本身当作目标，以及否认影响其行为的直觉和无意识方面的价值时。
