Critical reflection helps learners understand what and why they learn in a certain way and to assess the impact and perceptions of these practices (1). It is a method of experiential learning that problematizes one's professional performance as a potential learning situation so that practitioners can continue to learn, grow and develop in and through his or her practice (2). Critical reflection facilitates the development of awareness and examination of our unconsciously held values and beliefs about our practice that drive our learning and interactive clinical behaviors (3). It is hoped that this journal will assist you in exploring learning issues and professional attitudes and behaviours for dealing with addiction issues.

It is suggested that learners record a journal entry every few days (although some residents have done it daily). This activity should take approximately 15 minutes although some learners may choose to spend more time or document more frequently (e.g. some find it useful after each day to reflect on what and how they learned that day). For each entry in your journal, describe an experience as a learner/ practitioner in the addiction psychiatry rotation. The study of these significant events is often highly revealing and a great deal can be gained from reflecting on them. You are likely to find it even more helpful if you share insights, perceptions, recurring themes, concerns or difficulties identified from your reflections with faculty or peers (4). However, this journal is for your use only and will not be asked to be handed in at the end of the rotation. Times will be scheduled where discussion of issues of your choice arising from your reflections can be discussed. This process of analysis and discussion can also help you to identify your learning needs as a resident. Make sure that when you describe the activity you include your behavior and the behavior of others as well as your thoughts and feelings. If you are constantly coming up with the same suggestions you need to review earlier sections of the journal and establish why you are not making any changes to your practice. You should also consider discussing these recurring themes with others. You may wish to use the following format as a guide for your reflections but feel free to adapt as suits your needs.

Example Reflection on a critical incident (positive or negative) in my practice as a clinician (dealing with a patient, dealing with system, stigma issues)

1. Describe your expectations (aims/goals) and the experience (planned or not, who was there, your and others behavior, thoughts, feelings)2. What were the positive aspects? What were the difficulties encountered?3. What is your reflection and interpretation of the experience? How did it go and why did it go that way (issues)? 4. What will you do differently next time and why?5. What gaps (learning need) in your knowledge and skill have you identified and how do you plan to go about filling them?

References:

1. Brookfield SD. Becoming a Critically Reflective Teacher. San Francisco: Jossey-Bass,1995.
2. Jarvis P. Reflective Practice and Nursing. Nurse Education Today 1992;12:174-181.
3. Tate S, Sills M. The Development of Critical Reflection in the Health Professions.
http://www.health.ltsn.ac.uk/publications/occasionalpaper
4. Greveson G. Guidelines for reflective diary and examples of diary entries. Master in Clinical Education program. School of Medical Education Development. University of Newcastle upon Tyne.

Adapted from reflective journal instructions written by Susan Lieff MD FRCP(C), Director, Teaching Scholars Program. Faculty of Medicine, University of Toronto. September 2004 by Bruce Ballon MD FRCP(C) for Addiction Psychiatry PGYI core rotation November 2004.