The float model: visualizing personal reflection in healthcare

Challenge: 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. Educational model: 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. Applications: 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.