Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators

Abstract

There has been recent increasing interest in reflective practice within physiotherapy education as a method for reducing the ‘theory-practice gap’ and as a means of articulating, exposing and developing knowledge embedded in practice. Several contrasting theories have been developed to explain the role, place, purpose and definition of reflection in learning and teaching; however, much of the research to date has relied on theoretical debate rather than high quality empirical evidence. The aim of this paper was therefore, to report how a group of United Kingdom (UK) based physiotherapy Professional Practice Coordinators (n = 33) with their unique insight into the concept from both the academic and clinical perspective viewed and interpreted the use of reflective practice within their physiotherapy curriculum. Consent for the study was obtained via the professional body (The Chartered Society of Physiotherapists) (CSP) and data was collected via postal questionnaire. Results indicated a diversity of experience in respondents both in terms of their role as Coordinator and their training in reflective practice. There was also no clear consensus regarding facilitative models or assessment methods even though the majority of coordinators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies. The results of this survey provide a focus for further empirical research into reflective practice as part of the physiotherapy curricula, while advancing the understanding of reflective practice from a broader perspective and clarifying the benefits to students, teachers, patients and practitioners.

Introduction

The concept of ‘reflective’ thought was introduced by Dewey (1933) in his ‘How we think’ work. Educationalists have valued the process of reflection in the learning cycle for a number of years (Dewey, 1933; Boud et al., 1985; McCaugherty, 1991). Reflective practice has been espoused as facilitating theory and practice and producing critical thinkers and ‘doers’ (Schön, 1991; Reed & Procter, 1993; Hallett, 1997; Boud & Walker, 1998). Recently it has been adopted across a wide spectrum of the health care educational curricula, possibly in response to these courses now requiring the demonstration of higher levels of thinking (Boud & Knights, 1994).

Reflective practice as a term has been used in a number of ways by various authors (Boud et al., 1985). The preferred definition for this study was by (Gould & Taylor 1994) which stated ‘Reflective practice is a generic term for those intellectual and affective activities in which individuals engage to explore their experience in order to lead to new understandings and appreciations’. However, literature on the subject fails to demonstrate a universal clarity of the concept (Griffiths & Tann, 1991). Kottkamp (1990) further stated that the ‘uninformed use of reflective models and poor interpretation of the definition of reflective practice, reduces ideas with great potential to mere ‘tinkling jargon’.

Reflective practice, in physiotherapy, as in many other professions, has become a key issue for all those involved in curriculum development. The concept has become an explicit requirement within many health care professional degree programmes. The use of reflective practice has been advocated as a way of overcoming the divergence between health care theory and practice and as a means of articulating and developing knowledge embedded in practices this having been highlighted particularly within physiotherapy practice (Cross, 1993; Clouder, 2000).

Boud & Walker (1998) suggest that it is through the reflective process that new understandings and appreciations may be acquired. Others suggest that reflective practice assists with the development of ‘knowledge creation capacities’ (Eraut, 1985) and that ‘reflection may be a vehicle through which values or beliefs can be challenged or changed’ (Greenwood, 1993) and new perspectives achieved (Johns, 1995). However, literature suggests that reflective practice has been adopted across a wide range of professions including physiotherapy in the absence of thorough knowledge or debate regarding its definition, role, underpinning philosophy, process or indeed benefits to learning (Morrison, 1995; Clarke et al., 1996; Clouder, 2000; Clouder & Sellars, 2004).

The link between reflection, competence to practice and Continuous Professional Development (CPD) have been reiterated in several professional documents (Chartered Society of Physiotherapists, 1995; 1996; 2002), with the expectation that physiotherapists should be reflective practitioners (Cross, 1993) and lifelong learners (Donaghy & Morss, 2000). According to Schön (1983; 1987) ‘Students development as reflective practitioners should be facilitated and supported’, Quicke (1996) concurred, further adding ‘Students should be encouraged to reflect on self- knowledge and explore the beliefs that underpin their practice’.

Literature regarding models of reflective practice and physiotherapy education have been identified (Donaghy & Morss, 2000), however, to date, research into their use appears very limited. What research there is on the subject tends to be predominantly from a nursing perspective and is frequently discursive, complex or abstract and focuses principally on teaching staff or student perspectives (Burnard, 1995; Durgahee, 1996), identifying facilitative processes (Wallace, 1996; Durgahee, 1998) or assessing student's levels of reflexivity (Richardson & Maltby, 1995; Wong et al., 1995). Burrows (1998) further proposed that literature on the subject has now become repetitive.

Although there are many models, facilitative techniques and conceptions of reflective practice, which account for the interest in the technique, the ideas of Schön (1983; 1987) are most frequently explicated in literature and reflect current developments in educational strategy. The author differentiates between reflection ‘in’ action, which focuses interactively on the outcomes of action, the action itself and the intuitive knowing implicit in the action and reflection ‘on’ action a process of making sense of an action after it has occurred (Clouder, 2000). There has also been a proliferation of techniques, including reflective diaries, journals, portfolios and reflective logbooks (Francis, 1995; Snadden & Thomas, 1998) purported to promote reflection, in intending and practicing healthcare professionals. However, to date there remains little empirical evidence to demonstrate that any of the models or facilitative techniques is effective specifically in relation to reflective practice and its impact on patient care (Pee et al., 2002).

Therefore, the aim of this study was to survey physiotherapy Professional Practice Coordinator's views on reflective practice, focussing primarily on facilitation methods and models of reflective practice. The ultimate aim being to gain a unique insight into the concept of reflective practice from both the academic and clinical perspective, within the framework of the current physiotherapy curricula in the UK. The Coordinators unique role broadly involves student teaching and support, identification and development of new clinical placements and the development of improved educational strategies. Hence, a survey of this unique group provided the best opportunity to evaluate how reflection, with its roots firmly in phenomenology (Dewey, 1933) can be best integrated within the empirical scientific paradigm that underpins current physiotherapy and health care teaching and practice.

Methods

This study aimed to investigate the use of reflective practice through the views of physiotherapy Professional Practice Coordinators (n = 33) employed within universities offering undergraduate physiotherapy courses in the UK. The research drew on and developed a methodological approach that utilized both quantitative and qualitative data collection methods. The qualitative aspect was added to the study to add richness to the quantitative data, thereby further increasing validity. Burns (2000) purported that this type of knowledge is not exposed using purely quantitative research methods.

A postal questionnaire was developed with reference to previous research relating to methods and models of reflection and associated teaching strategies used in the facilitation of reflective practice. The questionnaire consisted of open, closed and multiple-choice questions. Wilson & McClean (1994) suggested that closed questions are quick to answer and easy to code, while open questions permit greater freedom of expression. The main aim of the questionnaire was to collect valid, reliable, unbiased and discriminatory data from a representative sample of respondents (Parahoo, 1997). However, although considered cheap in terms of design and administration, questionnaires are not always easy to formulate and generally have a poor response rate (Oppenheim, 1996).

A further disadvantage of using questionnaires is that when administered, the researcher relinquishes control over the environment. Thus the results of the survey rely significantly on the honesty of the respondents (McColl & Thomas, 2000).

An initial pilot questionnaire, along with covering letter and stamped addressed envelope were posted (22 January 2004) to the researcher's faculty tutors (n = 2), together with an external Coordinator, a CSP clinical education officer and the Chair of the Physiotherapy Clinical Educators Committee. The process of piloting aimed to identify any questionnaire design flaws and ambiguity of questions (Stone, 1993). The amended questionnaire contained questions in three sections; participant background (questions 1–5), reflective practice facilitation methods within physiotherapy curricula (6–10) and models of reflective practice and physiotherapy education (11–20). Question 21 was an open-ended question and inquired ‘Does the encouragement of reflective practice in students improve learning and create thoughtful, critically aware physiotherapists?’.

The census survey sample consisted of all physiotherapy Professional Practice Coordinators in the UK as defined by Higher Education Institutes (HEI) involved with the professional body (CSP). Some authors suggest a large sample improves reliability and validity. However, Field & Morse (1992) disputed this claiming that, ‘within qualitative research sample numbers tend to be small’. The study investigated the total sample population. The sample number (n = 33) was a total representation of both the study and sample population i.e. all physiotherapists working in Higher Education as a placement coordinators. Therefore the findings of this study may be considered representative and transferable within all UK universities offering undergraduate physiotherapy courses.

Ethical approval was not required after consultation with the university research office; however, the need for participant consent was highlighted. Placement coordinators meet three times per year in London facilitated by the professional body for physiotherapy (CSP), consent for individual participation in the study was obtained at a meeting (21 January 2004) of Coordinators. Participant's contact details were requested and obtained via email (25 January 2004) from the CSP (Clinical Education Officer) using the ‘National Network of Physiotherapy Professional Practice Coordinator's Database.’ The coded (1–33) identical questionnaires were mailed (1 February 2004) using A4 brown envelopes with computer generated address labels attached. To maximize response rate, each questionnaire included a stamped addressed envelope and a covering letter explaining the purpose of the study and assuring confidentiality and anonymity. A copy of the questionnaire and letter were forwarded via email two days later (3 February 2004) to ensure delivery. A follow up prepaid postcard containing five cues was mailed (20 February 2004) together with a covering letter requesting information regarding reason(s) for questionnaire non-completion to all non-respondents.

The analysis and interpretation of data collected from the individual questionnaires was completed using the Statistics Package for Social Sciences (SPSS, Version 11). This software package permitted ease of tabulation and allowed trends and patterns to be noted. Descriptive statistics were used to present data in graphical and tabular form. Responses to the final open-ended question were grouped by themes, prior to contextual analysis. Thematic coding identifies themes common to all participants while contextual analysis exposes individual perceptions (Polgar & Thomas, 1995). Codes were subsequently compared and key statements categorized using the framework of Fielding (1993). Reliability of coding was established on retest. However, Pope et al. (2000) claim inter-tester reliability is not necessarily a component of the qualitative research process. Finally, researcher bias cannot be abolished in qualitative research (Reed & Procter, 1995) however; it should be made plain at the outset to enhance the credibility of the findings (Mays & Pope, 2000).

Results

Of the 33 questionnaires mailed, 22 (67%) were returned, which was well in excess of the 30% response rate suggested by Oppenheimz (1996) for a postal questionnaire. A further 8 out of 11 (72%) follow up postcards were returned detailing reasons for non-completion, giving an overall response rate of 30 (91%). The main reasons for non-completion of questionnaire at follow up were given as ‘being too busy’ 50% (n = 4) and ‘not receiving the questionnaire’ 37% (n = 3).

Results indicated a variation in terms of both experience as a coordinator and levels of reflexivity. Half of the respondent's indicated that they had been employed as physiotherapy Professional Practice Coordinators for 5 years or less and a further 32% (n = 7) for between 6–10 years. The majority of the sample 61% (n = 14) claimed to reflect on their physiotherapy related actions on a daily basis, with a further 26% (n = 6) reflecting by specific or difficult case. However, the respondent's personal method of reflection, or their definition of a ‘specific’ or ‘difficult’ case was not addressed in the study. The Coordinators formal training in reflection was assessed and revealed that 43% (n = 13) had received university-based training, 13% (n = 4) hospital-based training and 13% (n = 4) via the CSP. The study did not, however, address the nature or extent of this training. It was interesting to note that 23% (n = 7) of the sample received no formal training in reflective practice (Figure 1).

Figure 1. What formal training have you had in the use of reflective practice?

Results indicated that reflective practice was utilized as a formal learning tool for between 6–10 years in 45% (n = 10) of universities and 36% (n = 8) for 3–5 years (Figure 2). However, there was no clear consensus regarding the universities methods of facilitation or assessment protocols. Results indicated that reflective practice was facilitated using clinical log/diary/journal in 27% of universities, reflective group/individual discussion in 25% and learning contract negotiations in 24%. There was also a diversity of assessment methods utilized. These primarily involved the use of a clinical log or diary, 32% (n = 14), university based assignments, 27% (n = 12) and feedback from the clinical educator, 25% (n = 11). Most respondents indicated that they used a combination of both facilitation (Table 1) and assessment methods. The results demonstrated a broad spectrum of perceived barriers to reflection within the physiotherapy curricula, these included; a lack of student motivation, 27% (n = 12), lack of student maturity, 22% (n = 10) and students negative preconceived ideas regarding reflective practice, 16% (n = 4) (Figure 3).

Figure 2. How long has reflection been utilized as a formal learning tool within your undergraduate curriculum?

Figure 3. What do you feel/are the main barrier(s) to reflective practice facilitation within your curriculum?

Table 1.  What is/are the main method(s) of facilitating reflective practice within your undergraduate physiotherapy curriculum?

Reflective method	Frequency	Responses (%)
Reflective discussion	18	25.4
Clinical log diary/journal/CPD	19	26.8
Critical incident	14	19.7
Learning contract	17	23.9
Stimulated recall via video/audiotape	1	1.4
Other	2	2.8
Total	71	100.0

The categories were not mutually exclusive and respondents ticked all responses that applied.

Attitude indices derived from summated Likert scale (strongly agree to strongly disagree) scores indicated a broad disagreement, 41% (n = 9) that reflection ‘in’ practice was preferable to ‘on’ practice. However, although the question clarified the terms ‘in’ and ‘on’ practice, 36% (n = 8) remained undecided.

There was a strong agreement that reflection should be considered to be a central component of physiotherapy teaching strategies and that reflection improved and facilitated the integration of physiotherapy theory and practice, 68% (n = 15), and 64% (n = 14) respectively. There was also an unambiguously positive response to the question posed regarding the importance of the reflective facilitator. The results indicated a broad agreement, 91% (n = 20) that the majority of physiotherapy students did require formal guidance to enable them to reflect effectively, however, the questionnaire did not request information as to who was best placed to facilitate this reflective guidance.

Information regarding the advantages and disadvantages of teaching reflective practice was gained through the use of a ranking scale (1–5). Results indicated that the main advantage of using reflective practice was that it aided clinical reasoning and problem solving, 64% (Table 2). The main disadvantage was that it was too time consuming, 54% (Table 3). A number of respondents qualified their responses with statements such as ‘Reflective practice helps identify personal strengths, weaknesses and possible solutions’ and ‘There are no disadvantages to using reflective practice’. The majority of Coordinators, 86% (n = 19) found that in general, clinical educators were keen to facilitate reflective practice. However, again, a number qualified their responses, with responses such as ‘Clinical educators need to be confident in the process of reflection themselves’ and ‘Coordinators and clinical educators should receive increased support from the HEI’.

Table 2.  What do you feel are the main advantages of teaching reflective practice to physiotherapy students?

Ranking variable	Frequency	%
Allows critical evaluation	7	31.8
Aids problem solving	14	63.6
Other	1	4.6
Total	21	100.0

Table 3.  What do you feel are the main disadvantages of teaching reflective practice to physiotherapy students?

Ranking variable	Frequency	%
Time consuming	12	54.5
Confidentiality/privacy affected	6	27.3
Relies on memory	3	13.6
Poor evidence to support use	0	0
Other	1	4.5
Total	22	100.0

An associated final open-ended question asked respondents if they thought that the encouragement of reflective practice in students created thoughtful, critically aware physiotherapists. The categories of response themes and concepts are set out in Table 4. In general, most statements were positive, with insights such as ‘Obviously regular reflection comes easier to some students than others’ (Category A) and ‘Students need time early on to develop their reflective skills’ (Category B), proving informative. The timing of reflection was also identified as a key issue among respondents with statements such as ‘Reflection needs to be ongoing and have follow up to assist students to be motivated to continue reflecting on their work’ and ‘They need time and assistance to enable them to reflect efficiently, i.e. more reflection “into” action’ (Category C). Also, the importance of reflective practice in relation to problem solving and decision-making was identified and qualified with statements such as ‘Reflective practice challenges ideas, procedures and practices, therefore, allowing the formulation of better ways of doing things’ (Category D).

Table 4.  Emergent Themes/Concepts from open-ended question responses

Category A: reflection is easier for some students than others

• On the whole developing the ability to reflect works well with some students, using the portfolio identifies which students do reflect.

• Reflective practice is a skill that needs to be developed like any other.

• Some are natural diary writers and may find reflective record keeping easy while others may be very good at internal reflection, however, they may find it difficult to quantify the reflection as written records.

Category B: reflection requires knowledge and experience

• Students need time early on to develop the skills necessary to reflect.

• There is a definite progression of attitudes in our third year students, they’ve developed strong skills of self-reflection and are much more responsive and less guarded in peer review.

• Undergraduate students do not necessarily act on plans arising from reflective assignments. Postgraduate students appear to be better able to utilize reflective practice to make major strides in their practice/careers.

Category C: reflection ‘on’/‘in’ action

• Reflection needs to be ongoing and have follow up to assist students to be motivated to continue. They need feedback, assistance to reflect efficiently i.e. more reflection ‘into’ action.

• Reflection ‘in’ practice is an advanced skill and to optimize learning by students, reflection ‘on’ practice is the starting point.

Category D: reflective practice aids problem solving & decision making

• Reflective discussion helps students to recognize how their decisions were made.

• Through reflection upon practice they are able to challenge ideas procedures practices etc. and therefore begin to formulate ideas for better ways of doing things.

Discussion

The results of this study highlight the fact that although reflective practice is not a new concept to physiotherapy education, there remains no one definitive method or model of facilitation or assessment currently operational within the undergraduate physiotherapy curricula in the UK. The study found that in general Coordinators lacked formal training in reflective practice techniques, with what training they did receive being gained from varied sources. Overall, reflection was however, considered to be a method that did improve and facilitate the integration of theory and practice and was regarded by Coordinators to be a central component of their physiotherapy teaching strategies. The consensus of opinion among Coordinators was that students did require time and formal guidance to enable them to reflect effectively and that the context of the reflection was fundamental to the educational outcome.

This lack of consensus of opinion among Coordinators regarding their methods of facilitation and assessment of reflective practice may have been due to the fact that the context of the reflective facilitation and assessment process were not fully investigated. Dewey (1933) stated ‘The methods which are permanently successful in formal education depend for their efficiency upon the fact that they go back to the type of situation which caused the reflection’. According to Boud & Knights (1994) ‘reflection is about something and it occurs in a particular context and it must be considered an element of an overall design which links learning goals to curriculum content and development’. Clouder (2000) further noted that reflection ‘in’ and ‘on’ action are clearly not dichotomous opposites within physiotherapy but are interwoven depending on the context, thereby challenging students and practitioners to ‘think on their feet’ as well as on paper––two very differing, but essential skills.

This study also highlights the important role that physiotherapy Professional Practice Coordinators have as facilitators for the implementation of reflective practice in physiotherapy curricula. The importance of facilitating reflection on experience to develop higher order cognitive skills, critical enquiry and deeper approaches to learning within education is now well accepted (Boud et al., 1985; Dewing, 1990; Reid, 1993). However, in accordance with the present study, evidence from nursing (Johns, 1993) and physiotherapy (Routledge et al., 1997) agrees that successful reflection is profoundly difficult without expert guidance and support; Paget (2001) further agreed stating that ‘the role of facilitator is pivotal in promoting reflection in students’.

Scanlon & Chernomas (1997), however, consider that to teach reflectively educators need to be reflective themselves. Nicholl & Higgins (2004) further indicated that poor preparation and support are clearly responsible for educators (nurse) lack of knowledge, both on how to reflect and how to assist students to do so. In this study it was noteworthy, that although 61% of Coordinators claimed to reflect on their physiotherapy related actions on a daily basis, however, the fact that 23% of the sample received no formal training in reflection highlights the urgent need for increased support from HEI, with structured training programmes in reflective practice for Coordinators and indeed all educators.

Literature generally again tends to concur with the study findings that reflection has the potential to assist practitioners to tap into knowledge gained from experience, thereby linking theory to practice (Glen et al., 1995; Durgahee, 1996; Duke & Appleton, 2000). Several authors have perceived a theory-practice gap across various health professions (Johns, 1995; Clarke et al., 1996; Burrows, 1998). Hallett (1997) conducted a phenomenological study of the significance of Schön's theories of coaching to nurse education, which has relevance to the present study. The author interviewed (n = 20) nursing diploma students and analysed the data using the well-referenced tool of Gadamer's (1975) ‘hermeneutics’. The author identified a ‘theory-practice gap’ in which initially students were confused when introduced to the clinical environment, but through experience, their knowledge and understanding of reflective practice developed. However, the sample size was small and the author drew heavily on her previous research findings, thus an element of bias may have existed within the study. In general, authors do tend to agree that reflective practice may remedy the theory-practice gap; however, to date there appears little high quality research evidence to support their claims.

The timing of reflection was perceived as an important theme in the final open-ended question. Schön's ideas of ‘reflection-in action’ have been influential within primary health care, especially within nurse education (Boud et al., 1985; Reed & Procter, 1993). However, results of this survey indicated that Coordinators viewed reflection ‘on’ practice as a preferable method to facilitate learning. It may be that both reflection ‘in’ and ‘on’ action have their place in the physiotherapy curricula. As one of the respondents succinctly stated, ‘Reflection ‘in’ practice is an advanced skill, but reflection ‘on’ practice may serve as a starting point’. In general, support for the increased allocation of time to enable students to reflect appears critical to the reflective process and highlights a need for creativity in providing space no matter how packed the curriculum, or hospital department may be (Tate & Sills, 2004).

The role of assessment and grading of students in relation to reflection also remains problematic (Boud & Knights, 1994). The present study indicated a divergence of methods and models used in the assessment of reflection within the UK physiotherapy curricula. Literature on the subject suggests that reflective practice assessment tools lack reliability (Richardson, 1995; Wong et al., 1995), and sensitivity (Tate & Sills, 2004). This study identified the clinical journal as the main assessment tool utilized within the universities surveyed. Boud & Knights (1994) noted ‘What is sought in considering a reflective journal or diary as an assessment tool is evidence that the learner can give an account of a particular experience, be aware of any emotional response and describe the outcomes of reflection on the experience’. Tate & Sills (2004) further acknowledged, ‘Where reflection is assessed, the criteria should be as broad as possible and not too prescriptive’. Therefore, it may be that the particular method or model of assessment within the physiotherapy curricula may not be as important as how it is used and in what context.

Overall, this study raised a number of interesting points; however, it is important to acknowledge the limitations of the study in order that the findings may be placed in context with other literature on the subject. The present study was limited in that it focused primarily on reflective practice use within the context of clinical placement modules, which may have biased the responses, as many universities may also use reflection as part of their academic curriculum. Also, the study was unable to ascertain whether the Coordinators remit was physiotherapy-specific or involved multiple allied health professions. The fact that this aspect of the Coordinators scope of practice was not fully investigated may have influenced their working knowledge of the reflective component of their university's physiotherapy curriculum.

The use of a questionnaire as the survey instrument did not provide an adequate opportunity for respondents to clarify their responses; this was particularly evident in questions relating to ‘improvement’ and ‘facilitation’ of practice. Parahoo (1997) stated that ‘questionnaires tell us little about the context in which the respondents formulate their response.’ The use of semi-structured interview or focus groups may have facilitated clarification of these and other ambiguities. However, due to time and financial constraints, individual interviews or focus groups were considered unsuitable for this research project. Therefore, the limitations of this study meant that it was unable to address the more profound aspects of phenomenology as described by Miles & Huberman (1994) such as deeper understanding, empathy and indwelling within the subject.

There is an obvious need for further empirical research to determine the effectiveness of reflection as a process to enhance clinical reasoning and decision making within physiotherapy education, both in higher education and (more importantly) in practice settings (Donaghy & Morss, 2000). This study also supports the need for further research to evaluate reflection as a means to reduce the physiotherapy theory/practice gap and its influence on patient care (Clouder, 2000) using standardized, sensitive, reliable and validated assessment tools and physiotherapy specific outcome measures. Future research should investigate reflective practice from a broader perspective involving perhaps patient perception's of reflective students and professionals and possibly exploring the merits of reflective ‘communities of practice’ as advocated by Clouder (2000), or as a social and political tool of empowerment as heralded by Habermas (1971).

Conclusion

This survey has demonstrated that physiotherapy Professional Practice Coordinators are ideally placed to effect a meaningful change with regard to reflective practice and physiotherapy curriculum development. The main aim of reflective practice is to improve the quality of patient care delivered by autonomous, thoughtful and knowledgeable practitioners (Durgahee, 1996). To prepare physiotherapy students optimally for their future, educators must attend to issues of both content and process of learning identifying what is required for their graduates and how it is best achieved (Higgs & Jones, 1995).

Employers already demand competency, efficiency and evidence-based practice from all healthcare professionals. This will ultimately affect curriculum development and educational programming (Saylor, 1990). A discipline's progress is measured by its theoretical developments and the ability of its members to solve central problems and answer its socially significant questions (Boud et al., 1985).

This unique survey of physiotherapy Professional Practice Coordinators has clearly demonstrated that there remains a need for all educators to be trained in reflective methods, taking into account the complexity of the subject. It is also evident that further good quality empirical research needs to be undertaken regarding reflective models, facilitation methods; timing of reflection and the influence reflection has on patient care. Empirical research data on the subject needs to be systematically collected, analysed, collated and disseminated to address the current paucity of literature regarding the value of reflective practice to physiotherapy theory and practice education.

Acknowledgement

The authors would like to acknowledge the support of the CSP and UK university based professional practice coordinators.

Additional information

Notes on contributors

Alan Ward

ALAN WARD, MA BSc (Hons) is currently a practicing State Registered Podiatrist. This paper forms part of the requirements for the Degree of Master of Science (MSc Pre registration Physiotherapy) completed at the University of Ulster.

Jacqueline Gracey

JACQUELINE GRACEY, BSc Hons, D Phil, is a Lecturer in Physiotherapy in the School of Health Sciences and is the Professional Practice Coordinator for physiotherapy education at the University of Ulster.

Practice points

Table

•Physiotherapy educators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies.

•There is great diversity of experience in educators both in terms of their role as Coordinator of clinical education and their training in reflective practice.

•Reflective practice within physiotherapy education is utilized as a method for reducing the ‘theory-practice gap’.

•There is no clear consensus regarding facilitative models or assessment methods for reflective practice in the physiotherapy curriculum.