Reflection levels – the next stage

Factual Reflection
Impact of Reflection
Critical Reflection


Schon, D. (1983). The reflective practitioner: how professionals think in action, London, Arena

Ball,K. (2009) Exploring professionalism in medical educators from model to tool. PhD thesis, University of Southampton

Thinking about what you have just done is a natural process that we all do at some point. This is “Reflection” and can lead to you doing things better next time round. Reflection is therefore a core part of learning how to improve the things you do every day (1).

It is possible to be more effective about how you reflect or think about things.
Kerry Ball, in her PhD thesis, has outlined three levels of reflection and gives advice on how you can be helped to move to the next level (2). Writing down what you think helps the process and subsequent recall. However this may not suit everybody as learning styles vary from person to person. A written account does allow others to help your review your thinking and build up your options or solutions.

Factual Reflection

This is just thinking and writing about what was actually done. It is a factual account of what happened without any additional comment. Often described as “concrete” following the work by Piaget.

Impact of Reflection

Thinking about how the event has changed what you would do next time, in similar circumstances. What you would do differently next time. How you might do things differently in other settings.

Think about how you felt and write it down. Does this give you new insights. Were you sad, angry, frustrated or happy?

It helps consider how others would view the same situation, how they might handle things and whether the perspective of others might change your own approach. See the perspective sieve to help you consider things from the viewpoint of colleagues, family, patients or the wider community

Consider all the options that were open to you.  Both the options for diagnosis and the options for management if it is a consultation.

Critical Reflection

Considering what is the accepted approach, perhaps in published documents and the literature and looking at this with an objective, critical eye. Questioning the accepted wisdom and whether or not you, and others, could take a better approach. This developes new insights and questions existing understanding, which can lead to new concepts and generalisations.

Kerry Ball described these three levels as building up on a continum from level 1 “situational awareness” to level 2 “relational” and then level 3 “critical” . Kerry designed a framework to apply these within a Professional Reflective Enrichment tool (PRET) using reflection on a brief scenario.

1) Schon, D. (1983). The reflective practitioner: how professionals think in action, London, Arena

2) Ball,K. (2009). Exploring professionalism in medical educators: from model to tool. PhD thesis University of Southampton

With thanks to Kerry Ball for permission to outline the three stages of reflection from her PhD thesis