There's a saying from William Carlos Williams: `despite our wonderful technological wizardry, a doctor has ultimately to fall back on his or her way of being in the world, his or her sense of self'. This idea is an important concession to accepting unreservedly the onslaught of technological progress in modern medicine. Technology tends to come with an accompanying mindset, which puts the measurement of specific parts of the patient above understanding the person as a whole.
Reflective Practice suggests a means of exploring the sense of self within the professional identity as a whole. Gillie Bolton attempts to describe how to use this process and its accompanying benefits. She uses individual examples to effectively convey the human side of their internal deliberations.
`We do not `store' experience as data, like a computer: we `story' it'.
Winter 1988, p.235
The following are the key issues examined in this text; Effective reflective practice; Deep reflection; Authority and responsibility; Willingness to stay with uncertainty; Professional identity; Deep values.
The author explains "The structures in which our professional and personal roles, values and every day lives are embedded are complex and volatile. Power is subtle and slippery; its location is often different from how it appears." She adds that deep reflection and reflexivity for development involve:
* Authority and responsibility for personal and professional identity, values, actions, feelings.'
* Willingness to stay with uncertainty, unpredictability, questioning
Paradoxically she proposes that "the route is not through angry and uncomfortable confrontation: such revolution leads to destructive cycles of action and reaction." She feels that "The route is through spirited enquiry leading to constructive developmental change and personal and professional integrity, based on deep understanding. It is a creative process demanding the practitioner adopt a dynamic, self-affirming philosophy in their work.
"But reflective practice is not a thorn-less rose bed." She warns "People only learn and develop when they enjoy the process, and benefit personally." She goes on to develop her theme. "Serious professionals may cavil at adopting such creative methods, and feel suspicious of using deeply accessible varied sources of wisdom."
Einstein could be promoted as an advocate and exemplar of this approach to professional development. His success in science derived partly because he doggedly and constantly asked questions to which everyone thought they already knew the answers. Childlike, his genius comprised of asking essentially simple questions from a different vantage point than the norm, trying to `see' theoretical problems in a way that could provide a solution.
"He loved the questions themselves like locked rooms and certainly lived the questions" (Rilke,1934) There is a paradox proposed-that the events we forget easily, are the ones that perhaps most need reflection-giving rise to the deepest reflexivity: to this effect Bolton recommends a human resource development exercise, namely `Writing What You Do Not Remember'.
Plato, said, "The life without examination is no life." The author suggests that we accept his wisdom. Authentic education should explore methods of digging into material to discover what we don't know we know.
The method of travel affects what happens along the way-and the destination may be different as a result. A medical student commented: "We spend so much time studying medicine that we never have time to study sick people." Some argue that enquiry based learning should become the organised logic of entire teaching education programmes, with students learning through Medical courses need shaking up and more enquiry-based methods introduced. (`Curriculum' is Latin for `racecourse'-perhaps we need to lose the association with ancient Romans and its attendant bellicosity and the mayhem of the amphitheatre)?
A story is an attempt to create order and security out of a chaotic world. But for our experience to help us develop-socially, psychologically and spiritually,- our world must be made to appear strange. We, and our students, must be encouraged to examine our story-making processes critically: to create and recreate fresh accounts of our lives from different perspectives, different points of view, and to elicit and listen to the responses of peers. Listening critically to the stories of those peers also enables learning from the experience. `It is the exploration of experience, knowledge, values, identity that matters, rather than any attempt to arrive at a true account.' (Doyle 2004)
Without doubt the subject Bolton writes about so eloquently is essential to any professional working in healthcare and doubtless other areas of work. In any job it may be easy to forget that the practitioner needs to keep their practice authentic and responsive to those they contact. I cannot recommend Reflective Practice: Writing and Professional Development sufficiently. It's an excellent work, which provides opportunity for the reader to find out why they're working as they are and how to improve their practice.