Reflective practice in health

Reflection-in-action and Reflection-on-action

Two main types of reflection are often referred to – reflection-in-action and reflection-on-action. The most obvious difference is in terms of when they happen.

Reflection-in-action

This is the reflection that takes place whilst you are involved in the situation, often a patient interaction. Reflection-in-action involves using analysis of observation, listening and/or touch or ‘feel’ to problem solve. It therefore sounds a lot like clinical reasoning – where reflection differs is that the problem solving leads to a change in the practitioner’s view of self, values and beliefs.

It is like ‘thinking on your feet’ but the focus is on gaining a new perspective, rather than just solving the problem.

Because it is happening on the spot, this type of reflection often appears very intuitive. It can take some time to develop the skills of reflection-in-action – it often is a skill associated with the development of expert practice.

Reflection-on-action

This type of reflection involves a stepping back from the situation, meaning that it happens at some time after the situation has occurred. Therefore it demands a time commitment – something that is often a challenge. Despite this, it has an important place in professional development.

"Routine treatments, based on implicit theories, may have the advantage of being easy to operate in practice, giving physiotherapists confidence and feelings of control. However, they may be based on assumptions, ideas and beliefs regarding practice that have gone unchallenged and as such, demonstrate a lack of clinical competence… There is a need to make professional and personal  knowledge accessible for reflection, testing and dissemination" (Donaghy and Morss, 2000, p. 7).