The use of critical reflection to foster reflective practice in student osteopaths

Reflection and reflective practice, have gained increasing importance in health practitioner education. This has led to the inclusion of reflection in the documentation of capabilities for health practitioners. Despite a growing literature and interest in reflective practice, it remains unclear how reflection facilitates the development of reflective health practitioners. Using a longitudinal qualitative case-study design, this research investigated the impact of embedding a pedagogical intervention of reflective learning across four years of the five-year osteopathic course at an Australian university. The aim was to understand how a cohort of student osteopaths used reflection to develop reflective practice and why reflection was important to these students during their preregistration education. Multiple qualitative data sets of student written reflections and focus group and interview transcripts were analysed using a validated level-of-reflection measurement scale and a thematic analysis approach. The key findings which also have implications for other health practitioner courses, are threefold: (1) sustained and repeated use of reflection enhances the development of critical reflective practice more effectively than brief, single course exposure; (2) students engaging with reflection require dedicated support, including access to professional counselling; and (3) an early introduction to and positive reinforcement of the benefits of reflective learning engenders an enculturation of the legitimacy of reflective practice as essential learning for health professionals. This research is the first to examine reflective practice in osteopathy and proposes a model of reflective practice in osteopathy. The use of reflection to facilitate the development of reflective practice in health practitioner education is supported with recommendations for future research in academic and workplace settings.