Narrative Reflection

“The young physician constantly encounters a wide range of patients who are facing sickness, disability and death. The resident physician often has no special skills for facing these issues personally or with patients. So it is not surprising to find that the focus of many residents is mainly biomedical. Asking residents in such a situation to be constantly patient centred, without focusing time and energy on their own personal development is unrealistic and unwise.”(Lipkin M, Quill TE, Napodeno RJ “The Medical Interview: a core curriculum for residencies in Internal Medicine.”)

Whilst the above statement is describing the experience of internal medicine residents it is also true for most residents in other disciplines of medicine, including Family Medicine.

Professionals with years of experience know more than novices to the profession, but what they know is not always in text books or journals. Experience generates a different kind of knowledge which is hard to teach and this knowledge (tacit knowledge, Polanyi 1962) is not retained by the expert in a verbal form which can be communicated. However if a professional tells of an experience it enables the learning to be translated into a verbal format which can be reflected upon and used for professional self development and for learning by others.

This way of learning builds on the work of the great educational theorist Dewey (1938) who explored ideas of knowledge grounded in experience, and more recently in the work of Donald Schon who asked the question: “how is professional knowing like and unlike the kinds of knowledge presented in academic textbooks, scientific papers and learned journals?” (Schon, D “The Reflective Practitioner: How professionals think in action” Jossey Bass Inc. (1983) San Francisco)

These ideas have been further explored by Clandinin and Connelly (1988) who developed a narrative view of experience. They see Practitioner knowledge as part of a developing narrative life history. The stories of professional experiences are integrated with each professional’s life story. The question then remains how do we best do this? Is there some way educators of professionals can facilitate the process? (Clandinin, DJ, Cave MT "Creating pedagogical spaces for developing doctor professional identity" (2008) Medical Education; 42:765-770.)

Drawing on the research methodology of Narrative Inquiry, Clandinin has developed a concept of “Narrative Reflective Practice” in which professionals learn to engage in narrative inquiry on their own practices in order to tell, retell, and relive their knowledge in re-storied ways. By doing this, professionals can become aware of their tacit knowledge, as knowledge expressed in practice. They can then refashion their knowledge by reflection, and perhaps, if need be, change their practice accordingly.

Much of the focus of Clandinin and Connelly’s work had been the professional lives of teachers. Then, in 2006, at the University of Alberta, Clandinin and Cave began to research the professional lives of physicians, (residents in family medicine) to see if, like other professionals, they too can use narrative reflective practice strategies to access tacit knowledge.

Narrative Reflective Practice Strategies