Educational feature:

Reflection ‘in action’ and ‘on action’: does it matter? By Dr Arunima Ghosh-Nodiyal

In medical school, students are often asked to ‘reflect’ on what they have learned. For trainees in Psychiatry, portfolios almost always have reflective notes. My understanding had been, albeit naively, that we reflected once something had happened. It seemed to be a process after the event, and reflection helped think about ways to improve.

Interestingly, Donald Schön (1983) talked about ‘in action’ reflection. Such reflection was during the event, akin to ‘thinking on your feet’. It involved looking at our experiences, connecting with our feelings, and attending to our theories in use. It entailed building new understandings to inform our actions in the situation that was unfolding. Schön also proposed ‘on action’ reflection. This was after the event and is what we as medics commonly do (by writing reflective notes and so on). The act of reflecting ‘on action’ enables us to spend time exploring why we acted as we did, what was happening at the time, etc. In so doing we develop sets of questions and ideas about our practice.

Together, reflection ‘in action’ and ‘on action’ can greatly enhance professional practice. So, as well as reflecting on what you have already done, why not think about it while you are doing it?

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Improve the quality of life of your patients and reduce premature death by recognising general ill health and undiagnosed physical illness. This module teaches you how and when to take a general medical history and covers proficiency in interview techniques, competence in core components of physical history taking, and knowledge of conditions requiring further history taking.

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Dr Lingford-Hughes and Ms Lees look in detail at the effects of alcohol on the brain and neurological system; for instance, drugs of abuse seem to dysregulate many of the major pathways that usually control aspects of motivation, reward and memory. The authors describe the functions of addiction and highlight the pharmacotherapies that can be used to treat withdrawal and help maintain abstinence from alcohol.