Physiotherapists are required by the Physiotherapy Board of Australia to continually upgrade their professional knowledge and skills to ensure the contribution they make to healthcare is of the highest standard.

There has been a gradual shift from requiring only evidence of formal learning towards maintaining a portfolio of continuing professional development and documenting reflection of impact on practice (Mann et al 2009, Paterson & Chapman 2013).

This reflective practice is increasingly being considered a critical dimension of professional development for health professionals.

Reflection is a critical part of learning from experience and is important in developing competency in clinical practice (Jones & Rivett 2019, Schön 1983).

Reflection should challenge a physiotherapist’s understanding of themselves, their attitudes and behaviours so that any biases are identified, allowing them to become more critical about their views on their practice.

The result of reflective practice has the potential to improve patient care, bridging the gap between knowledge and practice, clinical reasoning, and stimulation of critical thinking to encourage growth and change in practice (Jones & Rivett 2019, Mann et al 2009, Paterson & Chapman 2013).

The development and facilitation of reflection skills and critical thinking is essential to improving and developing clinical reasoning and driving the standard of professional practice.

Physiotherapists need to be reflective practitioners.

Reflective practitioners continually reflect on and improve the way they do things.

They actively search for understanding and are always open to further investigation, which brings about intellectual and epistemic humility.

There is attention to their own limitations and ability to critically think.

Reflection is not just thinking or replaying an event in your mind. The purpose of reflection is to work out what is already known and add new information with the result of drawing out knowledge, new meaning, and a higher level of understanding (Moon 2004).

Boud et al (1985) describe reflection within the context of consciously looking and thinking about experiences, actions, feelings, emotions, and responses, then interpreting them in order to learn from them.

There are many components to reflection.

Rolfe and Gardner (2006) discuss the concepts of ‘learning about practice’ and the generation of knowledge from it, and the ‘learning about self’, associated with exploring practitioner personal attributes.

Metacognition is another form of reflection, the self-awareness and monitoring of one’s own thinking; essentially ‘thinking about thinking’ (Higgs et al 2008).

Both components are associated with developing knowledge that is critical to decision-making in physiotherapy: propositional (theoretical), professional craft (skills and experience) and personal (ability to reflect; Higgs & Titchen 2000, Jones & Rivett 2019).

Mentoring and providing input from peers is one of the most influential elements in helping the development of reflection (Jones & Rivett 2019, Paterson & Chapman 2013).

Wainwright et al (2011) identified ‘mentorship’ among novice and experienced physiotherapists as a factor that influenced development of decision- making abilities over time.

The facilitation of a practitioner’s clinical reasoning and knowledge relies on promotion of depth and breadth of reflection, with intentional focus of critical self-reflection across all clinical reasoning strategies (Jones & Rivett 2019).

Many reflection models exist, including those proposed by Kolb (1984), Gibbs (1988), and Atkins and Murphy (1994), which aim to improve the ability of the clinician to learn from experience.

This results in short-term and long-term benefits to not only the clinician, but also to current and future patients (Paterson & Chapman 2013).

The concept of facilitating knowledge and reflection is the focus of Schön’s (1983) ‘reflection-on-action’ and ‘reflection-in-action’ theory.

‘Reflection-on-action’ is the conscious activity of looking back at one’s practice to seek improvement.

It transforms experience into knowledge and is predominantly performed by novice practitioners who have propositional knowledge but are yet to develop professional craft.

‘Reflection- in-action’ is reflecting on practice while it is happening, that is, the ability to think on your feet. It is a strong characteristic in expert practitioners—being able to generate new understanding of situations instinctively and adapt appropriately.

Novice practitioners’ use of reflection-on-action typically focuses on patient response and outcomes, while experienced practitioners are able to use reflection-in-action more and focus not only on patient performance and outcomes but also demonstrate high metacognition and self-awareness in their clinical reasoning.

Clinical reasoning plays a central role in critically reflective learning from practice experiences (Edwards & Jones 2004).

Research has described the clinical reasoning of novice practitioners to be therapist-centred, with more focus on the physical aspects of a patient’s presentation than understanding the patient’s narrative (Jensen et al 1990, Resnick & Jensen 2003).

The clinical reasoning process has been described as linear and deductive, lacking in collaboration and use of critical self-reflection (Christensen et al 2008).

Experience alone is not sufficient to develop clinical reasoning and reflective practice.

Attitudes that help form the basis of reflective practice include:

• open-mindedness and willingness to acknowledge and consider other perspectives, new evidence and admit the possibility of error 


• responsibility and careful consideration of one’s actions


• commitment and motivation to practice, engage, ask questions, critically think, and seek every opportunity to learn and develop through responding to experience.

The practice of physiotherapy needs to be reflective.

This fosters deep learning (Jones & Rivett 2019). Current literature suggests reflection and deep learning seem intrinsically related and mutually enhancing (Mann et al 2009).

Within physiotherapy, the concept of reflection plays an important and almost critical role in the development of advancing quality practice through challenging knowledge and any potential assumptions underlying it.

The physiotherapy profession is one that encompasses lifelong learning, and the process of reflective practice allows us to look systematically and thoroughly at our own practices as a means towards self- analytical growth and development.

>>Harry Truong is an APA Musculoskeletal Physiotherapist and APA Sports and Exercise Physiotherapist currently undertaking Fellowship of the Australian College of Physiotherapists by Clinical Specialisation in musculoskeletal physiotherapy. He currently works clinically at ProHealthCare and is an educator in the physiotherapy program at the University of South Australia.