Reflective practice is viewed internationally as an important activity within the dental professions and one which the General Dental Council expects to be part of all dental technician programmes in the United Kingdom (UK), irrespective of academic level. Informal discussions with colleagues delivering dental technology in UK higher education institutions agree that reflective practice is an important aspect of the curriculum, and learning is facilitated and assessed using various methods, for example, an online portfolio. Anecdotally, many of the current methods are shown to be ineffective, with up to fifty percent of students not meeting the reflective component. In the dental professions, consideration needs to be given to the use of creative methods to support reflective practice, in order to engage learners and contribute to the development of knowledge, skills and attitudes in this student group

Barton

Boud

Charon

Cooperrider

Coward

Driscoll

Furman

Gardner

Gibbs

Hanson

Hoggan

Howatson-Jones

Jack

Jasper

Jonas-Dwyer

Koole

Mann

McAndrew

Moon

Reeson

Schon

Shapiro

Smith

Threlfall

Lewis, J

Jack, K

E-space: Manchester Metropolitan University's Research Repository

Lewis, J and Jack, K (2018)The use of the arts to encourage reflection in thedental professions-A commentary. European Journal of Dental Education,22 (3). e648-e650. ISSN 1396-5883Downloaded from: http://e-space.mmu.ac.uk/624860/Version: Accepted VersionPublisher: WileyDOI: https://doi.org/10.1111/eje.12357Please cite the published versionhttps://e-space.mmu.ac.ukThe use of the arts to encourage reflection in the dental professions – a commentary.   Abstract Reflective practice is viewed internationally as an important activity within the dental professions and one which the General Dental Council expects to be part of all dental technician programmes in the United Kingdom (UK), irrespective of academic level. Informal discussions with colleagues delivering dental technology in UK higher education institutions agree that reflective practice is an important aspect of the curriculum, and learning is facilitated and assessed using various methods, for example, an online portfolio. Anecdotally, many of the current methods are shown to be ineffective, with up to fifty percent of students not meeting the reflective component. In the dental professions, consideration needs to be given to the use of creative methods to support reflective practice, in order to engage learners and contribute to the development of knowledge, skills and attitudes in this student group.  Reflective practice is not a new concept and has long been viewed as being beneficial to the development of graduates who go on to practice in their chosen professions (1). Reflective capability is linked to desirable qualities such as enhanced self-awareness, life-wide and lifelong learning and becoming a professional (2, 3, 4). However, many approaches to reflective teaching are inconsistent and misunderstood (5, 6). This is problematic as superficial approaches to the teaching of reflection have been linked to superficial levels of reflective thinking in students (7).  Reflective capacity is a formal requirement for registration in the dental professions and evidence of this competence is often provided through student portfolios, developed over the programme of study. However there is little guidance to support educators in understanding reflective ability in students (7). Further, in programmes such as nursing, where the concept of reflection has been embedded for many years, it has been shown that students find reflective practice challenging, particularly in the early years of their programme and many are suffering from reflection overkill (8). Less is known about reflective practice for dental professionals and there appears to be a paucity of research that explores the particular experiences of dental technology students. An informal assessment of the dental technology courses in the UK provided some understanding of the difficulties faced when trying to engage student dental technicians in the undertaking of reflection. Anecdotally it was reported that many students lacked understanding about the meaning and value of reflective practice.    Bearing in mind these difficulties, it remains important that educators endeavor to provide meaningful reflective opportunities for dental technology students. Being accepted as part of the team is important for students in the clinical area who often feel left out of patient care provision and have concerns that their input is being ignored (9). They are often left feeling insecure and this can lead to feelings of stress and anxiety. Reflective activity can support students to explore their feelings associated with incidents from practice and this is particularly important when learning the professional role (7). Not all of the answers to problems in practice can be found through formal learning and having the ability to reflect can help to close the theory/practice gap.  Ways to encourage reflective practice among the dental professions is an international concern and multiple methods have been explored to facilitate effective practice. For example, reflective discussions involving dental students, mentors and practitioners (10), the development of communities of inquiry to support reflection in operative dentistry (11) and electronic journaling to support reflection with student dental hygienists (12).  One way to support reflective abilities in other professional programmes has been through the use of the arts. Poetry writing has been shown to be beneficial as a way to critically reflect on practice, for example with medical, social work and sports coaching students (13, 14, 15). Narrative medicine can help develop the imagination, support changes in perspective and reverse burnout in medical clinicians (16). In nurse education, poetry, both published and student-authored, has been used to support students to reflect on their experiences (17). Developing collage has been shown to be helpful in encouraging emotional self-awareness development (18) and painting can support discussion of difficult experiences (19). Film has also been used with success within dentistry and medicine (20).  With this in mind the use of creative reflective methods was discussed with a small cohort of dental technology students at Cardiff Metropolitan University. For the purpose of this commentary we have chosen to present reflection on the use of a poem and cartoon strip. The poem described feelings of anxiety during placement in the laboratory in relation to answering the telephone. The anxiety is underpinned by lack of knowledge about product turnaround times and different items and prices and is stifling the ability to communicate effectively. The second piece, a cartoon strip, explored the experiences of a third year dental technology student, when using an expensive and dangerous piece of machinery in the laboratory. A cartoon style monster face had been added to a photograph of the machine. Even though students receive training about how to use the machine, it had remained daunting to him. The creative pieces helped the students to articulate feelings such as the anxiety relating to laboratory work and their thinking was not solely in relation to the technical aspects of their practice. Further, the pieces supported a careful consideration of the issues rather than solely reinforcing a focus on how their practice might change in the future. This is important as it was through this consideration that students were able to use creative reflection to raise and highlight problems, which potentially otherwise would have remained hidden. Decreasing the pressure to change practice supports students in creative thinking rather than reducing the reflective activity to a procedural task. In addition, the students reported an increase in confidence following the creative activity. A feature of some reflective models is the expectation that through the experience, learning and change will occur. Reflection can be interrogatory, asking the questions, ‘What’, ‘So what’, ‘Now what?’ (21). This approach might feel negative in tone compared to a more positive exploration of what is working well. For example, the concept of appreciative inquiry works on the basis that there are positive aspects to be found in any encounter (22). Adopting such an approach could add a depth to guided models of reflection. Some models suggest the development of an action plan (23). For some students, particularly if they are early in their studies, these expectations might be too difficult to meet. Further, the adoption of such models carries the risk of suggesting that there are clear cut answers to be found through the reflective activities. Often practice reveals the contrary, and what is required is a mulling over and contemplation of the messy issues raised through reflective thinking. The seminal work of Schon reminds us of the ‘swampy lowland’ of practice full of situations which are ‘confusing “messes” incapable of technical solution’ (24). This practical description fits the nature of work based placements well. Placing emphasis on art or fictitious characters as the focus for discussion, rather than the student themselves, is helpful as it develops a space for critical reflection, without threatening the students’ sense of self (25). Rather than solely discussing their feelings, the students in this example were able to relate the reflection to the art work and this was particularly evident in the cartoon strip. The machine was described as ‘The Beasty’ and was given a cartoon face. This removed some of the fear from the situation and assisted the student in coming to terms with using the machine in practice.  In conclusion, the arts have the potential to effectively engage the dental professions in reflective practice, enabling a creative outlet for exploration. Indeed, without some creative thinking, reflective practice might be at risk of remaining a tick box and incomplete exercise rather than being viewed as a valued way of considering and developing professional practice. Utilising different creative methods might be helpful when considering a way forward for dental technology students and presents opportunities for future research. References 1. Smith M, Trede F. Reflective practice in the transitions phase from student to novice graduate: implications for teaching reflective practice Higher Ed. Res & Dev 2013:32: 632 – 645. DOI: http://dx.doi.org/10.1080/07294360.2012.709226 2. Boud D. Avoiding the traps: seeking good practice in the use of self assessment and reflection in professional courses Soc Work Ed 1999:18: 121 – 132. DOI: http://dx.doi.org/10.1080/02615479911220131 3. Howatson-Jones L. Reflective Practice in Nursing 3rd Edition London: Sage, Learning Matters, 2016. 4. Jasper MA Nurses perceptions of the value of written reflection Nurse Ed Today 1999: 19, 452 - 463 5. Barton M, Ryan M. Multimodal approaches to reflective teaching and assessment in higher education Higher Ed Res & Dev 2014: 33: 409 – 424. DOI: http://dx.doi.org/10.1080/07294360.2013.841650 6. Moon J A handbook of reflective and experiential learning: Theory and Practice London: Routledge Falmer, 2004 7. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review Adv in Health Sc Ed 2009:14: 595 – 621. DOI: 10.1007/s10459-007-9090-2 8. Coward, M. Does the use of reflective models restrict critical thinking and therefore learning in nurse education? What have we done? Nurs Ed Today 2011:31: 883 – 886. DOI: http://dx.doi.org/10.1016/j.nedt.2011.01.012 9. Reeson, MG, Walker-Gleaves C, Jepson N. Interactions in the Dental Team: Understanding the Theoretical Complexities and Practical Challenges Br Dent J 2013: 215: 1 – 6. DOI: 10.1038/sj.bdj.2013;215:E16 10. Koole S, Christiaens V, Cosyn J. et al. Facilitating Dental Student Reflections: Using Mentor Groups to Discuss Clinical Experiences and Personal Development J Dent Ed 2016: 80: 1212 - 1218 11. Gardner K. An online community of inquiry for reflective practice in an operative dentistry course. J Dent Ed 2016:76: 641 - 650 12. Hanson K, Alexander S The influence of technology on reflective learning in dental hygiene education J Dent Ed 2010:74: 644 - 653 13. Shapiro J, Stein H.  Poetic Licence: Writing Poetry as a Way for Medical Students to Examine their Professional Relational Systems. Fam Sys Health. 2005:23: 278-292. http://dx.doi.org/10.1037/1091-7527.23.3.278 14. Furman R, Coyne A, Negi NJ. An International Experience for Social Work Students: Self Reflection Through Poetry and Journal Writing Exercises. J Teach Soc Work. 2008:28: 71-85 15. Threlfall S. Poetry in action (research). An innovative means to a reflective learner in higher education (HE). Ref Prac: Int Multidisc Persp. 2013:14: 360-367. https://doi.org/10.1080/14623943.2013.767232 16. Charon R. At the Membranes of Care: Stories in Narrative Medicine. Acad Med. 2012:87: 342-347 17. Jack K, Illingworth S. ‘Saying it without saying it’: Using poetry as a way to talk about important issues in nursing practice. J Res Nurs. 2017: 22: 508 – 519 https://doi.org/10.1177/1744987117715293 18. Jack K. “Putting the words ‘I am sad’, just doesn’t quite cut it sometimes!”: The use of art to promote emotional awareness in nursing students. Nurse Ed Tod. 2012:32: 811-817. DOI: 10.1016/j.nedt.2012.04.020. 19. McAndrew S, Warne T. Portraying an abstract landscape: using painting to develop self-awareness and sensitive practice. In Warne T, McAndrew S. (eds). Creative Approaches to Health and Social Care Education. London: Palgrave Macmillan, 2010: 129 - 141 20. Jonas-Dwyer DRD, Abbott PV, Boyd N. First reflections: third-year dentistry students’ introduction to reflective practice. Eur J Dent Ed 2013:17: 64 – 69 DOI: 10.1111/j.1600-0579.2012.00763.x. 21. Driscoll J. Practicing Clinical Supervision: A Reflective Approach for Healthcare Professionals. 2nd ed. Edinburgh: Bailliere Tindall Elsevier, 2007 22. Cooperrider D.L, Whitney, D. Appreciative Inquiry: A Positive Revolution in Change. CA: Berrett-Koehler Publishers, 2005 23. Gibbs G Learning by Doing: A guide to teaching and learning methods Further Education Unit. Oxford Polytechnic: Oxford, 1988. 24. Schon DA. The Reflective Practitioner: How Professionals Think in Action New York: Basic Books, 1988 25. Hoggan C, Cranton, P. Promoting transformative learning through reading fiction J Trans Ed 2015:13: 6 – 25. DOI: https://doi.org/10.1177/1541344614561864  Disclosure Statement – the online form would not generate a statement although both authors confirm that they have completed the form and there is nothing to disclose in any of the sections.       

English

The use of the arts to encourage reflection in the dental professions-A commentary

J. Lewis

K. Jack

Crossref

European Journal Of Dental Education

Lewis, Jeff

Jack, Kirsten

Cardiff Metropolitan Research Repository (DSpace)

The use of the arts to encourage reflection in the dental professions – a commentary.   Abstract Reflective practice is viewed internationally as an important activity within the dental professions and one which the General Dental Council expects to be part of all dental technician programmes in the United Kingdom (UK), irrespective of academic level. Informal discussions with colleagues delivering dental technology in UK higher education institutions agree that reflective practice is an important aspect of the curriculum, and learning is facilitated and assessed using various methods, for example, an online portfolio. Anecdotally, many of the current methods are shown to be ineffective, with up to fifty percent of students not meeting the reflective component. In the dental professions, consideration needs to be given to the use of creative methods to support reflective practice, in order to engage learners and contribute to the development of knowledge, skills and attitudes in this student group.  Reflective practice is not a new concept and has long been viewed as being beneficial to the development of graduates who go on to practice in their chosen professions (1). Reflective capability is linked to desirable qualities such as enhanced self-awareness, life-wide and lifelong learning and becoming a professional (2, 3, 4). However, many approaches to reflective teaching are inconsistent and misunderstood (5, 6). This is problematic as superficial approaches to the teaching of reflection have been linked to superficial levels of reflective thinking in students (7).  Reflective capacity is a formal requirement for registration in the dental professions and evidence of this competence is often provided through student portfolios, developed over the programme of study. However there is little guidance to support educators in understanding reflective ability in students (7). Further, in programmes such as nursing, where the concept of reflection has been embedded for many years, it has been shown that students find reflective practice challenging, particularly in the early years of their programme and many are suffering from reflection overkill (8). Less is known about reflective practice for dental professionals and there appears to be a paucity of research that explores the particular experiences of dental technology students. An informal assessment of the dental technology courses in the UK provided some understanding of the difficulties faced when trying to engage student dental technicians in the undertaking of reflection. Anecdotally it was reported that many students lacked understanding about the meaning and value of reflective practice.    Bearing in mind these difficulties, it remains important that educators endeavor to provide meaningful reflective opportunities for dental technology students. Being accepted as part of the team is important for students in the clinical area who often feel left out of patient care provision and have concerns that their input is being ignored (9). They are often left feeling insecure and this can lead to feelings of stress and anxiety. Reflective activity can support students to explore their feelings associated with incidents from practice and this is particularly important when learning the professional role (7). Not all of the answers to problems in practice can be found through formal learning and having the ability to reflect can help to close the theory/practice gap.  Ways to encourage reflective practice among the dental professions is an international concern and multiple methods have been explored to facilitate effective practice. For example, reflective discussions involving dental students, mentors and practitioners (10), the development of communities of inquiry to support reflection in operative dentistry (11) and electronic journaling to support reflection with student dental hygienists (12).  One way to support reflective abilities in other professional programmes has been through the use of the arts. Poetry writing has been shown to be beneficial as a way to critically reflect on practice, for example with medical, social work and sports coaching students (13, 14, 15). Narrative medicine can help develop the imagination, support changes in perspective and reverse burnout in medical clinicians (16). In nurse education, poetry, both published and student-authored, has been used to support students to reflect on their experiences (17). Developing collage has been shown to be helpful in encouraging emotional self-awareness development (18) and painting can support discussion of difficult experiences (19). Film has also been used with success within dentistry and medicine (20).  With this in mind the use of creative reflective methods was discussed with a small cohort of dental technology students at Cardiff Metropolitan University. For the purpose of this commentary we have chosen to present reflection on the use of a poem and cartoon strip. The poem described feelings of anxiety during placement in the laboratory in relation to answering the telephone. The anxiety is underpinned by lack of knowledge about product turnaround times and different items and prices and is stifling the ability to communicate effectively. The second piece, a cartoon strip, explored the experiences of a third year dental technology student, when using an expensive and dangerous piece of machinery in the laboratory. A cartoon style monster face had been added to a photograph of the machine. Even though students receive training about how to use the machine, it had remained daunting to him. The creative pieces helped the students to articulate feelings such as the anxiety relating to laboratory work and their thinking was not solely in relation to the technical aspects of their practice. Further, the pieces supported a careful consideration of the issues rather than solely reinforcing a focus on how their practice might change in the future. This is important as it was through this consideration that students were able to use creative reflection to raise and highlight problems, which potentially otherwise would have remained hidden. Decreasing the pressure to change practice supports students in creative thinking rather than reducing the reflective activity to a procedural task. In addition, the students reported an increase in confidence following the creative activity. A feature of some reflective models is the expectation that through the experience, learning and change will occur. Reflection can be interrogatory, asking the questions, ‘What’, ‘So what’, ‘Now what?’ (21). This approach might feel negative in tone compared to a more positive exploration of what is working well. For example, the concept of appreciative inquiry works on the basis that there are positive aspects to be found in any encounter (22). Adopting such an approach could add a depth to guided models of reflection. Some models suggest the development of an action plan (23). For some students, particularly if they are early in their studies, these expectations might be too difficult to meet. Further, the adoption of such models carries the risk of suggesting that there are clear cut answers to be found through the reflective activities. Often practice reveals the contrary, and what is required is a mulling over and contemplation of the messy issues raised through reflective thinking. The seminal work of Schon reminds us of the ‘swampy lowland’ of practice full of situations which are ‘confusing “messes” incapable of technical solution’ (24). This practical description fits the nature of work based placements well. Placing emphasis on art or fictitious characters as the focus for discussion, rather than the student themselves, is helpful as it develops a space for critical reflection, without threatening the students’ sense of self (25). Rather than solely discussing their feelings, the students in this example were able to relate the reflection to the art work and this was particularly evident in the cartoon strip. The machine was described as ‘The Beasty’ and was given a cartoon face. This removed some of the fear from the situation and assisted the student in coming to terms with using the machine in practice.  In conclusion, the arts have the potential to effectively engage the dental professions in reflective practice, enabling a creative outlet for exploration. Indeed, without some creative thinking, reflective practice might be at risk of remaining a tick box and incomplete exercise rather than being viewed as a valued way of considering and developing professional practice. Utilising different creative methods might be helpful when considering a way forward for dental technology students and presents opportunities for future research. References 1. Smith M, Trede F. Reflective practice in the transitions phase from student to novice graduate: implications for teaching reflective practice Higher Ed. Res & Dev 2013:32: 632 – 645. DOI: http://dx.doi.org/10.1080/07294360.2012.709226 2. Boud D. Avoiding the traps: seeking good practice in the use of self assessment and reflection in professional courses Soc Work Ed 1999:18: 121 – 132. DOI: http://dx.doi.org/10.1080/02615479911220131 3. Howatson-Jones L. Reflective Practice in Nursing 3rd Edition London: Sage, Learning Matters, 2016. 4. Jasper MA Nurses perceptions of the value of written reflection Nurse Ed Today 1999: 19, 452 - 463 5. Barton M, Ryan M. Multimodal approaches to reflective teaching and assessment in higher education Higher Ed Res & Dev 2014: 33: 409 – 424. DOI: http://dx.doi.org/10.1080/07294360.2013.841650 6. Moon J A handbook of reflective and experiential learning: Theory and Practice London: Routledge Falmer, 2004 7. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review Adv in Health Sc Ed 2009:14: 595 – 621. DOI: 10.1007/s10459-007-9090-2 8. Coward, M. Does the use of reflective models restrict critical thinking and therefore learning in nurse education? What have we done? Nurs Ed Today 2011:31: 883 – 886. DOI: http://dx.doi.org/10.1016/j.nedt.2011.01.012 9. Reeson, MG, Walker-Gleaves C, Jepson N. Interactions in the Dental Team: Understanding the Theoretical Complexities and Practical Challenges Br Dent J 2013: 215: 1 – 6. DOI: 10.1038/sj.bdj.2013;215:E16 10. Koole S, Christiaens V, Cosyn J. et al. Facilitating Dental Student Reflections: Using Mentor Groups to Discuss Clinical Experiences and Personal Development J Dent Ed 2016: 80: 1212 - 1218 11. Gardner K. An online community of inquiry for reflective practice in an operative dentistry course. J Dent Ed 2016:76: 641 - 650 12. Hanson K, Alexander S The influence of technology on reflective learning in dental hygiene education J Dent Ed 2010:74: 644 - 653 13. Shapiro J, Stein H.  Poetic Licence: Writing Poetry as a Way for Medical Students to Examine their Professional Relational Systems. Fam Sys Health. 2005:23: 278-292. http://dx.doi.org/10.1037/1091-7527.23.3.278 14. Furman R, Coyne A, Negi NJ. An International Experience for Social Work Students: Self Reflection Through Poetry and Journal Writing Exercises. J Teach Soc Work. 2008:28: 71-85 15. Threlfall S. Poetry in action (research). An innovative means to a reflective learner in higher education (HE). Ref Prac: Int Multidisc Persp. 2013:14: 360-367. https://doi.org/10.1080/14623943.2013.767232 16. Charon R. At the Membranes of Care: Stories in Narrative Medicine. Acad Med. 2012:87: 342-347 17. Jack K, Illingworth S. ‘Saying it without saying it’: Using poetry as a way to talk about important issues in nursing practice. J Res Nurs. 2017: 22: 508 – 519 https://doi.org/10.1177/1744987117715293 18. Jack K. “Putting the words ‘I am sad’, just doesn’t quite cut it sometimes!”: The use of art to promote emotional awareness in nursing students. Nurse Ed Tod. 2012:32: 811-817. DOI: 10.1016/j.nedt.2012.04.020. 19. McAndrew S, Warne T. Portraying an abstract landscape: using painting to develop self-awareness and sensitive practice. In Warne T, McAndrew S. (eds). Creative Approaches to Health and Social Care Education. London: Palgrave Macmillan, 2010: 129 - 141 20. Jonas-Dwyer DRD, Abbott PV, Boyd N. First reflections: third-year dentistry students’ introduction to reflective practice. Eur J Dent Ed 2013:17: 64 – 69 DOI: 10.1111/j.1600-0579.2012.00763.x. 21. Driscoll J. Practicing Clinical Supervision: A Reflective Approach for Healthcare Professionals. 2nd ed. Edinburgh: Bailliere Tindall Elsevier, 2007 22. Cooperrider D.L, Whitney, D. Appreciative Inquiry: A Positive Revolution in Change. CA: Berrett-Koehler Publishers, 2005 23. Gibbs G Learning by Doing: A guide to teaching and learning methods Further Education Unit. Oxford Polytechnic: Oxford, 1988. 24. Schon DA. The Reflective Practitioner: How Professionals Think in Action New York: Basic Books, 1988 25. Hoggan C, Cranton, P. Promoting transformative learning through reading fiction J Trans Ed 2015:13: 6 – 25. DOI: https://doi.org/10.1177/1541344614561864  Disclosure Statement – the online form would not generate a statement although both authors confirm that they have completed the form and there is nothing to disclose in any of the sections.       

The use of the arts to encourage reflection in the dental professions — A commentary

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The use of the arts to encourage reflection in the dental professions — A commentary

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