Received: 13 April 2022 Accepted: 27 September 2022

DOI: 10.1111/1460-6984.12815

RESEARCH REPORT

Written reflective practice abilities of SLT students across

the degree programme
Kate. J. Cook1 Cheryl Messick2 Megan. J. McAuliffe1,3

1 School
of Psychology Speech & Hearing,
Te Kura Mahi ā-Hirikapo, University of Abstract
Canterbury, Christchurch, New Zealand Background: Written reflective practice (WRP) is a teaching tool used across
2 Schoolof Health and Rehabilitation speech–language therapy (SLT) clinical education programmes. The process
Sciences, University of Pittsburgh,
aims to support the development of reflective skills required for the workplace
Pittsburgh, PA, USA
3 New Zealand Institute of Language, (e.g., problem-solving and self-evaluation).
Brain and Behaviour, University of Aims: This cross-sectional and repeated-measures study design investigated
Canterbury, Christchurch, New Zealand students’ demonstration of breadth of WRP across the clinical education
Correspondence programme.
Kate Cook, School of Psychology Speech Methods & Procedures: The participants were 77 undergraduate SLT students
& Hearing, Te Kura Mahi ā-Hirikapo,
in their first, second or final professional year of the clinical programme. Partic-
University of Canterbury, Private Bag
4800, Christchurch 8140, New Zealand. ipants wrote critical reflections following an interaction with a client/s as part
Email: [email protected] of their clinical education experiences. Formative feedback was provided after
each written reflection (WR). In total four WRs per participant were coded for
breadth of WRP using a modification of Plack et al.’s coding schema from 2005.
This was completed for each of the four time points across the academic year for
each professional year.
Outcomes & Results: There was a statistically significant association between
time (i.e., professional year of the programme) and likelihood of demonstra-
tion of breadth of reflection for the lower level reflective element of ‘attend’ and
higher level reflective element of ‘re-evaluate’. A positive trend between time and
likelihood of demonstration of breadth of reflection was seen for the lower level
element of ‘reflection-for-action’. Final-professional-year students exhibited sig-
nificant enhancements in the higher level elements (e.g., ‘premise’) compared
with first- and second-professional-year students.
Conclusions & Implications: This group of SLT students exhibited significant
change in breadth of WRP across the degree programme. This finding has posi-
tive implications for facilitating WRP with students and using the current coding
framework in clinical programmes.

KEYWORDS
clinical education, reflective practice, speech–language therapy

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,
provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language
Therapists.

994 wileyonlinelibrary.com/journal/jlcd Int J Lang Commun Disord. 2023;58:994–1016.

 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 995

What this paper adds

What is already known on this subject
∙ WRP is one form of reflective practice (RP) used in SLT, allied health, medical
and nursing clinical education programmes. Researchers have suggested that
RP skills develop over time for students. Previously, studies examining WRP
have focused on one off assessment of skill or over a timeframe of 6–10 weeks.
Here, we examine SLT students’ WRP skills across the degree programme.

What this paper adds to existing knowledge

∙ SLT students exhibited significant positive change in breadth of WRP across
the degree programme as their clinical experience increased. Our results
provide quantitative information in support of using RP as a learning tool
throughout clinical education programmes for SLT.

What are the potential or actual clinical implications of this work?

∙ This study offers support for educators of SLT students; for example, how
educators can assess WRP, and how educators can foster SLT student skill
development with formative feedback and reflective questioning. This study
also offers support for student SLT, for example, describing how WRP can
be part of their individualized learning approach and provide a purposeful
examination of self and clinical skill development.

INTRODUCTION RP activities have been used in allied health, medical

and nursing clinical education programmes (e.g., (Aron-
Reflective practice (RP) in clinical son et al., 2012; Chabeli, 2010; Chambers et al., 2011;
education programmes Cook et al., 2019; Dunne et al., 2019; Plack et al., 2005).
They have been found to have a positive impact on med-
RP is defined as ‘a generic term for those intellectual and ical students’ ability to diagnose complex cases (Mamede
affective activities in which individuals engage to explore et al., 2008) and predict the academic success of phar-
their experiences in order to lead to new understandings macy students (Tsingos-Lucas et al., 2017). In occupational
and appreciations’ (Boud et al., 1985: 19). RP is embed- therapy RP has been described as a foundation skill
ded in critical thinking descriptions (Colucciello, 1997; towards developing professional skills (Zimmerman et al.,
Facione, 1997), adult learning principles (Brookfield, 1986), 2007).
and Bloom’s taxonomy for higher education (Bloom, 1956; Feedback from students engaged in RP activities as part
see also Anderson & Krathwohl et al., 2001). As a result, of clinical education programmes has been largely positive,
RP is regularly employed in university clinical education with students stating they valued RP as a learning tool and
programmes for its perceived ability to support student memory aid, that engaging in RP increases self-awareness
development into competent and reflective practitioners, skills and developed their professional identities (Karpa
who then proceed to provide person-centered clinical prac- & Chernomas, 2013; Lim & Low, 2008a, 2008b; Ng et al.,
tice (Bulman & Schutz, 2013; Schön, 1983, 1987). Common 2012; Plack et al., 2008; Roche & Coote, 2008). However,
modes of RP or RP activities used in both university clinical additional feedback suggests that students find RP time-
education programmes and workplaces include: writing consuming and they may externalize RP activities, that is,
(Cook et al., 2019; Plack et al., 2005); verbal discussion focusing on what they thought the educator expected to
groups (Johnston & Banks, 2000; Schaub-de Jong et al., read or hear rather than using RP activities as an opportu-
2011; Tillard et al., 2018); one-on-one discussion (Geller, nity for internalized learning (Dunne et al., 2019; Harris,
2002) and video self-analysis (Cruice, 2005). 2005).
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
996 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

Development of written reflective practice Such aspects are described as higher levels of reflec-
(WRP) abilities tion such as ‘reflection-in-action’ (reflecting and making
changes in the moment), ‘content’ (consider another’s per-
The current study focused on WRP for speech–language spective), ‘re-evaluate’ (making comparisons with theory
therapy (SLT) students. WRP is one mode of RP regu- or clinical experiences) or ‘premise’ (acknowledging and
larly used in clinical education programmes, including working through the impact of one’s assumptions/bias and
SLT. WRP is written content ‘in which the writer aims beliefs). Comparatively breadth elements such as ‘return’
to consider an event, problem or time period from a (describing the event/session), ‘attend’ (describing one’s
reflective standpoint . . . ’ (Walker, 1985). While each clin- own emotions during the event/session), ‘reflection-on-
ical programme differs, in general a WRP activity may action’ (describing the event and then discussing one’s
be one where educators require students to write about learning from this event), ‘reflection-for-action’ (describ-
a clinical experience/s at specific timepoints during their ing the event and then discussing a plan for the future or
clinical placements. WRP activities may be guided with next step) and ‘process’ (the inclusion of strategies used or
questions, others unguided, and WRP activities can be available) are categorized as lower level reflective elements
assessed, voluntary or a mandatory part of the clinical pro- and are reported to develop sooner (Duke & Appleton,
gramme (Cook et al., 2019; Hill et al., 2012; McAllister & 2000; Mezirow, 1991; Schön, 1983, 1987; Wong et al., 1995)
Lincoln, 2004; Plack et al., 2005; Williams et al., 2000). (see Appendix A for a full explanation of RP breadth terms,
WRP is an important consideration for university educa- categorization, level of RP and examples).
tion providers due to its alignment with adult learning A number of studies have examined the development
principles as described by Brookfield (1986). It promotes of WRP abilities across time for university student learn-
questioning and critique of approaches and techniques, ers engaged in clinical programmes with positive outcomes
as well as self-evaluation and evaluation of the supervisor reported (Aronson et al., 2012; Cook et al., 2019; Duke &
(Brookfield, 1986). When compared with face-to-face inter- Appleton, 2000; Dunne et al., 2019; Tsang, 2012). Most
actions with a supervisor, WRP allows students the time to studies document significant development of student writ-
consider their evaluation of themselves or an interaction ten reflective abilities (Aronson et al., 2012; Cook et al.,
(Cook et al., 2019; Dunne et al., 2019; Plack et al., 2008). The 2019; Duke & Appleton, 2000; Dunne et al., 2019; Tsang,
written form is also considered a useful aid for students 2012). Across these studies, it has been found that stu-
who struggle to demonstrate and verbalize their reasoning dents benefit from being taught concepts inherent to RP,
and evaluation skills (Cook et al., 2019; Plack et al., 2008). and learning a framework for WRP before engaging in the
It allows students to develop and demonstrate indepen- process. The studies included varied assessment methods,
dent problem-solving skills related to clinical experiences, and either a content analysis approach (Aronson et al.,
without putting the student or client safety at risk. Further- 2012; Cook et al., 2019; Duke & Appleton, 2000), a the-
more, completing written reflections (WRs) was found to matic analysis approach (Tsang, 2012) or mixed-methods
promote emotional and cognitive learning, which resulted approach (Dunne et al., 2019). The time points investi-
in a new understanding of interdisciplinary team practices gated provide only a snapshot of student RP abilities, with
for allied health students (Domac et al., 2015). Finally, it examination over 6 weeks to a maximum of 12 months
has been suggested that when educators provide formative (Aronson et al., 2012; Cook et al., 2019; Dunne et al.,
feedback in a timely manner on WRP activities, this may 2019; Duke & Appleton, 2000; Tsang, 2012). Limitations of
have a positive impact on the demonstration of WRP abil- the above studies, which provide support for the current
ities by students (Aronson et al., 2012; Cook et al., 2019; study, include inconsistent provision of formative feedback
Dunne et al., 2019). between submissions of WR, inconsistent numbers of WR
When examining how to measure WRP in clinical pro- examined or number of WR examined per participant, and
grammes, several studies and theorists have used the no examination of WRP breadth from start to finish of the
categories of breadth and depth of reflection (Cook et al., clinical programme, including SLT students.
2019; Hill et al., 2012; Mezirow, 1991; Plack et al., 2005;
Schön, 1983, 1987). Depth of reflection is described as an
overall level of RP skill (Plack et al., 2005; Hill et al., SLT student WRP abilities
2012). Breadth of reflection, the focus of the current study,
refers to nine different reflective processes or elements Specific to SLT students, studies using instruments for
undertaken by the learner (Mezirow, 1991; Plack et al., evaluating WRP have demonstrated that students also
2005). Theorists have reported that some elements within improve in their abilities to demonstrate their WRP skills
breadth of reflection take longer to develop than others. across short periods of time (Cook et al., 2019; Hill et al.,
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 997

2012). However, it is unclear whether when examining What remains unclear is whether student development
the elements for breadth of WRP, students follow sim- of WRP skill exists both within and across the course of
ilar patterns of development across the course of the a degree programme for SLT. Examining the demonstra-
SLT clinical programme. For example, in Cook et al. tion of breadth of WRP across the degree may result in
(2019), the SLT students who demonstrated ‘process’ (an the identification of patterns of breadth of RP that allow
ability to describe their process or the strategies used) tailored support for students. This may also shed light
were more likely to demonstrate a higher level RP ability on the amount of WRP activities required to develop stu-
described as ‘premise’ (the ability to identify and explore dent learners into the ‘reflective practitioner’ required for
own assumptions, values, beliefs and biases) in the 6- competent workplace practice (Schön, 1983, 1987). Finally,
week period (Cook et al., 2019) compared with students examination of WRP over time may provide quantitative
who did not demonstrate ‘process’. In comparison, Dunne evidence of a positive growth relationship between RP,
et al.’s (2019) mixed methods case study design followed development of clinical skills and clinical competence.
six SLT students across a 10-week period as they com- Given this, the present study examined the impact of time
pleted two clinical placements. Findings with SLT students on the proportion and characteristics of breadth of WRP
suggested three different WRP development trajectories: skills for SLT students across year groups (first, second and
‘steady growth’, ‘no clear change’ and ‘gradual decline’. final). Second, it examined the impact of time on SLT stu-
Dunne et al.’s results suggested that students who inter- dent breadth of WRP skills within each year group (first,
nalized RP as a learning strategy maintained or developed second and final) of the SLT clinical programme.
RP abilities compared with those who externalized RP as
a requirement of the clinical programme (Dunne et al.,
2019). METHOD
We suggest that with improved understanding of the
patterns of development educators can aim to better SLT This study received ethical approval from the Educational
support student learning (Boles, 2018; Middlemas et al., Research Human Ethics Committee of the University
2001). Furthermore, educators could provide quantitative of Canterbury, New Zealand. All participants provided
evidence to SLT students in support of using RP activi- written consent to participate.
ties across SLT programmes. Specific to WRP activities,
this could include providing a suggested number of WRP
activities, tailored education and guidelines for provision Context of the study
of formative and summative feedback on WRP activities
by educators. Furthermore, the identification of patterns This cross-sectional and repeated-measures design study
of development or combinations of breadth elements for was conducted as part of the clinical programme for SLT
WRP at specific timepoints could support a transfer of students at the University of Canterbury, New Zealand.
learning for WRP abilities as clinical competency increases The students included in this study were all completing a
over time. The term ‘transfer of learning’ within the educa- 4-year undergraduate honours degree in SLT, similar to the
tion literature is described as the hypothesis that learning educational approach also undertaken in the UK and Aus-
in one area, context or time point will generalize to tralia. In the New Zealand version of this model, the first
another, and RP is thought to aid the transfer of learn- year of study is a generic year that does not include clinical
ing (Bransford & Schwarts, 1999). In the realm of SLT, this education, and years 2–4 students are professionally ori-
was shown as an increase in clinical competency as clin- entated (renamed first, second and final professional year)
ical experience increased for SLT students, regardless of and include considerable clinical placement experiences.
placement type or context (Sheepway et al., 2014). Students are eligible to practice as an SLT at the conclusion
Unlike the above studies that describe student growth in of the final professional year.
RP abilities, Williams et al. (2000) found no improvement As part of the regular clinical education programme,
in physical therapy students’ development of WRP abilities across each semester students were introduced to RP fol-
over an 8-week period. The possible reasons given for this lowing an intentional approach of using dialogic teaching,
were a lack of education to students about RP processes, class discussions, metacognitive discussions, informal dis-
disagreement between raters and no formative feedback cussions with clinical educators (individual or group) WR
provided by educators. (informal and assessed) and verbal RP groups (discussion
In summary, significant development of WRP has been groups with student peers and a clinical educator facili-
documented for specific timepoints within clinical educa- tating professional topics (see Tillard et al., 2018, for the
tion programmes (Aronson et al., 2012; Cook et al., 2019; structure of verbal RP groups for SLT students). Appendix
Duke & Appleton, 2000; Dunne et al., 2019; Tsang, 2012). B describes the RP clinical education programme followed
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
998 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

TA B L E 1 Biographical details of student participants by professional year

Professional year Number of students Males/females Average age/SD (years) Prior clinical experiencea
First 26 1/25 20.5 (2.24) None
Second 29 1/28 21.2 (0.81) 2 semesters
Final 22 0/22 23.0 (6.34) 4 semesters
a
Note: One semester is 12 weeks.

by the SLT clinical education programme. Submitting reg- breadth of reflection and (2) depth of reflection. For this
ular weekly WR was standard practice for all clinical study, only data for (1) breadth of reflection were exam-
courses and was embedded into clinical education learning ined. Depth of reflection was examined in a separate study.
outcomes. Breadth of reflection refers to the different processes of
The goal of this study was to estimate the propor- reflection undertaken by the learner (Mezirow, 1991; Plack
tion and describe the characteristics of SLT student WRP et al., 2005). As per Cook et al. (2019) minor adaptations
skills at the same time points for each cohort of stu- to Plack et al.’s framework were undertaken—including
dents (at the start and end of each clinical course) redefining the element ‘content’, inclusion of keywords
in the professional degree. This allowed for the exam- to signal and highlight different elements, the addition
ination of WRP skill across the degree programme as of common elements that co-occur in WRP, inclusion of
well as examination of WRP skill within each profes- examples that related to SLT topics and examples of what
sional year. For each professional year (e.g., first, second was not a specific breadth element. Breadth elements were
and final), students in the respective professional year organized from low-level RP elements to higher level RP
groups completed two semesters of academic study, which elements or elements that contribute to critical reflec-
included 12 weeks per semester of clinical experiences in a tions. Acceptable intra rater and inter rater reliability was
range of clinical environments and populations including gained following the modifications (Cook et al., 2019, based
preschool, school-aged children and adults. At two points on Boud et al., 1985; Mezirow, 1991; Plack et al., 2005;
in the clinical programme, students completed two clin- Schön, 1987). See Appendix A for the rater training proto-
ical placements described as ‘block placements’. A block col discussing breadth elements with examples. See Cook
placement is a full-time placement (i.e., 40 h per week) et al. (2019) for the full version with breadth and depth of
with no academic class requirements (McAllister et al., reflection included.
2013).

Procedure
Participants
Participants were required to write and submit ‘critical
The study included 77 undergraduate students enrolled in reflections’ as part of their regular clinical course require-
clinical courses as part of the SLT honours programme. ments. One WR per week was required following a clinical
Table 1 describes participant who agreed to participate session. Students were required to submit each WR within
in the study by professional year of study. The average 24 h of the clinical session or experience they were reflect-
age of the participants was 21.5 years (SD = 3.95) with 75 ing on. For this study only two WR from each clinical
females and two males participating in the study. The study course were analysed per participant. The WR selected for
excluded any students who withdrew from a clinical course analysis were taken from the start and end of each clinical
during the semester, or who declined to participate in the course for each semester, totalling a maximum of four WR
study (six students). for each student across the professional year (reported as
T1, T2 (start and end of semester 1), T3 and T4 (start and
end of semester 2).
Instrument Guiding questions were provided to assist reflecting and
are part of standard practice by the clinical education team.
Plack et al.’s (2005) framework for coding WRP was used As per Cook et al. (2019), guiding questions were reviewed
because of its validity and reliability, measurement of both and modified by the researchers to ensure all areas of
breadth and depth of reflection and for its previous use the modified Plack et al. (2005) coding system could be
with both SLT and physical therapy (PT) students (Cook addressed by students (see Appendices B and C for a list
et al., 2019; Hill et al., 2012; Plack et al., 2005). There were of sample questions provided to students and timing of
two primary components for the coding framework: (1) questions).
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 999

This study examined usual practice. Therefore, students T A B L E 2 Number of participants who submitted a written
in the same professional year group were asked to respond reflection (WR) for each time point across the academic year (% of
to the same questions. However, some students chose not WRs compared with the expected number)
to respond to all questions. Furthermore, some WR ques- Professional
tions posed to students varied between professional year year T1 T2 T3 T4
groups. No guidelines were given to students pertaining to First 26 (100%) 24 (92%) 19 (73%) 18 (69%)
WR length. As is usual practice, each of the clinical edu- Second 29 (100%) 28 (96%) 27 (93%) 24 (82%)
cators (CE) supervising the participants reviewed and gave Final 22 (100%) 20 (91%) 15 (68%) 13 (59%)
regular feedback on the WR submitted. As per Cook et al.’s Totals 77 (100%) 72 (94%) 66 (79%) 55 (71%)
(2019) procedure, all CE were encouraged to provide at
least two pieces of written formative feedback relating to
the process of reflection (breadth) undertaken. CE were
familiar with the coding framework and could use the cod- was implemented when reviewing the WR (similar to that
ing framework to construct the feedback if they desired of Cook et al., 2019; Hill et al., 2012) whereby 1 was used
(e.g., Element included: Process, element chosen for forma- to indicate presence of an element anywhere in the WR
tive feedback: Reevaluate. Feedback to student: ‘Good job, and 0 was used to indicate an element was not present in
you have described the strategies you utilized during the the WR. As there are nine breadth of reflection elements
session. Next time consider building on this by reflecting in the instrument, the highest tally a student could receive
on how and why you have changed the types of strategies for a WR was nine for each submission. As per past stud-
you use for this client compared to your other client’). CE ies, the research assistants and the researcher agreed that
were encouraged to provide formative feedback to students any one sentence or paragraph could contain more than
in a timely manner, so that the student could consider the one element (Cook et al., 2019; Hill et al., 2012). Descriptive
feedback provided, before their next WR was submitted. statistics were used to report the average scores partici-
The specific type and timing of formative feedback was pants in each year group exhibiting a specific element of
not controlled for or measured as part of this usual prac- breadth of reflection for each of the four time periods.
tice study. At the end of each semester, the CE supervising
the students removed any identifying information from the
four WR at the required timepoints (T1–T4) for each par- Statistical analysis
ticipant, and placed the WR in a shared locked computer
folder for analysis by the research team. Mixed effects models were used to analyse the effects of
time (both cross-sectional, i.e., professional year group,
and repeated-measures data, i.e., timepoints T1–T4) and
Data analysis element (e.g., ‘content’ or ‘process’) on the dependent
variable, breadth of WRP (Bates et al., 2015). Dependent
WRs were coded by a research assistant, who completed 7 h variables were coded as 1 = x and 0 = y. The repeated mea-
of training with one of the researchers before commencing surement structure was represented by random effects for
coding. A second research assistant, who underwent the the intercept and slope on the participant level, estimating
same training, completed coding for interrater reliability. the dependency structure between random effects for each
Training consisted of a review of Cook et al.’s (2019) modifi- of the elements, assuming a multivariate normal distri-
cations to Plack et al.’s (2005) code descriptions and sample bution with an unstructured variance–covariance matrix.
questions (see Appendices A and C) as well as practice Analysis was carried out in the statistical software environ-
in joint coding to establish intra- and interrater reliabil- ment R (R Core Team, 2015), using the add-on packages
ity. Where disagreements in coding arose during training, lme4 (Bates et al., 2015) and ordinal (Christensen, 2015).
discussion continued and breadth elements and examples The analysis for each element began with a full model con-
were redefined until consensus was reached (as per Cook sisting of the full effects of professional year group and
et al., 2019; Hill et al., 2012). time point for each breadth element. We created a ran-
A total of 273 of a possible 308 WR were submitted (from dom effects structure adding participants as random effects
77 participants, across the three year groups, at four time (with individual slopes for time point). Model evaluation
points—T1–T4). Table 2 indicates the number of partici- proceeded in a backward-stepwise iterative fashion seek-
pants by year group who submitted a WR for each time ing to reduce the full model to a reduced model containing
point. Coding of the words, sentences and paragraphs was only significant effects (with alpha set at 0.05). Model fit-
carried out within each participant’s responses to the guid- ting for each element was independently supported by
ing questions in each of their WR. A binary coding system fitness comparisons.
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1000 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

Reliability ipants consistently demonstrated use of the lower level

breadth element ‘return’, with ‘reflection-on-action’ and
Analysis of inter- and intra-rater agreement for breadth ‘attend’ also demonstrated by the majority of partici-
of reflection at the paragraph level was completed for pants. The elements described as higher level RP elements
20% of WR using per cent agreement (number of times ‘reflection-in-action’, ‘premise’, ‘content’ and ‘re-evaluate’
the raters agree divided by the total number of observa- were demonstrated by a smaller number of participants.
tions multiplied by 100) (Miles & Huberman, 1994) and However, the higher level RP elements show an upward
kappa statistics (difference between observed and hypo- trend across the three professional-year groups indicating
thetical probability of chance agreement) (Landis & Koch, that, as clinical experience increased, more participants
1977). Strength of agreement was determined using cri- demonstrated these elements.
teria by Landis and Koch (1977) (kappa < 0 suggest To examine the data statistically, separate generalized
poor agreement, 0.01–0.20 slight agreement, 0.21–0.40 linear mixed effect models (glmer) were run, with each of
fair agreement, 0.41–0.60 moderate agreement, 0.61–0.80 the elements as a binomial dependent variable (Bates et al.,
substantial agreement and 0.81–1.00 almost perfect agree- 2015). The fixed effects were professional year group (first,
ment). Interrater reliability of mean percentage agreement second and final) and time point within those professional
presence of breadth of elements ranged from 75% to 99% year groups (T1–T4). The outputs of the final statistical
with a mean of 91% kappa values ranged from −0.03 models for each element are shown in Table 3. Models
to 1 with a mean of 0.44. Strong interrater reliabil- could not be fitted for ‘content’ and ‘reflection-in-action’
ity was demonstrated for ‘attend’ and ‘return’ elements. due to limited data samples and for ‘return’ due to ceil-
Moderate interrater reliability was demonstrated for ‘pro- ing effects. To compare second-professional-year students
cess’ (89%), ‘premise’ (98%) and ‘reflection-for-action’ against final-professional-year students we releveled each
(95%) elements. Fair agreement was demonstrated for model for each element with second-professional-year
‘reflection-on-action’ (90%) and ‘re-evaluate’ (95%). Poor students mapped to the intercept (Table 3).
to slight agreement was demonstrated for ‘reflection-in- The final models revealed that for the element of ‘attend’
action’ (97%), ‘content’ (99%) and ‘re-evaluate’ (95%). The there was a significant positive effect of time across all pro-
variation in kappa values despite high per cent agree- fessional year groups (final-professional-year students β =
ment is a result of kappa underestimating agreement for 1.45 (0.71), z = 2.04, p < 0.05), second-professional-year
elements ‘reflection-in-action’, ‘content’ and ‘re-evaluate’. students (β = 3.09 (0.82), z = 3.75, p < 0.001), first-
These elements only occur in a small number of instances professional-year students β = −3.09 (0.82), z = −3.75, p <
(Viera & Garrett, 2005). Intra-rater reliability for breadth of 0.001). There was a significant positive effect of time and
elements yielded a mean per cent agreement of 98% with ‘re-evaluate’ for second-professional-year students only (β
a range of 97–100% (kappa values ranged from 0.65 to 1 = 1.02 (0.53), z = 1.92, p < 0.05). Positive trends over
with a mean of 0.88) indicating strong reliability across the time was identified for second-professional-year students
elements. for the elements of ‘reflection-on-action’ (β = 1.13 (0.60),
z = 1.90, p = 0.06) and final-professional-year students
for the element ‘reflection-for-action’ (β = 0.81 (0.46), z =
RESULTS 1.75, p = 0.08). A significant negative effect of time was
also identified for the element of ‘re-evaluate’ for final-
A total of 46 participants (60% of possible participants who professional-year students only (β = 0.72 (0.27), z = 2.67,
consented to participate in the study) submitted a WR p < 0.05). Combined, the models for ‘attend’, ‘premise’, ‘re-
at each of the four time points (T1–T4). Table 2 provides evaluate’ and ‘reflection-for-action’ support a trend for an
details of participants, organized by professional year and increase in the proportion of RP elements across the degree
time point, and it indicates participant WR submissions. programme, with all students demonstrating the element
All professional year groups demonstrated participant of ‘return’ and a small data sample limiting interpretation
attrition over time. of elements ‘content’ and ‘reflection-in-action’.

Effect of time on breadth of WRP across Effect of time on breadth of WRP within
year groups professional year groups

Figure 1 demonstrates the distribution of participants in Figures 2–4 demonstrate the proportion of participants
each year group exhibiting a specific element of breadth in each professional year group exhibiting a specific ele-
of reflection averaged over the four time periods. Partic- ment of breadth of reflection at each of the four time
 COOK et al.

TA B L E 3 Coefficients of six binomial mixed-effects models, one for each element of breadth of written reflection (WR) (excluding return, reflection-in-action, content)
Model Fixed effects Estimate SE Z-value Pr (>|z|)
Model 1: Attend Intercept 0.05 0.42 0.12
First-year students −3.09 0.82 −3.75 0.00 ***
Second-year students 3.09 0.82 3.75 0.00 ***
Final-year students 1.45 0.71 2.04 0.04 *
Time 0.72 0.27 2.67 0.01 **
First-year student development over time compared with second-year students 1.41 0.42 3.38 0.00 ***
Final-year student development over time compared with first-year students 0.06 0.53 0.12 0.91
Final-year student development over time compared with second-year students 1.47 0.56 2.65 0.01 **
Model 2: Reflection on action Intercept 0.82 0.39 2.09
First-year students −1.13 0.60 −1.90 0.06
Second-year students 1.13 0.60 1.90 0.06 .
Final-year students −0.43 0.56 −0.76 0.44
Time 0.17 0.23 0.75 0.45
First-year student development over time compared with second-year students 0.67 0.32 2.08 0.04 *
Final-year student development over time compared with first-year students 0.18 0.35 0.51 0.61
Final-year student development over time compared with second-year students 0.84 0.34 2.46 0.01 *
Model 3: Reflection for action Intercept −0.95 0.54 −1.76
First-year students −0.37 0.43 −0.87 0.39 .
Second-year students 0.37 0.43 0.87 0.39
Final-year students 0.81 0.46 1.75 0.08 .
Time −0.28 0.14 −2.04 0.04 *
(Continues)
1001

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 1002

TA B L E 3 (Continued)
Model Fixed effects Estimate SE Z-value Pr (>|z|)
Model 4: Process Intercept 0.93 0.29 3.24
First-year students 0.41 0.31 1.34 0.18
Second-year students −0.41 0.31 −1.34 0.18
Final-year students −0.41 0.34 −1.20 0.23
Time −0.14 0.12 −1.24 0.22
Model 5: Re-evaluate Intercept −1.09 0.42 −2.60
First-year students −1.02 0.53 −1.92 0.05 .
Second-year students 1.02 0.53 1.92 0.05 *
Final-year students −1.22 0.70 −1.75 0.08 .
Time −0.35 0.40 −0.86 0.39
First-year student development over time compared with second-year students 0.35 0.34 1.02 0.31
Final-year student development over time compared with first-year students 1.38 0.41 3.35 0.00 ***
Final-year student development over time compared with second-year students 1.73 0.39 4.49 0.00 ***
Model 6: Premise Intercept −3.02 0.82 −3.69
First-year students −0.96 0.90 −1.07 0.28
Second-year students 0.96 0.90 1.07 0.28
Final-year students −0.07 1.04 −0.06 0.95
Time 0.01 0.40 0.03 0.97
First-year student development over time compared with second-year students −0.96 0.90 −1.07 0.28
Final-year student development over time compared with first-year students 0.77 0.54 1.43 0.15
Final-year student development over time compared with second-year students 0.92 0.46 1.99 0.05 *
Note: Following the backwards step-wise process, the best-fit models are reported.
*p = 0.05, **p = 0.01, ***p = 0.001.
WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 1003

FIGURE 1 Proportion of participants in each year group exhibiting a specific element of breadth of reflection averaged across T1–T4

periods (T1–T4). Within professional year groups the within the first-professional year we releveled each model
majority of trend lines are moving in a similar positive for each element with second-professional-year students
direction over time. For final-professional-year students, mapped to the intercept. This analysis revealed a signif-
the final time point visually indicates an effect of time for icant positive effect of time within first-professional-year
higher level elements (Figure 4). Time point two for first- students for the elements of ‘reflection-on-action’ (β = 0.67
and second-professional-year students visually indicates (0.32), z = 2.08, p < 0.05) and ‘attend’ (β = 1.41 (0.42), z =
an effect of time for the element ‘re-evaluate’ (Figures 2 3.38, p < 0.001).
and 3). Negative trends for ‘reflection-for-action’, and
‘process’ elements and variable proportion of ‘reflection-
on-action’ are seen for final-professional-year students DISCUSSION
(Figure 4). The negative trend ‘reflection-in-action’ in the
final professional year was unexpected. The purpose of the study was to examine the effect of time
To evaluate the effect of time on the demonstration of on breadth of WRP across the SLT clinical programme and
the various elements within each professional year group within professional year groups. The results indicated that,
we used the separate glmer models and backwards stepwise in general, as clinical experience increased so did demon-
process described above for each element (Table 3). A pos- stration of SLT student WRP abilities, specifically for
itive interaction effect exists between final-professional- the elements ‘attend’, ‘reflection-for-action’, ‘re-evaluate’
year students and time for the elements ‘attend’ (β = 1.47 and ‘premise’. Within SLT professional year groups, final-
(0.56), z = 2.65, p < 0.01), ‘re-evaluate’ (β = 1.73 (0.39), z = professional-year students improved the most in their
4.49, p < 0.001) and ‘premise’ (β = 0.92 (0.46), z = 1.99, p < ability to demonstrate higher level RP elements, second-
0.05). A positive interaction effect exists between second- professional-year students were the most variable group
professional-year students and time for the elements of in their WRP abilities and first-professional-year students
‘attend’ (β = 1.47 (0.56), z = 2.65, p < 0.001), and ‘reflection- improved the most in their demonstration of WRP abilities
on-action’ (p < 0.05). Finally, to examine the effect of time for low-level RP elements of ‘attend’ and ‘reflection-on-
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1004 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

F I G U R E 2 Proportion of first-professional-year participants who demonstrated an element of breadth of reflection at that particular
time point (T1–T4). See Appendix A for a definition of each breadth element

action’. The findings are discussed with implications for ilar results in a 6-week period. In that study, the timing
clinical education, limitations and future research. and characteristics of feedback were controlled for, pos-
sibly positively influencing the emergence of higher level
reflective skills within the 6-week study. For the current
Breadth of WRP as clinical experience study, as part of following usual practice, this practice was
increases encouraged but not evaluated. It is unknown whether the
provision of feedback provided in a systematic fashion
Consistent with previous studies, SLT students demon- (in terms of timing and type), as implemented in Cook
strated a trend towards increasing the presence of specific et al. (2019), would have resulted in the demonstration of
elements of WRP over time as clinical experience increased higher level reflective elements more often. The role of for-
(Cook et al., 2019; Hill et al., 2012; Plack et al., 2005). The mative feedback in fostering WRP skills warrants further
elements of ‘attend’ (acknowledges and begins to work investigation.
with feelings) and ‘reflection-for-action’ (occurs before Students in the first-professional year of their degree
being faced with the situation; begins to plan for the future) programme exhibited a high proportion of low-level RP
were present significantly more often across the degree elements (‘return’, ‘attend’ and ‘reflection-on-action’) as
programme as clinical experience increased, with a pos- clinical experience increased. As a group, these students
itive trend across the degree programme for the element appeared to have a strong focus on reflecting on feelings,
of ‘re-evaluate’ (reappraises the situation vis-à-vis past emotions, and describing events—possibly due to being
experiences). One reason for the similar findings across exposed to a number of new clinical experiences. This find-
a longer time period, as compared with previous studies, ing was expected given similar findings for a previous study
could be related to the provision and timing of formative by Hill et al. (2012) for first-professional year SLT students.
feedback (Cook et al., 2019; Plack et al., 2005; Williams The results are also in line with Cook et al. (2019)’s sug-
et al., 2000). For example, Cook et al. (2019) found sim- gestion that the guiding questions may prime students to
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 1005

F I G U R E 3 Proportion of second-professional-year participants who demonstrated an element of breadth of reflection at that particular
time point (T1–T4). See Appendix A for a definition of each breadth element

demonstrate the low-level RP elements. For students in 5.9% of final year physical therapy student WRP contained
the second and final professional years, these RP elements reflection-in-action, and only one of 45 first-professional
(‘return’, ‘attend’ and ‘reflection-on-action’) are demon- year SLT student writing samples contained ‘premise’
strated in similar proportions of students in both year or ‘reflection-in-action’ (Hill et al., 2012). Therefore, we
groups. Additionally, emotional reactions even perhaps suggest that this finding can be attributed to two possi-
appear of less importance to students as they attempt to ble considerations: that the asynchronous mode of WRP
explore higher level reflective elements (Cook et al., 2019). may limit demonstration of some RP elements as stu-
It seems likely that these results relate to enhanced con- dents are looking back on the experience. It may be that
fidence facilitated by an increase in academic knowledge WRP lends itself to better demonstrating specific breadth
and clinical experiences. elements compared with the higher level breadth ele-
Regardless of clinical experience level, the presence of ments. Second, that students with the most autonomy
the majority of higher level RP elements, for example, in clinical placements (final-professional-year students),
‘content’, ‘premise’ ‘reflection-in-action’ was low. While are more intrinsically motivated to showcase their rea-
it was anticipated that final-professional-year students soning, learning and problem-solving in written form,
might demonstrate greater presence of these elements knowing that their CE or supervisor has not already
over time, the small number of final-professional-year observed their practice in the moment. Therefore, edu-
SLT students identified as demonstrating these elements cators could encourage final-professional-year students to
was unexpected. However, on further examination, this use WRP as an opportunity to discuss their reasoning
finding is similar to past studies for SLT, nursing and for decision making, and problem-solving in-the-moment
physical therapy students regardless of year of clinical in detail, with comparisons with previous clinical expe-
experience (Cook, et al., 2019; Duke & Appleton, 2000; riences (Cook et al., 2019; Duke & Appleton, 2000; Plack
Hill et al., 2012; Plack et al., 2008). For example, only et al., 2005).
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1006 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

F I G U R E 4 Proportion of final-professional-year participants who demonstrated an element of breadth of reflection at that particular
time point (T1–T4). See Appendix A for a definition of each breadth element

Breadth of WRP within each professional Second-professional year (or mid-level) students, as
year group a group, demonstrated the most variability across time
points and elements for WRP. While unexpected, the
The current study highlighted both a positive transfer variability may in fact be related to student patterns of
of learning and variability for demonstration of specific development in clinical education. Dunne et al.’s (2019),
elements within professional year groups for specific study described three trajectories of development for WRP
elements of WRP. First-professional-year students demon- and noted that variability characterized SLT learners’ RP at
strated more low-level RP elements over the course of the similar stages of the professional programme to students
first-professional year in comparison to other year groups. in the current study. Furthermore, clinical competency
The continued presence of many lower level RP elements data from Competency Assessment in Speech Pathology,
(excluding ‘process’) both within the first-professional COMPASS R
, (a valid and reliable standard outcome mea-
year and between the first- to second-professional year sure for clinical competency of SLT students that is used
suggests that a transfer of learning may exist for demon- throughout SLT clinical programmes in Australia, New
strating low-level RP elements. The consistency of using Zealand and Hong Kong) for second-professional-year
low-level RP elements from the first-professional year students, also suggests such variability is an acceptable
to the second supports the notion that WRP practice is pattern for this group of SLT learners (McAllister et al.,
effective as a learning tool for students, particularly for 2013). In the current study, some second-professional-year
first identifying the low-level RP elements the student is students are trending towards exploring higher level reflec-
readily able to demonstrate, and then providing individu- tive elements such as examining theories, bias, values and
alized education and feedback with the aim of developing other perspectives (‘re-evaluate’, ‘content’ and ‘premise’).
the student’s higher level RP elements (Cook et al., Although, within this group of students, demonstration of
2019). such WRP skills were inconsistent over time. This further
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 1007

reinforces the developing nature of higher level RP skills, and second-professional-year students was unexpected.
and suggests this process could be similar to learning a new No previous studies have reported this finding for the
skill, where time can play a role in new skill acquisition ‘refection-for-action’ element. Instead, this lower level RP
(Duke & Appleton, 2000). element has previously been present for a high propor-
As a group, final-professional-year students demon- tion of student WR (Cook et al., 2019; Hill et al., 2012;
strated a higher proportion of higher level RP ele- Plack et al., 2005). One suggestion is that this finding
ments (‘revaluates’, ‘content’, ‘premise’, ‘reflection-in- could be relative to all participants finishing their respec-
action’) compared with first- and second-professional-year tive clinical placements. One might expect students on
students. This finding further reinforces that some aspects their final placements for the year, to continue to identify
of RP require time and repeated exposure (Cook et al., future learning opportunities, and thus support life-long
2019; Duke & Appleton, 2000; Mezirow, 1991; Wong et al., learning practices. Rather, we suggest, that students may
1995). Of significance was the increase in proportion of instead be signaling closure on the clinical experience, and
final-professional-year students demonstrating the ele- evaluating their overall learning for the clinical placement
ments ‘re-evaluate’ (reappraises the situation vis-à-vis past via demonstration of the element ‘reflection-on-action’. A
experiences) and ‘premise’ (recognizes and explores own final interpretation of this finding could suggest that stu-
assumptions, values, beliefs and biases) by T4 of the final dents might RP as a requirement for the course, rather
professional year. This finding may illustrate the students than a life-long learning strategy (Duke & Appleton, 2000;
moving towards the description of ‘reflective practitioner’ Dunne et al., 2019; Greenwood, 1998).
required in the workplace, which supports workplace
readiness as students make comparisons between past
experiences, clients and evidence-based practice (Chabeli, Implications for clinical education
2010; Dowling, 2001; Hill et al., 2012; Plack et al., 2005;
Reynolds, 1997; Russell, 2005; Schön, 1983, 1987; Williams The findings of this study have positive implications for
et al., 2000). both assessment and development of students’ WRP skills
Of interest to note is the specific time point where sec- including the provision of tailored support, formative feed-
ond and final-professional-year students demonstrated a back for students and promoting RP as a self-directed
high proportion the element of ‘re-evaluates’ (reappraises learning experience. This study has demonstrated that in
the situation vis-à-vis past experiences). Both occurred general students do demonstrate an increase in proportion
during ‘block placements’ (‘block placements’ are typi- and type of breadth of WRP abilities over time across the
cally described as full day clinical placements across a clinical programme. This indicates a transfer of learning
consecutive number of weeks). Several reasons should be may exist for demonstration of WRP skills by SLT stu-
considered for this finding. Firstly, it may be that the dents. However, the variation across RP elements and time
full-time clinical experience promoted higher levels of points for each professional year group suggests that clin-
comparisons between clinical experiences and academic ical educators and field supervisors should first assess RP
theory (‘re-evaluates’). For example, on a full-time block abilities, using the coding schema or its concepts, and then
placement one would typically expect that students spend aim to foster development of RP abilities on an individ-
more time in clinical practice and work alongside more ual scale (Dunne et al., 2019; Plack et al., 2005). This also
clients compared with a part-time placement. As a result, mirrors the individualized way that SLT work alongside
this may contribute to an increased understanding of clients in the field. For example, educators could use the
clinical issues, as well as the cumulative effect of more student’s first WR as a baseline for reflective ability and
clients and experiences, from which to make comparisons then plan to support, engage, and scaffold development of
between, in a shorter period of time. Second, perhaps the student RP abilities via use of formative feedback on the
block placement better promotes internalization of reflec- reflective processes used beginning with the low-level RP
tion as a learning strategy. Finally, the greater autonomy elements. Further examples of tailoring RP opportunities
given to the SLT students in their final weeks of the place- to the individual can be achieved by a focus on forma-
ment possibly had a positive impact on the demonstration tive feedback, reflective questioning, and even directing
of critical RP skills (Duke & Appleton, 2000; Dunne et al., students to a theme to focus on for the WR (e.g., compari-
2019). This, however, warrants further investigation. son between familiar and unfamiliar clinical experience)
The finding of the current study of the complete absence in order to further develop and then evaluate RP abil-
of the ‘reflection-for-action’ element for final-professional- ities. When considering formative feedback, given the
year participants, and significant reduction in proportion high proportion of low-level reflective elements (‘return’,
of students demonstrating the same element at T4 for first- ‘attend’ and ‘reflection-on-action’) exhibited by students,
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1008 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

particularly across the first-professional year, educators CONCLUSIONS

can feel confident in moving away from formative feed-
back and reflective questioning focused heavily on exam- This study indicated a positive impact of time on the
ining student emotions, feelings, and description of events demonstration specific WRP skills for SLT students. Sec-
for repeated clinical experiences, and direct reflective ques- ondly, the study identified a positive trend for demonstrat-
tioning toward higher level reflective elements such as ing a higher proportion of WRP breadth elements across
‘re-evaluate’ and ‘content’. Finally, this study reinforces the SLT degree programme. A usual practice, and con-
that, WRP continues to provide students with another sistent format of guiding questions, formative feedback
learning space promoting individualized and self-directed on the student’s process of reflection and real-life clinical
learning as well as time to deliberate after a session to placement experiences was used. The results support the
supplement face to face discussions with educators (Cook continued use of WRP activities in clinical education pro-
et al., 2019; Dunne et al., 2019; Plack et al, 2008). WRP grammes. WRP supports the theory of transfer of learning
appears to provide a purposeful opportunity for exam- across clinical placements, offers a reliable way for the edu-
ination of one’s clinical and professional performance, cator or clinician to first assess and then tailor reflective
growth and feelings, which may not arise in face-to-face questions to foster student development of RP ability and
exchanges. remains a useful tool to use alongside face-to-face inter-
actions with students (Cook et al., 2019; Sheepway et al.,
2014). Finally, a number of questions remain unanswered
Limitations and future directions including the role of feedback in developing WRP skills
and how RP activities completed in clinical programmes
The current study has some limitations but provides sug- transfer to SLT workplaces.
gestions for useful future research directions. The current
study resulted in similar interrater reliability outcomes AC K N OW L E D G E M E N T
to past studies, specifically for the higher level elements Open access publishing facilitated by University of Can-
of RP (‘reflection-in-action’, ‘content’, ‘premise’ and ‘re- terbury, as part of the Wiley - University of Canter-
evaluates’), despite a robust training package for the SLT bury agreement via the Council of Australian University
coding the transcripts (Cook et al., 2019; Plack et al., Librarians.
2005). This reinforces past suggestions that perfect inter-
rater agreement is not achievable due to the individualized CONFLICT OF INTEREST
nature of WR, and the kappa equation underestimating The authors report no conflicts of interest.
reliability where few instances of a specific breadth ele-
ment occur (Cook et al., 2019; Garrity et al., 2019; Plack D A T A AVA I L A B I L I T Y S T A T E M E N T
et al., 2005; Viera & Garrett, 2005). As also suggested by the The data that support the findings of this study are
authors and others, the small number of students demon- available from the corresponding author upon reasonable
strating higher level RP elements in writing may be due request.
to the asynchronous nature of WRP (i.e., not occurring
at the same time as the experience) or level of auton- ORCID
omy on clinical placement (Cook et al., 2019; Duke & Kate. J. Cook https://orcid.org/0000-0002-5083-5757
Appleton, 2000; Plack et al., 2008). The nature of WRP
activities, whereby students are looking back on the expe- REFERENCES
rience, combined with the guiding questions used for this Airasian, P.W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., Raths,
study, yields important future research and clinical super- J. & Wittrock, M.C. (2001) In: Anderson, L.W. & Krathwohl, D.R.
vision considerations. Such as, exploring whether we are (Eds.) A taxonomy for learning, teaching, and assessing: a revision of
asking the right questions to promote and evaluate higher bloom’s taxonomy of educational objectives (complete edition). New
level RP thinking? In particular, are educators asking the York: Longman.
Aronson, L., Niehaus, B., Hill-Sakurai, L., Lai, C. & O’Sullivan, P.S.
right questions for the RP abilities of final-year students
(2012) A comparison of two methods of teaching reflective abil-
who are about to enter the workforce? Useful future direc- ity in year 3 medical students. Medical Education, 46(8), 807–814.
tions to support enhanced engagement for SLT students https://doi.org/10.1111/j.1365-2923.2012.04299.x
may include, the role of formative feedback in developing Bates, D., Mächler, M., Bolker, B.M. & Walker, S.C. (2015) Fit-
WRP skills, the optimum amount of WRP activities and ting linear mixed-effects models using lme4. Journal of Statistical
guiding question type for optimizing WRP and how WRP Software, 67(1). 1–48. https://doi.org/10.18637/jss.v067.i01
and RP activities transfer to SLT workplaces. Bloom, B.S. (1956) Taxonomy of educational objectives, handbook I: the
cognitive domain. New York: David McKay Co Inc.
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 1009

Boles, L. (2018) Predicting graduate school success in a speech– Geller, E. (2002) A reflective model of supervision in speech–
language pathology program. Teaching and Learning in Commu- language pathology: process and practice. The Clinical Supervisor,
nication Sciences & Disorders, 2(2), Article 1. 20(2), 191–200. https://doi.org/10.1300/J001v20n02_14
Bransford, J.D. & Schwarts, D.L. (1999) Rethinking transfer: a sim- Greenwood, J. (1998) The role of reflection in single and double loop
ple proposal with multiple implications. Review of Research in learning. Journal of Advanced Nursing, 27(5), 1048–1053. https://
Education, 24, 61–100. doi.org/10.1046/j.1365-2648.1998.00579.x
Brookfield, S. (1986) Understanding and facilitating adult learning: Harris, M. (2005) Is journaling empowering? Students’ perceptions
a comprehensive analysis of principles and effective practices. UK: of their reflective writing experience. Health SA Gesondheid, 10(2),
Open University Press. 47–60. https://doi.org/10.4102/hsag.v10i2.194
Boud, D., Keogh, R., & Walker, D. (Ed.). (1985). Reflection: Turn- Hill, A.E., Davidson, B.J. & Theodoros, D.G. (2012) Reflections on
ing Experience into Learning. New York: Nichols Publishing clinical learning in novice speech–language therapy students.
Company. International Journal of Language & Communication Disorders,
Bulman, C. & Schutz, S. (2013) Reflective practice in nursing, 5th 47(4), 413–426. https://doi.org/10.1111/j.1460-6984.2012.00154.x
edition, Oxford UK: Wiley-Blackwell. Johnston, G. & Banks, S. (2000) Interprofessional learning mod-
Chabeli, M. (2010) Concept-mapping as a teaching method to facil- ules at Dalhousie University. The Journal of Health Administration
itate critical thinking in nursing education: a review of the Education, 18(4), 407–427.
literatureeview of the literature. Health SA Gesondheid, 15(1), 7. Karpa, J.v. & Chernomas, W.M. (2013) Nurse educators’ perspec-
https://doi.org/10.4102/hsag.v15i1.432 tives on student development of reflection for psychiatric mental
Chambers, S., Brosnan, C. & Hassell, A. (2011) Introducing medical health nursing practice. International Journal of Nursing Educa-
students to reflective practice. Education for Primary Care, 22(2), tion Scholarship, https://doi.org/10.1515/ijnes-2012-0040
100–115. Landis, J.R. & Koch, G.G. (1977) The measurement of observer agree-
Christensen, R.H.B. (2015) Ordinal-Regression Models for Ordinal ment for categorical data. Biometrics, 33(1), 159. https://doi.org/10.
Data. R package version 2015.1-21. https://cran.r-project.org/web/ 2307/2529310
packages/ordinal/index.html Lim, P.H. & Low, C. (2008a) Reflective practice from the perspectives
Colucciello, M.L. (1997) Critical thinking skills and dispositions of of the bachelor of nursing students: a focus interview. Singapore
baccalaureate nursing students—A conceptual model for evalu- Nursing Journal, 35(4), 8.
ation. Journal of Professional Nursing, 13(4), 236–245. https://doi. Lim, P.H. & Low, C. (2008b) Reflective practice from the perspec-
org/10.1016/S8755-7223(97)80094-4 tives of the bachelor of nursing students in International Medical
Cook, K., Tillard, G., Wyles, C., Gerhard, D., Ormond, T. & McAuliffe, University (IMU). Singapore Nursing Journal, 35(3), 5.
M. (2019) Assessing and developing the written reflective practice Mamede, S., Schmidt, H.G. & Penaforte, J.C. (2008) Effects of
skills of speech–language pathology students. International Jour- reflective practice on the accuracy of medical diagnoses. Medical
nal of Speech–Language Pathology, 21(1), 46–55. https://doi.org/10. Education, 42(5), 468–475. https://doi.org/10.1111/j.1365-2923.2008.
1080/17549507.2017.1374463 03030.x
Cruice, M. (2005) Common issues but alternative solutions and inno- McAllister, L. & Lincoln, M. (2004) Clinical education in speech–
vations. Advances in Speech–Language Pathology, 7(3), 162–166. language pathology. London: Whurr.
https://doi.org/10.1080/14417040500181429 McAllister, S., Lincoln, M., Ferguson, A. & McAllister, L. (2013)
Domac, S., Anderson, L., O’Reilly, M. & Smith, R. (2015) Assessing COMPASS R : Competency assessment in speech pathology technical
interprofessional competence using a prospective reflective port- manual, 2nd edition, Speech Pathology Australia.
folio. Journal of Interprofessional Care, 29(3), 179–187. https://doi. Mezirow, J. (1991) Transformative dimensions of adult learning. San
org/10.3109/13561820.2014.983593 Fancisco: Jossey-Bass.
Dowling, S. (2001) Supervision: strategies for successful outcomes and Middlemas, D.A., Manning, J.M., Gazzillo, L.M. & Young, J. (2001)
productivity, 2nd edition, Boston, MA Allyn Bacon. Predicting performance on the national athletic trainers’ associa-
Duke, S. & Appleton, J. (2000) The use of reflection in a palliative care tion board of certification examination from grade point average
programme: a quantitative study of the development of reflective and number of clinical hours. Journal of Athletic Training, 36(2),
skills over an academic year. Journal of Advanced Nursing, 32(6), 136–140. https://go.exlibris.link/0MCC0BTj
1557–1568. https://doi.org/10.1046/j.1365-2648.2000.01604.x Miles, M.B. & Huberman, A.M. (1994) Qualitative data analy-
Dunne, M., Nisbet, G., Penman, M. & McAllister, L. (2019) Facili- sis: an expanded sourcebook, 2nd edition, Thousand Oaks: Sage
tating the development and maintenance of reflection in speech Publications.
pathology students. Health Education in Practice: Journal of Ng, S.L., Bartlett, D. & Lucy, S.D. (2012) Reflection as a tool for audi-
Research for Professional Learning, 2(2). https://doi.org/10.33966/ ology student and novice practitioner learning, development, and
hepj.2.2.13579 self-care. Seminars in Hearing, 33(2), 163–176. https://doi.org/10.
Facione, N.C. (1997) Critical thinking assessment in nursing education 1055/s-0032-1311676
programs: an aggregate data analysis. Millbrae, CA: The California Plack, M., Driscoll, M., Blissett, S., McKenna, R. & Plack, T. (2005)
Academic Press. A method for assessing reflective journal writing. Journal of
Garrity, A., Keck, C., Bradshaw, J.L. & Ishikawa, K. (2019) Toward Allied Health, 34(4), 199–208. https://doi.org/10.1097/00001416-
the development of a quick, reliable assessment tool for reflec- 200607000-00014
tive journals. Teaching and Learning in Communication Sciences Plack, M., Dunfee, H., Rindflesch, A. & Driscoll, M. (2008) Vir-
& Disorders, 3(2), 1–19. https://doi.org/10.30707/tlcsd3.2garrity tual Action Learning Sets: a Model for Facilitating Reflection in
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1010 WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

the Clinical Setting. Journal of Physical Therapy Education, 22(3), of 12 months. Journal of Dental Hygiene : JDH/American Dental
33–42. https://doi.org/10.1097/00001416-200810000-00005 Hygienists’ Association, 86(2), 120–129.
Reynolds, S.W. (1997) Journal writing in nursing. In: Poirrier, G. Tsingos-Lucas, C., Bosnic-Anticevich, S., Schneider, C.R. & Smith, L.
(Ed.) Writing-to-learn: curriculum strategies for nursing and other (2017) Using reflective writing as a predictor of academic success in
disciplines. Thousand Oaks: National League for Nursing Press. different assessment formats. American Journal of Pharmaceutical
Roche, A. & Coote, S. (2008) Focus group study of student phys- Education, 81(1), 1–8. https://doi.org/10.5688/ajpe8118
iotherapists’ perceptions of reflection. Medical Education, 42, Viera, A.J. & Garrett, J.M. (2005) Understanding interob-
1064–1070. server agreement: the kappa statistic. Family Medicine, 37(5),
Russell, T. (2005) Can reflective practice be taught? Reflective Practice, 360–363.
6(2), 199–204. https://doi.org/10.1080/14623940500105833 Walker, D. (1985) Writing and reflecting. In: Boud, D., Keogh, R.,
Schaub-de Jong, M., Schönrock-Adema, J., Dekker, H., Verkerk, M. & Walker, D. (Eds.) Reflection: turning experience into learning,
& Cohen-Schotanus, J. (2011) Development of a student rating London: Kogan Page, pp. 52–68.
scale to evaluate teachers’ competencies for facilitating reflec- Williams, R.M., Sundelin, G., Foster-Seargeant, E. & Norman, G.R.
tive learning. Medical Education, 45(2), 155–165. https://doi.org/10. (2000) Assessing the reliability of grading reflective journal writ-
1111/j.1365-2923.2010.03774.x ing. Journal of Physical Therapy Education, 14(2), 23–26. https://
Schön, D.A. (1983) The reflective practitioner: how professionals doi.org/10.1097/00001416-200007000-00005
think in action. New York: Basic Books. https://go.exlibris.link/ Wong, F.K., Kember, D., Chung, L.Y.F. & CertEd, L.Y. (1995) Assess-
Ls1LSVPR ing the level of student reflection from reflective journals. Journal
Schön, D.A. (1987) Educating the reflective practitioner: toward a new of Advanced Nursing, 22(1), 48–57. https://doi.org/10.1046/j.1365-
design for teaching and learning in the professions, 1st edition, San 2648.1995.22010048.x
Francisco, CA: Jossey-Bass. https://go.exlibris.link/gc2w3xqd Zimmerman, S., Byram Hanson, D., Stube, J., Jedlicka, J. & Fox, L.
Sheepway, L., Lincoln, M. & McAllister, S. (2014) Impact of place- (2007) Using the power of student reflection to enhance profes-
ment type on the development of clinical competency in speech– sional development. Internet Journal of Allied Health Sciences and
language pathology students. International Journal of Language & Practice, 5(2), 1–7. https://doi.org/10.46743/1540-580x/2007.1146
Communication Disorders, 49(2), 189–203. https://doi.org/10.1111/
1460-6984.12059
Team. R.C. (2015) A language and environment for statistical com-
puting. from http://www.R-project.org/. In: R Foundation for
Statistical Computing (Vol., 10, Issue 1). http://www.r-project.org/ How to cite this article: Cook, K.J., Messick, C.
Tillard, G.D., Cook, K., Gerhard, D., Keast, L. & McAuliffe, M. & McAuliffe, M.J. (2023) Written reflective practice
(2018) Speech–language pathology Student Participation in Ver- abilities of SLT students across the degree
bal Reflective Practice Groups: perceptions of development, value,
programme. International Journal of Language &
and group condition differences. Teaching and Learning in Com-
Communication Disorders, 58, 994–1016.
munication Sciences & Disorders, 2(2). https://doi.org/10.30707/
tlcsd2.2tillard https://doi.org/10.1111/1460-6984.12815
Tsang, A.K.L. (2012) Oral health students as reflective practition-
ers: changing patterns of student clinical reflections over a period
 APPENDIX A
COOK et al.

TA B L E A 1 Coding schema for written reflective practice (WRP)

Guiding question where
Element Description of Key Sentence Co-occurring element may be
No. (code) breadth elements words/phrases example What it is not elements identified
1 Returns to the Describes the ‘Today’s session’ ‘Today we did x, y, Listing items with All can co-occur What was your overall
experience experience. z today’ no description of impression of the
(RETURN) Narrative event session?
retell/replay of the
session (‘in some
detail’; Plack et al.
2005)
2 Attends to Acknowledges and Emotions, e.g., ‘I felt sad because ‘I was nervous for All can co-occur What emotions can you
feelings begins to work with nervous, sad, . . . ’ ‘I felt this session’—no remember feeling during
(ATTEND) feelings. Needs to do happy, excited nervous because why given the session?
more than state an Feelings, tired, shy, ...’ Did you observe or think
emotion or interest about client emotions or
feeling—give the behaviours during the
why—some session?
discussion of impact What were your thoughts
of emotion on and feelings at the time
situation (Plack of the incident?
et al. 2005)
3 Reflection on Occurs after the action ‘Learnt/learning’ ‘I did x, y, z and Describing the Must co-occur with What things went well
action (ROA) has been completed from this I learnt event either: return, during the session and
...’ or attend what did you learn from
Only describing these?
what learnt What things went wrong
(with no during the session and
description of what did you learn from
the event) these?
What have you learned,
e.g., about yourself,
relationship with others,
the SLT task,
organizational policies
and procedures?
(Continues)
1011

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 1012

TA B L E A 1 (Continued)
Guiding question where
Element Description of Key Sentence Co-occurring element may be
No. (code) breadth elements words/phrases example What it is not elements identified
4 Reflection for Occurs before being ‘Next time/session’ ‘I did x, y, z and Describing the Must co-occur with What things went well
action (RFA) faced with the ‘I should have’ next time I will event either: return, during the session and
situation; begins to ‘in the future’ ...’ or attend what did you learn from
plan for the future ‘I will’ Only describing these?
what will do What things went wrong
next time (with during the session and
no description of what did you learn from
the event) these?
What do you need to learn
or find out about before
the next session?
What future learning needs
have you identified as a
result of this incident?
How might this be
achieved?
5 Process (PROC) Describes the Cues or strategies, ‘I used x cues to . . . ’ Listing strate- Can co-occur with What things went wrong
strategies/clinical e.g., stopwatch, ‘I reminded the gies/clinical all other codes during the session and
techniques used or cheat sheet, role patient to use his techniques with This is a significant what did you learn from
available for use and play, questioning loud voice’ no explanation correlation these?
the impact/or techniques ‘I could have used of the why/what between premise Did you observe or think
reason for use ‘I tried’ my information used for General and process about client emotions or
‘I could have tried’ sheet to . . . ’ mention of co-occurring behaviours during the
‘reminded’ ‘strategies’ or session?
‘processes’— Did the session follow your
need to be plan? Why or why not?
specific What do you need to learn
or find out about before
the next session?
What are the areas you feel
you need to develop
further about yourself
and your
communication?
(Continues)
WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 TA B L E A 1 (Continued)
COOK et al.

Guiding question where

Element Description of Key Sentence Co-occurring element may be
No. (code) breadth elements words/phrases example What it is not elements identified
6 Reflection in Occurs while in the ‘During’ ‘In the moment I Describing what Must co-occur with What things went wrong
action (RIA) midst of an action; ‘Change’ changed . . . ’ learnt (ROA) either: return, during the session and
on-the-spot ‘In the ‘I decided to Describing what to attend what did you learn from
decisions or middle/moment’ change xx do next time these?
experiment. The ‘and this meant’ during the (RFA) What things went well
impact of the session as . . . during the session and
change will be or. . . the result what did you learn from
described was’ these?
Distinguishing
feature: the
immediate
significance for
action. Ask yourself:
did they make a
difference to the
situation at hand?
(Schon 1987)
7 Content (CON) Explores the ‘point of view’ ‘Another way I A statement of Can co-occur: What things went wrong
experience from ‘different beliefs’ could look at emo- Return likely during the session and
another perspective this is . . . ’ tions/feelings as they describe what did you learn from
(beyond ‘From my and the impact the situation these?
description), for client’s/supervisor/physio’s
this had (attend), Re-evaluate Did the session follow
example patient, point of view . . . ’ e.g., ‘I thought your plan?
client, family or “I think the patient about how I Why or why not?
supervisor felt . . . this was would feel if I What are your thoughts
New understanding of because . . . The had 5 students and feelings now about
an event (updated result was/this observing me this incident?
from Plack et al. meant I needed and know that I What were the responses of
2005, similar to Hill to . . . ” wouldn’t like it the other key people to
et al.’s, 2012, at all!’ this incident? If not
definition) known, what do you
think they might have
been?
(Continues)
1013

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 TA B L E A 1 (Continued)
1014

Guiding question where

Element Description of Key Sentence Co-occurring element may be
No. (code) breadth elements words/phrases example What it is not elements identified
8 Re-evaluates Reappraises the ‘last time/patient ‘In the past I have Stating textbooks, Can co-occur: What theoretical
(RE-EVAL) situation vis-à-vis . . . this time’ done x, I used clinical notes, Return likely as knowledge did you use or
past experiences ‘I could have . . . this this again and lecture notes, they describe the could have used during
New understanding of would have’ the result was e.g., ‘I used my situation this session?
an event ...’ lecture notes to Content What past experiences did
‘I used my previous help me know you use or could have
knowledge from what to used during this session?
clinical notes at expect’—needs Are there ways in which
this hospital to to be specific this incident has led (or
help orientate and give the might lead to) changes in
myself on how to comparison how you think, feel or act
set these notes from learning to in particular situations?
out’ current What are your thoughts
experience and feelings now about
this incident?
What theory (or theories)
has (or might have)
helped develop your
understanding about
some aspect of this
incident?
9 Premise (PREM) Recognizes and ‘my opinion’ ‘I had thought all Description of the Can co-occur: What emotions can you
explores own ‘my family values’ clients/parents assump- Return likely as remember feeling during
assumptions, ‘assumption’ would want to . . . tion/value/bias/belief they describe the the session?
values, beliefs and ‘belief’ As this is the given—no situation What impact do you feel
biases ‘before I met the way I would do it change/confirmation This is a significant your own assumptions,
New understanding of patient I thought . . . however now of perspective correlation values, beliefs or biases
an event . . . instead’ I can see another given between premise may have had on the
So what, now what? side/understand and process session or observation?
why this is co-occurring What are your thoughts
important for and feelings now about
them which is this incident?
...’ What are the values and
ethical issues which are
highlighted by this
incident?
Note: Breadth = made up of reflective practice elements that can be identified at the word, sentence or paragraph level. Elements are organized by level of RP, with 1 = lowest level of RP.
Sources: Modified from Pack et al. (2005) (first modification for Cook et al. 2019, second modification by Cook et al. 2020).
WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
COOK et al. 1015

APPENDIX B

TA B L E B 1 Clinical education programme of learning for reflective practice by year group and semester
Professional year First First Second Second Third/final Third/final
Semester One Two One Two One Two
Reflective practice (RP)
education
Full class teaching: X X X X
group reflections
(what went well,
what was
surprising, what
would you do next
time), dialogic
teaching, Journal
article discussion:
topic RP
Mentoring/peer Mentee Mentor
learning
Reflective discussions X X X X X
with clinical
educator pre-
and/or post-clinical
interactions (small
group or one on
one)
Verbal RP group: one X X
per week; 50-min
duration
Written RP: one per X X X X
week; formative
feedback given
Written RP: X X X X X X
assessment;
summative
feedback given
Type and sequence of Set 1 Set 2 Sets 2, 3 Set 2 Set 2 Sets 2, 3
questions used for
written RPa
Clinical practice
requirementsb
Observation 12 weeks
placement
Part-time placement 12 weeks 6 weeks 12 weeks 12 weeks 6 weeks
Block placement: full 5 weeks 12 weeks
time
Notes: X indicates the type of RP activity completed.
a
See Appendix C for a full list of questions used as part of standard practice for the clinical education programme.
b
An observation placement is one whereby students are not actively involved in SLT, a part-time placement is completed in conjunction with academic teaching
requirements, a block placement is a full-time placement (i.e., 40 h per week) with no academic teaching requirements (McAllister et al., 2013).
 1016

APPENDIX C
TA B L E C 1 Guiding questions used for WRP
Set 1 Set 2 Set 3c
What happened? What was your overall impression of the Account of the incident
Brief summary of what you did, what you session?a What happened, where and when; who was involved?
talked about, any new experiences What things went well during the session and What was your role/involvement in the incident?
What did not go well and why? what did you learn from these?a What was the context of this incident, e.g., previous involvement of yourself or
Explain what you learned from this What things went wrong during the session workplace staff with this client/client group?
What next? and what did you learn from these?a What was the purpose and focus of your contact/intervention at this point?
What have you learned from this visit and What emotions can you remember feeling Initial response to the incident
how will this experience influence your during the session?a What were your thoughts and feelings at the time of the incident?
future interactions? What did you observe or think about client What were the responses of the other key people to this incident? If not known,
Think about specific actions and how you emotions or behaviours during the session? what do you think they might have been?
are going to put them into practice, Did the session follow your plan? Why or why Issues and dilemmas highlighted by this incident
describe any resources you might need not?a What practice dilemmas were identified as a result of this incident?
What theoretical knowledge did you use or What are the values and ethical issues which are highlighted by this incident?
could have used during this session?a Are there any implications for your collaborations with any of the following?
What past experiences did you use or could Clients, Their family members, Peers, Supervisors, SLT clinicians, Inter-disciplinary
have used during this session?a team members
What do you need to learn or find out about Learning
before the next session?a What have you learned, e.g., about yourself, relationship with others, the SLT task,
What impact do you feel your own organisational policies and procedures?
assumptions, values, beliefs or biases may What theory (or theories) has (or might have) helped develop your understanding
have had on the session or observation?b about some aspect of this incident?
What future learning needs have you identified as a result of this incident? How
might this be achieved?
Outcome
What were the outcomes for the various participants?
Are there ways in which this incident has led (or might lead to) changes in how you
think, feel or act in particular situations?
What are your thoughts and feelings now about this incident?
Sources: a McAllister & Lincoln (2004)
b
Plack et al. (2005)
c
Crisp et al. (2005).
WRITTEN REFLECTIVE PRACTICE ABILITIES OF SLT

14606984, 2023, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12815 by University of Turku, Wiley Online Library on [29/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License