Reflection’s role in learning: increasing engagement and deepening participation

It’s a pleasure to write a commentary that has as its basis a study which examines the impact of reflection on learning. As one considers the evolution of our understanding of reflection and its place in health professions education, several observations emerge. Educators have understood reflection as a key element of learning for decades, dating at least back to John Dewey [1]. However, its place in medical education has emerged more recently. Donald Schön’s [2, 3] description of how learning from experience occurred in practice introduced a new epistemology of learning to medical education. For some time, attempts at introducing reflection into medical and health professions education curricula ran separately from and parallel to what were regarded as the central curricular elements [4] and challenges existed for their integration [5]. Pedersen [6], in a review of empathy teaching, noted the dichotomy of science and humanities in the world of physicians. He suggests that the effect of learning biomedical skills and knowledge, combined with an unquestioned reliance on ‘objectivity’ of biomedical knowledge, may not allow for or recognize the importance of deriving meaning and interpretation, such as through reflection. Hence it may remain on the periphery. How our ideas have changed! Reflection is now regarded as an essential capacity fundamental to self-regulation and learning. Accumulating evidence demonstrates many benefits: it is integral to self-assessment, enhances acceptance of feedback, allows for the integration of new and existing knowledge and experience, facilitates reconciliation of cog-