Developing a Self-Regulated Learner

Cashell (2010) suggests that reflection is a coping mechanism - particularly in relation to negative clinical outcomes - that qualified radiotherapists use to help manage difficult aspects of clinical practice that they encounter. Whilst this empirical work was profession- focussed, in light of the fact that all healthcare professions manage profession-specific difficult clinical situations, there is no reason to suggest that these findings may not be relevant to other professional groups. What is interesting about this work is that it reports that one barrier to engaging in active reflection is the reluctance to show or fear of showing weakness to others. It suggests through a quote from one participant (Cashell, 2010, p. 134) that this is particularly so for someone “new” to a professional community. More recent work by Bulman et al. (2014) supports the notion that reflection has the potential to be an emotionally-laden activity and, I propose therefore, one that should not be

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undertaken lightly or without appropriate support. Whilst reflection should be used to critically explore the “self” within experiences, doing so may give rise to feelings of unease. I argued earlier in this chapter that learners whose primary goal is self-protection tend to have lower confidence levels than their counterparts who are driven by self-enhancement (Jiang & Kleitman, 2015). I now submit that this additional layer of low confidence, together with the existing desire to protect the “self” by avoidance of exposing one’s vulnerability through reflective engagement, strengthens the notion that new members of a community of practice may not be open to reflective engagement.

Transposing this to the context of a learner and a professional community of practice

presents a situation in which the student healthcare professional is, as a “new” member, on the margin of a community (Lave & Wenger, 1999), unwilling to or being fearful of exposing their weakness (Cashell, 2010) and therefore not effectively engaging in active reflection. Conversely, more expert clinicians are situated more centrally within a community of practice (Fenton-O'Creevy et al., 2015), become increasingly confident in their reflective skills (Cashell, 2010) and recognise the professional gain from such inward-looking analytical learning tools. For students who are “new”, unfamiliar or uncomfortable with a community of practice within which they are situated, the dilemma is then how they might best be supported to overcome fear, and permitted – possibly encouraged – to potentially show their weaknesses by engaging in reflection. Engagement in reflection would provide a vehicle for the students to learn from their critically-explored experiences and become empowered to take more ownership of their learning (D. Boud et al., 1985) – skills necessary of a graduate healthcare professional.

The findings of this research have argued that for learning to be authentic and meaningful for future healthcare practitioners who are required to make clinical decisions and problem- solve patient-by-patient on a daily basis, it needs to involve active engagement (Mackaway et al., 2011) on the part of the learner. To put this in context, whilst the rote learning of anatomical knowledge and physiological principles might provide a firm foundation for understanding the cardiac system and homeostasis, this is without value if the nurse cannot then utilise this underpinning knowledge within an authentic clinical situation. Without a pre-registration healthcare student consciously attending to an experience before (to plan), during (to reflect and modify) and after (to analyse and action plan) it (D. Boud et al., 1985), the opportunity for the student to maximise learning from exploration of the experience is lost. A questioning approach might be used to assist students with this self- regulated analytical process.

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7.4.1 Use of questions

A significant theme that emerged from the data is how and why questions were used within the lived feedback experiences that this research explored. This theme arose from both students and educators and was identified in both university-based and practice-based settings. It is a well-established practice to use questions within healthcare education to guide a student through the process of reflection in order to give authenticity to their learning experiences and to help the student take ownership of their learning. Reflective models vary in format (e.g. Barksby et al., 2015; Branch & Paranjape, 2002; Hannigan, 2001; C. Johns, 2002) but all use a questioning style to help structure the learner’s exploration of an experience.

The use of a questioning style within feedback is overtly supported by one of the university- based educators, Diane. Diane stated that she poses questions within her feedback because she “does not want to be doing all the work for the students” by offering them the answers in the form of instruction. It is interesting that Diane’s initial focus for her use of questions was around who was taking responsibility for the learning. Diane appears to want to

empower her students to be responsible for their own learning – a requirement of graduate healthcare practitioners (Health and Care Professions Council, 2013; Nursing and Midwifery Council, 2010) – but this seems to be a secondary outcome after her primary concern about her own academic workload. Diane was very clear about not wanting to undertake the instructional workload herself rather than recognising the opportunity to use a questioning style to facilitate a deeper level of enquiry in the student.

Another academic, Susan, discussed her explicit and purposive use of questioning to help students reflect on their progress. Whilst it was evident that Susan expects students to engage in the agency of learning from feedback, she described herself as wanting to be a “therapist” to the students when she first moved from clinical practice into higher education. She explained to me that it took some time for her to realise that she had to focus on the academic rather than pastoral dimensions of learning and signpost the students to other services when their need was pastoral:

[You are] in a semi-therapeutic mode when you are supporting someone because you are helping them find their own answers, aren’t you? (Susan)

It is clear from Susan that she views her role within a feedback situation as offering guiding empowerment to the student. Core to her approach is her own professional clinical

background that was focused on enabling individuals to maximise their quality of life through their own actions and engagement. This is interesting as educators tend not to be

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taught the attributes of “skilled facilitation” (p. 1230) necessary for reflection despite this being a clear requirement of successful academic and clinical educators from the post- registration nursing work of Bulman et al. (2014). Based on her previous clinical role and insight associated with it, it seems that Susan is able to recognise that she has been able to transpose her enabling model of healthcare – in contrast to a biomedical model of

healthcare that is often implicit within some professional disciplines - into the educational arena. As such, Susan is able to utilise quasi-therapeutic skills with students to promote ownership of learning.

True to all reflective models is guidance of the learner through some form of explorative structure, as has already been discussed with the MSR by Johns (2009). Evident in several reflective models, including that of Johns (2002 and 2009), are a formalised set of

questions to guide the learner. These questions guide the learner through both an introspective and outward-looking account of a socially constructed experience such that they have the best opportunity for maximum learner outcome. Bulman et al. (2014) cite the 1998 influential work of Brockbank and McGill who claim that the use of dialogue and

questioning is pivotal to critical thinking and explorative reflection, and their own work further supports the impact that a questioning dialogue can have on the development of a learner.

The work of colleagues in the university whose primary role is to help students develop their academic skills is interesting. One colleague, Alan, explicitly reported that he “works and teaches through provocation” in that he purposively uses challenging questions with students in feedback situations in order to empower them to take responsibility for their own critical review of their work. Alan’s language is of interest in that even though he is talking about empowering the students, he still refers to him “teaching” rather than to the student learning. Situating this in the context of lifeworld “sociality” (A. Ashworth &

Ashworth, 2003), this questions whether Alan perceives a power differential between teacher and learner, in contrast to the partnership that was seen earlier in the quasi- therapeutic example by Susan. Susan’s language of “supporting” learners in the context of the feedback process suggests more of an equal relationship and appears to shift the balance of responsibility to the learner. Her pedagogical style appears more enabling in its focus and, through this, is more encouraging and scaffolding (Kelsey & Hayes, 2015) to the [learning from] feedback experience.

In their nurse education work, Kelsey and Hayes (2015) describe scaffolding structures as non-permanent tools that support and guide student learning, rather than as permanent

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features or ones that dictate learning. They consider reflective tools as one way by which scaffolding may occur. With the support of Hargreaves (2004) who suggests that the

product of learner reflection is often modified in practice to meet assessment criteria, Kelsey and Hayes (2015) go on to suggest that reflection in healthcare education may, in fact, constrain learner development rather than foster it. Of particular note here is the

underpinning work by Hargreaves (2004) and Hannigan (2001) who both suggest that learners may falsify their outcomes of reflection in order to evidence what they believe their educators want to see. Such false learner practice would prohibit genuine learning from an experience and presents as a challenge for educators if reflection is to be used to

successfully scaffold and enable the ongoing learning of healthcare practitioners. Bulman et al. (2014) suggest that often the institutional culture – or culture within a community of practice – needs to be explored further in order that the real value of reflection can be optimised by it being genuinely embedded into its “being”.

7.5 Chapter Summary

This chapter has explored the relationship between the facets of questions, reflection and ownership in the support of learning from feedback. It has used quotes of data, and social learning and communities of practice theory to contextualise this exploration and

understand the lived experiences of the participants.

This chapter has identified that reflection tends to be structured in a questioning manner and that some educators use questions within feedback as a matter of course. The underpinning purpose for educators using questions within feedback appears to be inconsistent, with some educators using it to empower the learner and others using it to help manage their own workload. This chapter has also provided evidence to suggest that reflection does not always result in a positive gain for the learner and there is concern by some learners, particularly those new to a community of practice, about how engagement with reflection might expose their weaknesses.

Throughout this chapter the need for healthcare students to develop skills of ownership and learner self-regulation has been underpinned by regulatory requirements. This chapter has argued that it is important that students invest in their learner “self” to help them form positive learner identities. Reflection is a tool by which one might impose one’s own

verification of learning in order to develop a stronger learner “self”. Finally, this chapter has argued that outcomes of engagement in reflection may assist novice learners to become fuller members of a community of practice.

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