The use of reflection in medical education: Guide supplement 44.1--Viewpoint.

During the past few decades, self-reflection has been a topic of widespread interest among researchers and practitioners across diverse domains such as education, psychology, and sports sciences. In general, it is a multi-dimensional process that is referenced in most accounts of self-directed or selfregulated learning (SRL). In my opinion, Sandars (2009) presents a timely and relevant Guide for medical educators because it not only integrates multiple lines of research into a single volume but also addresses some key researchto-practice issues that educators should consider when working with medical students, particularly those who struggle. Furthermore, given that this well-written Guide provides a reader with a broad lens from which to understand the nature of self-reflection, it might have wide appeal across different fields within the medical community. Given the importance of this topic, I would like to make a couple of constructive comments and then expand on a few important concepts that were briefly presented in the Guide. More specifically, I would like to provide feedback regarding self-reflection as a theoretical construct and discuss the importance and relevance of considering contextual factors in the evaluation of students’ self-regulatory processes, along with the emergent techniques to reliably assess such processes. In most accounts, self-regulation is typically conceptualized to be a cyclical, multi-dimensional process involving a few general phases or sub-processes, such as forethought, volition or self-control, self-observation, and self-reflection (Zimmerman 2000; Puustinen & Pulkkinen 2001). From such a framework, forethought (e.g., goal-setting) precedes action, volition and self-observation typically occurs during learning or performance, and self-reflection (e.g., self-evaluation) follows performance. Within each of these general regulatory categories is a set of more narrowly defined and specific psychological constructs. For example, the general category of self-reflection is not a single process or activity, but rather a host of cognitive reactions and self-judgments following performance. These sub-processes often include an individual’s evaluations of performance (self-evaluation), perceptions of the causes of these outcomes (attributions), and his or her affective (anxiety, satisfaction), and behavioral reactions to this performance (modifying strategy use). Interestingly, the Guide defines self-reflection in very broad terms as a metacognitive process occurring before, during, and after situations. In many respects, this conceptualization is comparable to definitions of self-regulation put forth by many educational psychology researchers. Sandars (2009) suggested that delineating self-reflection in this manner was intentionally done in order to increase its potential application to readers across a diverse array of situations and contexts. Although this is a very reasonable objective, I do not believe that the term self-reflection adequately encompasses all forms of metacognition that typically operate across each of the three cyclical phases. Of particular concern is that in describing selfreflection as a before, during, and after phenomenon, one runs the risk of distorting or diluting its precise meaning and or masking its conceptual distinctiveness relative to other wellestablished forethought and performance phase regulatory sub-processes, such as task analysis, planning, and selfmonitoring. In short, self-reflection is ultimately one component of a broader self-regulatory framework. Thus, medical