Standard 4: Reflective practice

Reflection leading to self-awareness is a process by which a health professional deliberately, objectively and regularly examines their underlying principles, including their personal values and attitudes and the influence these have on their practice. Reflection and self-awareness are central tenets to health practice and to professional development. These skills are particularly relevant when working with individuals experiencing pain to ensure pain management is unhindered by unconscious (implicit) biases, prejudices, or inaccurate information or approaches that could lead to inequity or disparate treatment and outcomes. As such, pain management education and training designed for health practitioners must embed and reinforce these concepts to encourage their integration into routine practice. 

“There are not many areas of health care where bias is more prevalent than in pain management. Practitioners need to be self-reflective, and able to identify and counteract their own biases.” – Stakeholder consultation workshop participant 

“Reflective practice requires applying a critical lens to attitudes, biases, assumptions, beliefs, knowledge, skills, experiences, and quality of thinking/actions. It has the goal of improving performance to improve outcomes.”^{59 p.5}  

^{Note: All references supporting this information can be found in the full Australian Standards for Health Practitioner Pain Management Education document. View or download the document here.}

Reflective practice (also referred to as critical thinking or reflection60) is considered a critical component of clinical practice and is reflected in the codes of practice for many health practitioners.^57,58,61,62 Reflective practice defines the process whereby health practitioners actively and iteratively examine their thoughts, attitudes, actions and personal underpinning conceptual and/or ethical framework.⁶¹ The process seeks to advance professional practice through personal exploration, mindfulness and self-awareness.^61,63,64 Reflective practice also has personal benefits with respect to the health practitioner’s own health and wellbeing. 

^{Note: All references supporting this information can be found in the full Australian Standards for Health Practitioner Pain Management Education document. View or download the document here.}

Reflective practice is particularly relevant in the context of pain management because it is demonstrated to have a positive influence on core tenets of pain management – delivery of person-centred care⁶³ (outlined in the person-centred care standard) and person-centred communication⁶⁵ (outlined in the communication standard). The process of reflective practice enables health practitioners to identify and address any negative, preconceived, personal attitudes or views they hold (often unconsciously). Given the identified issue of stigmatisation that many individuals experiencing chronic pain face (for example, being viewed as untrustworthy, depressed, drug-seeking or drug-abusing), health practitioners undertaking personal improvement processes that address these possible biases can contribute to the delivery of higher quality care.³⁷ Likewise, reflective practice can assist health practitioners to deliver more equitable and bias-free care to diverse groups experiencing chronic pain (for example, Aboriginal and Torres Strait Islander peoples, women and people from other cultural groups).^66,67

^{Note: All references supporting this information can be found in the full Australian Standards for Health Practitioner Pain Management Education document. View or download the document here.}

Incorporating reflective practice into a health practitioner’s initial education and training promotes lifelong learning and self-awareness.^61,68,69 Early exposure to self-reflective practice should reinforce the importance of reflective practice as an ongoing component of professional development. Despite its acknowledged importance and value, reflective practice is identified as an area requiring improvement within health-related education and training curricula.^60,70 Barriers to the teaching of reflective practice include the limited understanding health educators may have with respect to reflective practice and skills acquisition that should be taught,^59,61 as well as the large volume of content required in health curricula,⁶¹ a perceived lack of value of reflective practice from the perspective of both learners and the educators, and lack of organisational/institutional commitment.^61,70 When efforts to address reflective practice within pain management education are inauthentic, there is a risk that learners will become disengaged.⁷⁰

Educators play an important role in embedding this lifelong professional skill. Educator modelling, particularly with respect to willingness to engage in reflection, is identified as an important teaching strategy.^59,63,71 Rather than assuming that all learners intrinsically know how to undertake reflection, reflective skills and strategies should be taught and practised.^59,61 Some strategies include formal narrative writing, small group discussions, the use of video-recordings, peer support and mentorship. Creating appropriate safe spaces and a supportive atmosphere for reflective activities facilitates the ability of learners to engage meaningfully in the reflective process.^60,70  

^{Note: All references supporting this information can be found in the full Australian Standards for Health Practitioner Pain Management Education document. View or download the document here.}