Virtual Action Learning Sets: A Model for Facilitating Reflection in the Clinical Setting

Abstract

Background and Purpose. Reflection is a strategy for learning from experiences that requires active, conscious engagement of the learner. Action learning promotes reflection and higher-order thinking and uses questions to solve real world problems. The authors present a model of learning using virtual-action learning (VAL) sets in the clinical setting. They sought to determine whether this model facilitated reflection and higher-order thinking, whether any differences existed between mentorfacilitated and peer-facilitated groups, and students' perceptions of the process. Method/Model Description and Evaluation. Two groups of physical therapist students (group 1: n=4; group 2: n=3) on their final clinical internship were oriented to reflective process and participated in VAL activity. Each submitted 1 critical incident to an electronic discussion board. Once posted, group members posed questions to facilitate reflection and further analysis. Group 1 was mentored by the clinical instructor (CI); Group 2 was peer-facilitated. An online discussion ensued to enable students to resolve their incidents. After 4 weeks students wrote a 1-page summative, reflective essay on the process and insights gained. Discussion threads and summative essays were analyzed. Descriptive statistics summarized evidence of the elements of reflection and levels of higher-order thinking achieved. Chisquare tests of independence were used to assess differences in frequencies of the reflective elements evident and of the levels of thinking achieved between the groups. Mann-Whitney U tests were used to compare groups for the number of questions posed versus advice given per entry. Finally, qualitative methods were used to analyze the summative reflective essays for students' perceptions of the process. Outcomes. No significant differences were noted between groups in the frequency of reflective elements evident in the postings. Group 1 exhibited greater proportions of data gathering (chi-square = 14.467, P < .001) and data analysis (chi-square = 4.025, P = .05), but no significant difference was noted when reaching a conclusion. Furthermore, while the mean number of responses phrased as questions did not differ significantly between the groups, those phrased as advice or experience sharing were significantly less in group 1 than in group 2 (z = -4.234, P < .001). Finally, the following themes emerged from the summative essays: (1) reflection is a deliberate analytic process; (2) reflective practice offers insight into the depth of patient management; and (3) VAL sets enhanced collaborative learning. Discussion and Conclusion. Virtualaction learning enabled students to work collaboratively to solve problems using the reflective process in the fast-paced clinical environment. Students valued and learned from the asynchronous dialogue and resultant reflective and questioning processes that promoted further thought, analysis, and problem solving.