A pedagogical approach for reflection on PPD

To implement reflection into your own teaching practices, SCOPE has constructed a pedagogical approach that consists of seven steps. These steps can be used as guidelines for developing or improving education that invites students to critically reflect on their PPD. You can be flexible in using these steps by, for example, combining steps three and four. Consistently adhering to and repeating the principles of these six steps in your educational practices, however, has one significant advantage: it will enable students to gradually internalise the reflective process, fostering a reflective attitude towards their PPD. In the following section, we will explain these six pedagogical steps. Afterwards, we will describe the (curricular) conditions that facilitate the implementation of this approach. In following parts of the book, exercises that we use in our education are provided as examples.

Step 1: Provide a brief knowledge base and a rationale

In order to engage students in a teaching activity, they will first need a theoretical basis and understand its relevance. Knowing the rationale behind PPD  gives students the necessary tools to reflect on their PPD and supports their learning (Clement et al., 2023). Indeed, students need to know what critical reflection is, how it works, and why the action is an essential competency in their PPD. We therefore suggest making PPD and reflection explicit and provide instructions on these activities.

In addition, it may be helpful to provide a reflective model for students who are not so familiar with reflection. This will help them understand what the elements of reflection are and how the process works. Several reflection models exist, such as those by Gibbs (1988), Korthagen and Vasalos (2005) and Rolfe et al. (2001). We prefer reflection models that explicitly mention a step for analysis to encourage students to explore their experiences and analyse their beliefs and assumptions.

Step 2: Provide students with an experience (‘experience’)

The first step in creating critical reflection educational practices on PPD is to offer students experiential exercises (experiences) that elicit thoughts, feelings, and/or physical sensations that have the quality to foster critical reflection. Theorists agree that an experiential exercise needs to have an ‘interruptive quality’, include a ‘disorientating dilemma’, or contain a ‘surprise’. In other words, a situation needs to be created where there is no immediately apparent response based on past experiences or knowledge, pushing students to experience some kind of friction. Friction can mean that students feel (a little) uncomfortable, confused, frustrated, or confronted. This friction can be the starting point for critical reflection because it challenges students to question their beliefs, assumptions, or previous ways of knowing. However, the experience should also engage students. Engagement is vital because only when students are engaged learning can occur. An engaging experience should not only have an interruptive quality , but also build on students’ prior knowledge and experiences (i.e. continuity). If the experience is too far-fetched, students will not be able to connect what they encounter to what they already know.

So, when you want to invite students to critically reflect, starting with an experience increases the chance that students will actually do so. There are many kinds of experiences that you can use. First of all, you can make use of the experiences students have had outside the classroom. For example, they can examine the experiences they had during an internship or interviews for a project. In terms of boundary crossing, you could say that any ‘boundary experience’ can be used as input for this first step. As a teacher, you can use these experiences as a starting point for critical reflection on PPD. You can, for example, ask about the professional behaviour they observed during their internship (socialisation), which values or assumptions they think underpin that behaviour, and how they relate to that themselves (subjectification). How, for example, do those attitudes, values and assumptions fit in with the student’s own professional identity?

Another possibility is to create an experience in the classroom. We interpret ‘an experience’ quite broadly. For instance, it can be a more cognitive experience where students use a table-size foamboard with 49 values on it as a conversation starter to reflect on their own values and those of their fellow students (see Figure below), or a visualisation exercise where students try to imagine they are experiencing the situation that they are visualising. You could also make use of methods of the arts, such as art-based learning (Lutters, 2020). We also discovered that the method of systemic constellations—which is often used to gain insight into organisational and team relations—is useful for increasing students’ awareness of the implicit knowledge that is conveyed through socialisation (Scholtens et al., 2023).

Make sure that the educational practices will encourage students to engage in reflection and that you guide them through this process. The content should be personally relevant for students, and the teaching methods that are used should make students genuinely curious and motivated to explore themselves and their experiences.

Step 3: Let students observe (‘observe’)

The second step is to guide students through their observations of the experience. Kolb (1984) introduced the term reflective observation to refer to one’s own experiences: What did I observe? What was I aware of? What does this experience mean to me? Through reflective observation, students become aware of their personal responses to the experience of Step 1. These responses can take the form of thoughts (e.g. ideas, judgments, deep-rooted beliefs, or assumptions), physical sensations (e.g. tension, energy, pain, or comfort), and feelings (e.g. happy, sad, angry, or afraid). A deep awareness of these intuitive reactions is a necessary first step in achieving authentic reflection on oneself and one’s development. It generally takes time to become aware of such responses, so it is vital not to rush through this step.

As a teacher, you guide your students through this step. This can be done in multiple ways. One way is to guide students through the experiential exercise by asking specific questions that make students more aware of their intuitive responses. For example, by making use of pauses (a moment of silence) in a visualisation exercise (a direct experience in the classroom) where you ask, ‘What are you experiencing now?’ or ‘Are there any thoughts, feelings, or physical sensations that you can notice?’ In addition, when you make use of experiences that took place outside the classroom, you can help students become aware of their intuitive responses to those experiences as well. For example, when students are drawing a rich picture of a specific situation, you might ask them to include the thoughts and feelings that they had in that specific moment.

I have learned to look at myself and others in a different way. I have started paying more attention to my senses and how I feel in certain situations. I have also learned that you can occasionally try to zoom out to observe the whole picture from a distance. (Bachelor student Medicine)

Step 4: Let students externalise their reflections for themselves (‘externalise’)

In the third step, students externalise their personal and intuitive responses so that they can observe them from a distance. An effective way of letting students externalise these responses is by asking them to give voice to their reflection through speech or writing (Mäkelä & Löytönen, 2017), which often happens within education. However, other means to externalise reflection are equally as valuable but less often used, such as making rich pictures, a collage, making music, or writing a poem. Externalising a reflection through such materialisation (i.e. creating or developing something new in a materialised form) is generally considered a bit challenging at first (Mäkelä & Löytönen, 2017; Sandlin et al., 2011), because students are not used to it. In our experience, however, students eventually always find a medium for their externalisation. By not providing a checklist or rubric, and by allowing a more open-ended approach to reflection, students are encouraged to genuinely engage with the material. This process of materialising their reflections makes it less likely that students will give responses they believe are socially expected, which leads to richer reflections.

I still keep the notebook with the reflections of the SCOPE workshops. The workshops helped me so much; they provided an opportunity for me to pause and reflect on who I am and what I want to become away from the distractions of daily homework/work. For me, this type of self-reflection has always been difficult because I always just go with what feels comfortable. (Research master student Clinical and Psychosocial Epidemiology)

An additional benefit of materialisation is that it will likely result in reflection-in-action (Schön, 1991), meaning that the process of creating something can stimulate additional reflection and thus deepen the reflective experience. For example, when students make a collage about what they learned regarding their PPD, they choose images intuitively. As students pick images and see the collage come together, however, reflective thoughts about what the images say about their PPD might form. The picture above provide examples of materialisations made by second-year medical students. The created product is an expression of their search for answers to a personal question that they investigated during one of our courses. These questions are formulated by the student themselves or introduced by the teacher and often relate to the student’s professional development (e.g. ‘What does it mean to be a medical doctor?’). The end results, such as the example above, reflect their endeavour to find a balance between their own perspective and what is conveyed through socialisation.

An insight I also gained through the materializations in the course is that we are often occupied with many things (these can be problems, discussions, actually anything), and because we are human—and therefore verbally oriented—we always try to put this into words, whereas words are not enough for many issues. By first formulating the question (essentially capturing it in words, which was a difficult problem for me) and then engaging with it in an artful way, you are actually investigating what truly lies behind that question. (Bachelor student Medicine)

Step 5: Let students share their reflections (‘share’)

The fourth step is to let students share their reflections with their peers in a debriefing session. This can be done through, for example, presenting the materialisation or voicing reflections, after which fellow students can respond to these reflections. Sharing their reflections prevents individual students from becoming overly focused on themselves and their own perspective (De la Croix & Veen, 2018). Moreover, each student may construct different understandings of the same experience (Fenwick, 2001), which creates the opportunity for students to learn that many perspectives co-exist. Furthermore, hearing other reflections can help students to question their own perspectives and assumptions. This may result in them shifting or transforming their way of viewing the world, which is a reflective practice in itself (Mezirow, 1991). Moreover, it can be a valuable experience for students to realise that they are not alone in their experiences and that they can support each other (see also the Deep Dive on common humanity below). In our experience, students highly value this step of sharing with peers, which is why we always allocate considerable time for it.

As a teacher, you have an important role in facilitating the sharing of reflections (e.g. through a debriefing session). There are multiple ways of having a debrief, but the first step is always to know what you want to get out of this ‘Share’ step (i.e. you should know the goal). This will determine the direction of the discussion. Examples of learning goals for a debriefing session are:

• Students become more aware of their own and other students’ responses (e.g. thoughts, feelings, and physical sensations) to an experience.
• Students become more aware of the perspectives of others.
• Creating common humanity in the group
• Students become more aware of and reflect on their underlying assumptions

When the goal of the debrief is clear, you can start by asking students to share their reflections (see Step 3). As a teacher, you can ask follow-up questions so that the discussion among students will progress towards the goal of the debrief. For example, if you goal is that students become more aware of their responses to an experience, follow-up questions could be:

• ‘You mentioned you experienced stress. How did you experience this? Did you, for example, experience something in your body or have a lot of thoughts or feelings?’

By engaging in this process, students can broaden their vocabulary, for example when describing their experiences with stress. For instance, if a student mentions feeling stressed, follow-up questions may help them articulate this more specifically, such as noting an increased heart rate or experiencing a flood of thoughts.

After you have asked about the direct experiences, the second step is to investigate the intuitive response to those experiences (e.g. is the student ignoring the experience, worrying about it, getting completely into it, opening up to it, etc.). This is important because students first need to be aware of their intuitive response (this can be a feeling, but also a thought pattern, belief, or an unconscious way of doing things) before they can reflect on it and possibly take action. For example, you can ask the following questions:

• ‘So you felt tension in your body, what did you do with that tension? Did certain thoughts or feelings come to you?’
• ‘When you noticed your mind was wandering, how did you deal with that?’
• ‘When you did/said this, what thoughts/beliefs were behind it?’

If you want to read more on this topic, we wrote a Substack piece on it.

Step 6: Broaden their perspective (‘broaden’)

After sharing, it is vital to connect the reflections to general principles and concepts (Step 0), previous experiences of students, or learning goals (Kolb, 1984). This broadens students’ understanding of why it is important to have a reflective attitude towards their PPD.

An example of linking reflections to general principles and concepts is when students express that an exercise made them realise they are not alone in their experience, after which the teacher explains the concept of common humanity. To explain the underlying theoretical concepts that are linked to the experiences, the teacher can also provide knowledge clips, reading materials, and lectures. Within the tradition of experience-based learning, the link with the knowledge base and rationale comes after the experience. However, we sometimes prefer to show students a knowledge clip or let them read an article before or at the start of a class to introduce the theme of the workshop, get their thinking started, or simply get the relevance of a workshop across (also see Step 0). For instance, we start our workshop ‘Values’ with a knowledge clip about PPD to help students understand why values are important to reflect on and how these values are part of both their personal and professional development.

You can also enrich the reflections by inviting students to relate the experience to their existing frames of reference or previous experiences. Examples of questions are:

• ‘Have you encountered this thought or belief in other places, and if so, can you question it?’
• ‘How does this experience relate to your previous experiences?’
• ‘How does this experience relate to the concepts we have discussed?’

Finally, you can point out the link between the experience and the learning outcome of the exercise. For example, when the students state the learning outcome themselves (for example: ‘So you noticed when you stayed with the sensation of discomfort in your body, without trying to get away from it, that you eventually came to terms with it. That is exactly what this exercise was about, to learn this skill’). This will allow teachers to lift the debriefing to a higher level by linking the students’ input to the learning outcome or concept. It is important, however, to stay as close as possible to the experience of the student. What can help with this is using the student’s own words, but only link them to the learning outcome if it is easy.

Steps 5 and 6 are both to be found in the debrief on an activity. These steps—that you as a teacher can follow for doing a reflective debrief—are based on the mindful inquiry that is followed in mindfulness training (Crane et al., 2015). Below you will find a manual that you can use as a teacher for doing a reflective debrief.

Supervising a debrief

Step 7: Let students explore their freedom of choice through experimentation (‘experiment’)

In Step 6, students explore their freedom of choice in their own PPD. By doing so, they will ideally attain a sense of autonomy regarding this development. This means that they will be the ones deciding to what degree they want to go along with these aspects of their socialisation process. In that sense it could be a moment of subjectification, in which they feel they can make autonomous choices. Kolb (1984) calls this step ‘active experimentation’, which entails students asking themselves: ‘What will I do differently next time? How will I apply the principle I just learned in other contexts?’ Such questions help students understand that PPD does not happen without a conscious effort to learn from previous experiences or mistakes (Chiavaroli & Trumble, 2018). Active experimentation also supports the transfer of knowledge from one context to another, amplifying students’ repertoire of practices. This refers to the last step of double-loop learning: ‘taking action’.

Within our educational context, it is not always possible to let students develop a new behaviour, but it is always possible to have them think through its application. For example, in one of our workshops, we discuss the topic of coping with stress and let students formulate an ‘if–then strategy’ to help them think about alternative ways of responding to stress in the future (e.g. if my stomach hurts because I am stressed, I will take a break and talk to a friend about how I am feeling). However, when we do have the opportunity to see students multiple times, we make practising new behaviour part of the program, because we know from the scientific field of behavioural change how difficult it can be to move from having the intention to implement new behaviour to actually doing it (Armitage & Conner, 2001; Gollwitzer & Brandstätter, 1997). For example, we invite students to put their experiment into practice after the first session, and ask them to prepare the next session by reflecting on how their experiment went.

Enabling factors in the teaching setting

In addition to the implementation of a teaching practice, there are specific curricular conditions that are conducive to the development of students’ reflective attitudes towards their PPD (Chan & Lee, 2021; Marshall et al., 2022).

Create a setting that enables students to slow down

As the process of reflection requires time, it is important to create a safe environment with space and time to reflect. Students need time to work through all that they experience. Curricula and courses, therefore, need to give them the opportunity to slow down, even though this is contrary to the prevailing trend in contemporary education. According to Biesta (2020), this trend is characterised by a focus on ‘fast and furious rather than slow and with a degree of patience’. Additionally, as teachers, we often have a lot to share in terms of content, so we tend to create overly full schedules that cause us to rush through activities, achieving the opposite effect of what we aim for. To create a sense of time and space, therefore, it is best to follow the adage ‘less is more’. In addition, it can be valuable to organise teaching activities that take place outside the faculty building where students normally learn. This removes students from the context in which they could possibly be socialised, thereby making it easier to reflect.

What really helped was the open and safe space. Everyone, including the teacher, was very respectful, and that made it easy to open up. I felt comfortable sharing my thoughts; it felt like there wasn’t a wrong answer. It allowed me to get to know myself better and hear about other students’ personal experiences. (Bachelor student Dentristry)

Train the teachers

There are several important elements to be considered regarding the teachers who are to guide undergraduate students in the reflective practice as described in our pedagogical approach.

We have learned that being a teacher of reflective practice can be quite demanding, so we cannot expect teachers to take up this challenge and be successful right away. Indeed, the quality of the reflective practice depends not only on the quality of the experiential exercises used in an educational practice, but also on the competencies of the teacher (Brookfield, 2017; Chan & Lee, 2021). Teaching reflection requires skilled teachers who understand the process of reflection, probe, and ask reflective questions. Furthermore, reflective practices are not about the outcome but the process, which is opposite to more traditional ways of teaching where the transfer of knowledge is the central task of the teacher. Therefore, the main task of the teacher is to support and enhance the reflective process, which requires the skill to ask questions that elicit reflections and adhere to the learning goals (Freire, 2000). Moreover, they have to show a reflective attitude themselves. This way, their own reflective attitude will serve as an example for students (i.e. the teacher becomes a role model) and support students in their learning and reflection (Brookfield, 2017).

Teachers need to create an atmosphere that not only encourages trust and open conversations but also embodies genuine interest in the students and enjoyment of teaching and learning. This will provide optimal ground for overcoming obstacles and promoting positive development (Frenzel et al., 2009; Zigmont et al., 2011). In addition, teachers should ideally convey a mindful and compassionate attitude that prioritises being curious, open, engaged, non-judgmental, accepting and patient (Ferdig & Pytash, 2021; Kabat-Zinn & Living, 1990).

To achieve this, we have set up several teacher training sessions. This training includes knowledge transfer about the theoretical framework and the six steps of the pedagogical approach, as well as a discussion of the teacher’s role and attitude. In the next writing stage of this book, we will elaborate more on the role of the teacher.

Make it part of the formal curriculum

The pedagogical approach to foster a reflective attitude needs to be an integrated part of the formal curriculum. We know from experience that offering classes or courses aimed at training reflection and PPD as electives will lead to the participation of only those who are already inclined to reflect. Students are often occupied by tests, exams, and other assessments, unaware of the importance of reflection for their PPD. Therefore, curricula should convey the message that reflection is a vital skill that students must develop to eventually become professionals who take responsibility for themselves and their context. Reflection on PPD needs to have a similar status as knowledge acquisition or the development of other skills.

Take a longitudinal approach

Students will have to navigate their socialisation process and make sure that their personal and professional identities remain synchronised throughout their studies (as well as thereafter). From day one, they start to internalise collective values, attitudes, and behaviours of the culture around them (Biesta, 2020). Therefore, the cultivation of a reflective attitude in students towards their own PPD should commence during the undergraduate program and continue from there.

For the optimal development of competencies, students will require repeated practice, feedback, and structured reflection (Malecka et al., 2022). Repetition alone, however, is insufficient; students also need to connect new experiences to prior learning to achieve progression (Merrill, 2002). In addition, students tend to ‘overlook’ their development or do not recognise their learning—when competiences are not made explicit, students prioritise disciplinary content and overlook competency development (Clement et al., 2023).

The development of a reflective attitude and PPD in general, therefore, requires a longitudinal approach, which includes classes and courses that are offered regularly throughout the curriculum.

Establish an interdisciplinary expert team

We have experienced that developing educational practices that facilitate reflection is complex. It requires expertise, time, and energy. It is essential, therefore, to have the right individuals—who have an affinity with the topic and time for the task—with the right expertise on board. It would be advantageous to form an interdisciplinary team of teachers who know the curriculum and the profession, and teachers with backgrounds in behavioural sciences or the humanities (who can help broaden the scope of the experiential exercises). At our university, two faculties have decided to install a centre of expertise to develop this education. An advantage of centralising this educational expertise is that other educational tracks can also make use of the educational practices developed by this centre.

A few words on assessing reflection and PPD

We live in an educational culture in which curriculum developers often assume that assessment drives learning. In their paper, De la Croix and Veen (2018) have identified how this affects current reflective educational practices in medical curricula. There appears to be a mismatch between curricula, which tend to focus on assessment and measurement, and the innate, complex, and personal nature of reflection that does not lend itself to an instrumental and output-oriented approach.

Although the importance of developing reflective competencies is recognised, most educators agree on the complexity of assessing critical reflection competencies (Chan & Lee, 2021; Daff et al., 2024; Tsingos et al., 2015), and some even have doubts about whether it is useful or even appropriate to assess. Moreover, teachers have expressed their uncertainty about how to assess reflection in a valid and transparent manner that also supports students’ learning. After all, evaluating students’ reflection competiences may hinder students from experimenting, exploring, and opening up. Students may experience discomfort if they feel pressured to ‘open up’ or censor their reflections in front of their peers and teachers (Chan & Lee, 2021). In addition, assessment has become even more challenging due to the widespread availability of generative AI (GenAI) tools, which can easily be used to enhance written reflection reports (Corbin et al., 2025).

However, there are good reasons to include a formative or summative assessment of your students’ reflection competencies. Also, you might be in a situation where you cannot make your own decision on whether to assess or not. Although we often do not grade students’ reflection skills,  we would like to share some of our perspectives on and experiences with assessing reflection skills.

First of all, it is of prime importance for both students and teachers to distinguish clearly between teaching and learning reflection on the one hand, and the evaluation or assessment of students’ accomplishments on the other. Teaching, practice, and exploration should always come first, and teachers should ensure that students can experiment without fear of judgment or evaluation. During the learning process, evaluation should be avoided to prevent disrupting students’ exploration. Placing too much focus on assessment and incorporating it into the learning process may result in the creation of ‘reflective zombies’ (i.e. students who have been conditioned to follow prescribed steps rather than engage in genuine reflective behaviour). However, formative feedback can be included to guide the development of students.

Second, teachers should use an assessment approach that matches the intended learning outcomes and focus on the students’ reflection competiences rather than another skill or outcome (e.g. how their teamwork has evolved). A rubric might help to inform students about the expectations of the teachers and could also increase transparency. This will not only facilitate student learning but also provide a structured framework for teachers to offer feedback on  students’reflection competiences (Alsina et al., 2019; Cheng & Chan, 2019).

It [reflection presentation] gives you the chance to reflect in the moment, and questions are being thrown at you that makes you think even more (Master student Business Administration)

Finally, it is preferable to work with teachers whom students do not depend on for their future education or diploma. Although teachers who grade students can, of course, also promote authentic reflection, the chances are higher that this dependency will drive students away from engaging in authentic reflection and lead them to behave in a socially desirable and performance-oriented way.

Although we agree that evaluating and assessing reflection competencies may be challenging, we have seen that, by following the steps mentioned in the previous section, students’ reflections become observable for trained teachers, enabling them to get insight into the process students go through, and assess the depth of the reflection.