Christie Anna1 & Lian Dee Ler2

1National Healthcare Group Polyclinics (NHGP), Singapore; 2Health Outcomes and Medical Education Research (HOMER), National Healthcare Group, Singapore


Aims: The evidence on how reflection associates with clinical teaching is lacking. This study explored the reflection pattern of nursing clinical instructor trainees on their clinical teaching and its association with their teaching performance.

Methods: Reflection entries on two teaching sessions and respective teaching assessment data of a cohort of Registered Nurses participating in the National Healthcare Group College Clinical Instructor program (n=28) were retrieved for this study. Reflection entries were subjected to thematic analysis. Each reflection statement was coded and scored according to topics in relevance to three clinical teaching phases – preparation, performance and evaluation. Teaching assessment scores were then used to group the participants into different performance group. Reflection patterns derived from the coding scores were compared across these groups.

Results: Participants’ reflections focused on the performance phase (57% of reflected items), followed by preparation (30%) and evaluation (13%) phases. To assess the reflection pattern of trainees with differing teaching performance, participants whose teaching assessment scores were already high from first teaching session were classified into Consistently High group (score>22). Remaining participants were further categorized based on their improvement in teaching assessment scores into Higher Change (score difference>1) and Lower Change (score difference≤1). Compared to Lower Change group, participants in the Consistently High and Higher Change groups had higher trend of reflection focus on performance (57% and 59% vs 48%) and evaluation phases (14% and 14% vs 8%), but lower on preparation phase (29% and 27% vs 44%).

Conclusions: The finding suggests a possible role of reflection in teaching performance of nurse clinical instructors, warranting further investigation.

Keywords:            Registered Nurses, Clinical Instructor, Reflective Thinking, Clinical Teaching, Reflective Journal

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