LAUSR

For the purposes of thismanuscript, whenwe say “reflection,” we are referring to “critical reflection.” Critical reflection is not simply thinking about ourselves, our thoughts, and our feelings. If the process stopped here, it would stay at the level of “introspection” [2]. In critical reflection, we ask learners to take an additional step towards transformative learning [1, 3, 4]. While we recognize the importance of reflection as a skill, when used in medical education, reflection becomes a teaching tool that advances learners towards other learning objectives. In medical education, reflection activities may improve reflective skill and diagnostic thinking, enhance perceived autonomy and meaningfulness in learning, clarify professional identity, and raise scores on examinations and standardized patient activities [5–9]. In psychiatry, reflection activities have been incorporated into clerkships in the form of oral and written reflection on difficult or meaningful patient encounters, critical incident reports, and on students’ feelings after attending Alcoholics Anonymous meetings [10–13]. Reflective writing was also incorporated into an addiction rotation for psychiatry residents [14]. Despite the popularity of reflection exercises, implementation of a reflection activity may present challenges for educators. While existing literature outlines important aspects of the reflective process, additional resources are needed to guide curriculum developers through the process of problem identification and needs assessment in the implementation of reflective activities [1, 15]. This article serves as a how-to guide for designing a reflection activity.We will follow the “Six Step Approach” as described by Thomas et al. and illustrate with an example of a reflection activity developed by two of the authors (SEB and KE) at Dell Medical School at the University of Texas at Austin [16].