Reflecting on practice

How does reflective thinking make you a better pharmacist? And how do you measure a student’s ability to think reflectively? Just ask Cherie Tsingos-Lucas.

“To be a good health professional you should be able to think critically, learn from past experiences and have excellent communication skills,” says Lecturer Cherie Tsingos-Lucas, “and the pharmacy profession is no exception to this.”

Tsingos-Lucas, a registered pharmacist for more than 24 years and clinical educator for more than 16, recently completed her PhD on the benefits of integrating reflective thinking activities into a pharmacy curriculum.

Now the Course Coordinator and Clinical Placement Coordinator for the Pharmacy discipline in UTS’s Graduate School of Health, she explains, “Enhancing reflective thinking abilities helps students make better informed decisions and clinical judgments – which could reduce misdiagnoses, miscommunication and medication errors in the health industry.”

For UTS Master of Pharmacy students, this means keeping a weekly e-portfolio to record reflective statements about how they’re progressing in their clinical placements, what they’ve learned, what their thinking processes have been and whether they would do something differently if given the chance.

“It’s always interesting to read their statements and see how they develop,” says Tsingos-Lucas.

Final-year masters student Laura Hailstone agrees the e-portfolio has been essential for self-evaluation. “It was actually quite difficult in the beginning,” she admits, “but once you get into the habit of self-reflection it allows you to understand exactly what you’re taking away from each learning experience.”

With this kind of reflective thinking billed as a graduate attribute for postgraduate programs at UTS, it has been essential to develop a structure that allows lecturers and tutors to accurately and fairly assess a student’s reflective abilities. 

But how do you assess a subjective statement about a student’s feelings towards their progress?

Tsingos-Lucas’s solution, developed from her body of research and experience, involves multiple elements. Firstly, a new assessment strategy to incorporate reflective learning practices into the curriculum; secondly, a marking rubric that gives a numerical value to the expression of conceptual ideas; and finally, the assurance that markers will be consistent in their grading of subjective statements. 

In multiple studies to measure the rubric’s performance and the markers’ reliability, Tsingos-Lucas found her system to be robust and the consistency of grades to be very high.

She has since published this work and presented it at three international pharmacy conferences at Northeastern University, Boston, USA in 2014; Prato, Italy in 2015 and the University of Aberdeen, Scotland in 2016. In addition to this success, Tsingos-Lucas has also recently been appointed as the only Australian member serving the editorial board of Currents in Pharmacy Teaching and Learning – overseeing reflective practice research manuscripts.

“The whole idea with reflective learning,” says Tsingos-Lucas, “is to prepare students for the fact that they might never get the same case twice in their whole careers. They may need to apply knowledge from previous cases to new cases, but never for the exact same patient with the exact same history and background.”

This preparation for diverse cases and uncertainties in practice is something first-year masters student Nasiha Ahmed is grateful for. “The reflective skills have helped me make better informed decisions and judgements in clinical practice.

“I think they’ll have a great benefit later on, particularly by relating key examples of these skills to a selection criteria, which will hopefully make me more employable and desirable in the workplace.”

By embedding reflective activities in the 520 hours of clinical placements completed by Master of Pharmacy students, and with the newly integrated pharmacy career-related workshops initiated and run by Tsingos-Lucas in conjunction with UTS Careers Service, she believes UTS graduates will have an edge in employment outcomes and professional attributes.

“The students go on weekly placements and block placements over the holidays,” she explains. “It’s all about getting the students out of their comfort zone and realising that working in a community pharmacy or in a hospital is a multidisciplinary experience.”

Says Hailstone, “My placement experiences have taken me everywhere from Kings Cross to Kyogle – a tiny rural town in northern NSW! Seeing how vital a pharmacist is in the rural community was so rewarding.”

And now, in 2016, UTS has taken the idea of clinical placements global with the introduction of the Master of Pharmacy (International), which incorporates a year-long placement overseas. Tsingos-Lucas is coordinating the first 2017 international placements to include Canada, USA and Germany.

Germany-bound masters student Daniel Barnaby says, “Being placed in the pharmaceutical industry in Europe for a year is an opportunity incomparable to anything else offered in Australia – and Cherie has been crucial in organising this so far.

“I’ll have the chance to expand my skills, network globally and experience pharmacy in a unique location and way.”

With the introduction of international degrees, as well as the upcoming Master of Physiotherapy, the future of interdisciplinary health education in UTS’s Graduate School of Health is looking bright.

“We have simulation spaces with a robotic pharmacy as well as rooms that look like real hospital wards,” explains Tsingos-Lucas. “It’s a very innovative, dynamic and interactive learning space shared by clinical psychology, orthoptics, physiotherapy and nursing students so it would be great to integrate a multidisciplinary approach to clinical simulation into the curriculum!

“There’s a young feel to UTS,” she says, “which inspires you to do things, explore new ideas and make progress.”