title: Reflection: a casualty of modularisation?
abstract: BACKGROUND
  The use of reflection in nursing and midwifery is well-established and reflective skills are taught on both pre- and post-registration courses as a way of integrating theory and practice, and of developing students' critical and analytical skills. Reflection is generally regarded positively with an assumption that reflective skills benefit both practitioners and patients. The aim of this study was to identify the educational strategies used to develop reflective skills in one pre-registration diploma in nursing curriculum.
  
  
  METHODS
  The survey was cross-sectional in design. A questionnaire was designed for the study to explore perceptions of both students and lecturers in one educational establishment. Curriculum documentation was analysed to examine where in the curriculum the development of reflective skills was prominent. The sample consisted of two student cohorts from the adult branch and all senior lecturers within the Institute who taught on the pre-registration programme.
  
  
  RESULTS
  The findings revealed a complex picture of students' and lecturers' views of the teaching and learning strategies used to develop reflective skills. Lectures and group work were the strategies cited most commonly by the students, whereas the lecturers felt the strategies used most often were personal tutorials, group work and case scenarios. The documentary analysis revealed that out of the 13 modules, there was explicit reference in only three modules to reflective practice. Furthermore, it was evident that the majority of lecturers were not clear where in the curriculum reflective skills were taught which suggested that an overview of the whole curriculum is not always evident.
  
  
  CONCLUSIONS
  Modularisation may have contributed to a fragmentation in the way in which some key health practitioner skills are developed and built upon throughout a curriculum. There needs to be agreement on the nature of the skills which are central to the development of reflective practitioners and clear thinking on how these are developed and assessed within a curriculum.
authors.affiliation: Institute of Health Studies, University of Plymouth, Penhaligon Building, Trevenson Lane, Pool, Cornwall TR15 3RG, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Cadman
authors.forename: Elaine
authors.initials: E
authors.lastname: Clack
authors.forename: Zena
authors.initials: Z
authors.lastname: Lethbridge
authors.forename: Jennifer
authors.initials: J
authors.lastname: Millward
authors.forename: Jenny
authors.initials: J
authors.lastname: Morris
authors.forename: Rachel
authors.initials: R
authors.lastname: Redwood
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D003479:Curriculum / Q000592:standards*; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D005181:Faculty, Nursing; D005260:Female; D006801:Humans; D008297:Male; D017145:Models, Educational; D015402:Nursing Education Research; D009736:Nursing Process; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods*; D013850:Thinking