Effectiveness of past and current critical incident analysis on reflective learning and practice change.
Medical Education 2011: 45: 894-904 OBJECTIVES Critical incident analysis (CIA) is one of the strategies frequently used to facilitate reflective learning. It involves the thorough description and analysis of an authentic and experienced event within its specific context. However, CIA has also been described as having the potential to expose vulnerabilities, threaten learners' coping mechanisms and increase rather than reduce their anxiety levels. The aim of this study was to compare the analysis of current critical incidents with that of past critical incidents, and to further explore why and how the former is more conducive to reflective learning and practice change than the latter. METHODS A collaborative research study was conducted. Eight occupational therapists were recruited to participate in a reflective learning group that convened for 12 meetings held over a 15-month period. The group facilitator planned and adapted the learning strategies to be used to promote reflective learning and guided the group process. Critical incident analysis represented the main activity carried out in the group discussions. The data collected were analysed using the grounded theory method. RESULTS Three phenomena were found to differentiate between the learning contexts created by the analysis of, respectively, past and current critical incidents: attitudinal disposition; legitimacy of purpose, and the availability of opportunities for experimentation. Analysis of current clinical events was found to improve participants' motivation to self-evaluate, to increase their self-efficacy, and to help them transfer learning into action and to progressively self-regulate. CONCLUSIONS The results of this collaborative research study suggest that the analysis of current clinical events in order to promote reflection offers a safer and more constructive learning environment than does the analysis of incidents that have occurred in the past. This learning strategy is directly grounded in health professional practice. The remaining challenge for continuing education providers is that of creating conditions conducive to its use.