Kris English, PhD

Professor Emeritus

University of Akron, Ohio US

In 1983, Donald Schön¹ published a best-seller entitled The Reflective Practitioner: How Professionals Think in Action. The book explored “reflection-in-action” (or “in-the-moment”) problem-solving processes, as well as reflection-on-action (i.e., “after-the-moment”considerations). He presented reflection as an advanced learning process, involving the “exploration of experience, understanding its impact on oneself and others [emphasis added], and learning from this to inform future actions” (p. 481).² His theories have been found to be applicable to virtually any profession, including healthcare and education.^3-7

“Reflective practice” has since evolved to include not only an ongoing review of professional tasks, but also of personal interactions during those tasks. Audiologists can certainly relate to this dual experience: our appointments involve a number of patient-specific tasks while also engaging with the patient-as-person. “Task” details and “next steps” are clearly summarized in our clinical notes, readily available for review; however, although equally important, the nature and “feel” of a patient’s engagement (trusting, skeptical, enthusiastic, resistant) may not recorded, and could easily be minimized or forgotten. And yet it is fair to say that patient outcomes can heavily depend on the nature of these personal interactions.

Post-appointment or end-of-day reflections can help us review these relational dimensions. To that end, a validated 10-item self-report was recently designed to focus specifically on the provider-client encounter.⁸ The Reflective Practice Questionnaire (RPQ) “sets itself apart from other self-report reflection measures by predominately focusing on working with clients, and by utilizing broad phrasing so that the measure can be used across a wide range of professions where reflective practice is relevant” (p. 2). The RPQ is appropriate for professionals and students, and because it is brief, it meets the concerns of audiologists’ time constraints.

The authors have given blanket permission to reprint the RPQ.* (See quote at end of this article.) A copy of the RPQ can be downloaded here: 10-Item RPQ.

Following are the questionnaire items, compressed into narrative form. Response options range from 1-6: “very rarely” to “almost always.” Per audiology convention, the term clients is replaced with patients.

Items 1-4: During interactions with patients:  I recognize when my pre-existing beliefs are influencing the interaction / I consider how my personal thoughts and feelings are influencing the interaction / I recognize when a patient’s pre-existing beliefs are influencing the interaction / I consider how their thoughts and feelings are influencing the interaction.

Items 5-8: After interacting with patients: I spend time thinking about what was said and done / I wonder about the patient’s experience of the interaction / I wonder about my own experience of the interaction / I think about how things went during the interaction.

Item 9: I think about how I might improve my ability to work with patients.

Item 10:  I critically evaluate the strategies and techniques I use in my work with patients.

It is notable that the items prompt the clinician to consider their own experiences as well as what their patients might have experienced. Responses that include often, very often, and almost always are consistent with person-centered and equitable care. Responses ranging from very rarely, rarely, or sometimes suggest that we should explore personal barriers, biases, or inhibitions and, if appropriate, consult with a colleague or mentor for support. If our responses are not aligned with our person-centered, equitable goals, Campbell et al.⁹ recommend “…a variety of implicit bias mitigation strategies named in the literature. These include continuous reflection on one’s beliefs on specific social groups, gaining access to regular training, and seeking feedback from outside sources such as the (Implicit Association Test) IAT.”(p. 6).

Conclusion

 Given the range of possible differences that can exist between audiologist and patient (ethnicity, race, gender, age, etc.), it may seem most efficient to focus solely on hearing issues. When we do so, however, we miss nonverbals, nuances, quality-of-life references – even as the patient wants to be seen and values as a unique person. As Kazemi et al.¹ predict:

The future of person-centered care lies not in further technical refinement but in reimagining care as a moral and relational process, i.e., as something created with rather than delivered to persons.

* “The RPQ is free to use and there is no requirement to obtain permission from the authors for use. However, we do enjoy hearing from people about how they are using it and are always happy to receive emails letting us know what you are using it for, or any questions you may have” (p. 13). (shane.rogers@ecu.edu.au)

References

1. Schon, D. (198). The Reflective Practitioner: How Professionals Think in Action. New York, NY: Basic Books.
2. Ooi SM et al. (2021). A systematic review of reflective practice questionnaires and scales for healthcare professionals: A narrative synthesis.Reflective Practice, 22(1), 1–15. 
3. Heydari S, Beigzadeh A. (2024). Medical students’ perspectives of reflection for their professional development.BMC Medical Education, 24(1), 1399.
4. Mantzourani E et al. (2019). The role of reflective practice in healthcare professions: Next steps for pharmacy education and practice.Research in Social and Administrative Pharmacy, 15(12), 1476-1479.
5. Taylor D. (2020). Reflective practice in the art and science of counselling: A scoping review.Psychotherapy and Counselling Journal of Australia 8(1).
6. Machost H, Stains M. (2023). Reflective practices in education: A primer for practitioners.CBE—Life Sciences Education, 22(2), es2.
7. Hernandez RA et al. (2013). Fostering students’ reflection about bias in healthcare: Cognitive dissonance and the role of personal and normative standards. Medical Teacher, 35(4), e1082-e1089. DOI: 10.3109/0142159X.2012.733453
8. Rogers SL et al. (2024). Further development of the Reflective Practice Questionnaire. PeerJ, 12, e16879.
9. Campbell CN. (2025). Healthcare inequities and healthcare providers: We are part of the problem. International Journal for Equity in Health, 24(1), 97.
10. Kazemi A, Corlin TE. (2026). Person-centered care revisited: From problematizing its conceptual and methodological assumptions to proposing alternative foundations.International Journal of Nursing Studies, 176, 105325.