Engaging student analysis of the practitioner-patient relationship assessed with reflective outcomes.

The representations and beliefs of both patient and practitioner influence the relationship that develops between them. We developed an innovative, interactive teaching tool in two stages (1- interviews with the patient or healthcare practitioner and 2- a session with sharing of the patient's and practitioner's perspective) whose objectives are to recognize the basic characteristics of PPR and identify how it can be influenced by expectations, beliefs and emotions. This pedagogical device was particularly appreciated by the students, as it enabled them to identify the importance of the patient's point of view and to reflect on their future professional identity.

Equity-related 'knots' in theory of change development: Conceptualization and case illustrations.

Theory of change (ToC) is an approach widely used to guide planning, implementing, and evaluating change initiatives. While there is substantial guidance, there has been little attention on equity within ToC research and practice. We propose and illustrate the metaphor of 'knots' to frame practical and ethical challenges that arise when centering equity within ToC processes. Drawing on our experiences using a ToC approach in two case examples, we identify and illustrate five equity-related knots: (a) clarify root causes, pathways, and success; (b) facilitate participation across power and perspective differences; (c) integrate research evidence and practitioner knowledge; (d) represent complex change visually; and (e) creatively navigate constraints. We show why framing these as knots can help practitioners make wise judgments within the circumstances and close with recommendations for including knots in ToC processes, reporting, and guidance.

Concreción de competencias transversales para lograr competencia intercultural en estudiantes de ciencias de la salud / Concretization of Cross-Sectional Competences for Achieving Intercultural Competence among Health Sciences Students

El proceso formativo de estudiantes de ciencias de la salud se ve desafiado a responder ante una sociedad diversa. Las experiencias, las costumbres, las creencias, la religión y la cultura influyen en las decisiones del paciente ante un proceso de salud/enfermedad, lo que genera incertidumbre en el estudiantado. A nivel internacional, la capacitación en competencia intercultural en salud es requisito de acreditación; pero en Sudamérica no ocurre lo mismo. Lineamientos internacionales han instaurado el desarrollo de competencias transversales para adquirir habilidades que le permitan al individuo desenvolverse en el escenario mundial, lo cual podría constituirse en la base fundamental para adquirir competencia intercultural en salud. Los objetivos de este artículo son identificar cómo los lineamientos para desarrollar competencias transversales tributan al logro de competencia intercultural en salud en relación con cuatro modelos de competencia cultural en salud, y exponer estrategias didácticas que permiten desarrollar ambas competencias durante el proceso formativo del estudiantado de las ciencias de la salud. Se concluye que las competencias transversales permiten adquirir habilidades, valores y competencias que facilitarían lograr las características que los diferentes modelos de competencia cultural en salud indican. Diversas metodologías activas resultan apropiadas para concretar el desarrollo de ambas competencias; no obstante, deben acompañarse de debriefing para adquirir pensamiento crítico y reflexividad en el estudiantado, además de que este proceso no se realice bajo patrones etnocentristas. Por lo tanto, es necesario indagar cómo se está desarrollando la reflexividad en el proceso formativo del estudiantado de ciencias de la salud(AU)

The training process of health sciences students is challenged to respond to a diverse society. Experiences, customs, beliefs, religion and culture influence the patient's decisions in the face of a health/disease process, which causes uncertainty among students. Internationally, training in intercultural competence in health is a requirement for accreditation, but this is not the case in South America. International guidelines have established the development of cross-sectional competences for acquiring skills that allow the individual to practice an activity in the global scenario, which could become the fundamental basis for acquiring intercultural competence in health. The objectives of this article are to identify how the guidelines to develop cross-sectional competences contribute to the achievement of intercultural competence in health in relation to four models of cultural competence in health, as well as to expose didactic strategies that allow to develop both competences during the training process of health sciences students. It is concluded that cross-sectional competences allow to acquire skills, values and competences that would facilitate the achievement of the characteristics indicated by the different models of cultural competence in health. Different active methodologies are appropriate to concretize the development of both competences; however, they should be accompanied by debriefing for the students to acquire critical thinking and reflexivity, while this process should not be carried out under ethnocentric patterns. Therefore, it is necessary to investigate how that reflexivity is being developed in the training process of health sciences students(AU)

Structurally collecting patient feedback on trainee skills: A pilot study in Obstetrics and Gynaecology.

OBJECTIVE: This pilot study tested a tool that collects patient feedback on trainees' skills in shared decision-making (SDM) and general consultation. It also examined trainees' views on SDM and patient feedback, exploring potential skills improvement through reflexive practice. METHODS: Patients were asked to rate trainees after consultation in a six-itemed questionnaire. The questionnaire included 'CollaboRATE' (a validated tool to test SDM), the 'Net Promoter Score' and two open-ended questions. Questionnaire results were described quantitatively and tested for differences. Results were presented to trainees at three intervals. Trainees were interviewed afterwards. Interview transcripts were thematically analysed. RESULTS: Eleven trainees in Obstetrics and Gynaecology participated. Out of 1651 sent questionnaires 399 were returned (response rate 24%). Questionnaire results showed no differences when comparing trainees or group scores over time. Interview results were thematically analysed using the reflexivity framework. Trainees were able to reflect on their SDM skills. They valued receiving patient feedback, yet were able to formulate few learning points from it. CONCLUSION: Although skills improvement was not evident, patient feedback still has potential benefits. PRACTICE IMPLICATIONS: Patient feedback should be combined with facilitated reflections at timely intervals to reinforce behaviour change. Supervisors play an important role in facilitating reflections with trainees.

A catalyst for change: Developing a collaborative reflexive ethnographic approach to research with hospital doctors during the COVID-19 pandemic.

The understanding of what ethnography looks like, and its purpose, is continuously evolving. COVID-19 posed a significant challenge to ethnographers, particularly those working in health-related research. Researchers have developed alternative forms of ethnography to overcome some of these challenges; we developed the Mobile Instant Messaging Ethnography (MIME) adaptation to ethnography in 2021 to overcome restrictions to our own research with hospital doctors. However, for ethnographic innovations to make a substantial contribution to methodology, they should not simply be borne of necessity, but of a dedicated drive to expand paradigms of research, to empower participant groups and to produce change - in local systems, in participant-collaborators and in researchers and the research process itself. In this paper, we reflect on our experiences using MIME, involving collaborative remote observation and reflection with 28 hospital doctors in Ireland from June to December 2021. After reviewing literature on ethnography in COVID-19 and general epistemological developments in ethnography, we detail the MIME approach and illustrate how MIME presents an evolution of the ethnographic approach, not only practically but in terms of its reflexive shift, its connected and co-creative foundations, and its ability to drive change in research approaches, participant life-worlds and real-world improvement.

Valuing All Voices: refining a trauma-informed, intersectional and critical reflexive framework for patient engagement in health research using a qualitative descriptive approach.

BACKGROUND: Critical stakeholder-identified gaps in current health research engagement strategies include the exclusion of voices traditionally less heard and a lack of consideration for the role of trauma in lived experience. Previous work has advocated for a trauma-informed, intersectional, and critical reflexive approach to patient and public involvement in health research. The Valuing All Voices Framework embodies these theoretical concepts through four key components: trust, self-awareness, empathy, and relationship building. The goal of this framework is to provide the context for research teams to conduct patient engagement through the use of a social justice and health equity lens, to improve safety and inclusivity in health research. The aim of this study was to revise the proposed Valuing All Voices Framework with members of groups whose voices are traditionally less heard in health research. METHODS: A qualitative descriptive approach was used to conduct a thematic analysis of participant input on the proposed framework. Methods were co-developed with a patient co-researcher and community organizations. RESULTS: Group and individual interviews were held with 18 participants identifying as Inuit; refugee, immigrant, and/or newcomer; and/or as a person with lived experience of a mental health condition. Participants supported the proposed framework and underlying theory. Participant definitions of framework components included characterizations, behaviours, feelings, motivations, and ways to put components into action during engagement. Emphasis was placed on the need for a holistic approach to engagement; focusing on open and honest communication; building trusting relationships that extend beyond the research process; and capacity development for both researchers and patient partners. Participants suggested changes that incorporated some of their definitions; simplified and contextualized proposed component definitions; added a component of "education and communication"; and added a 'how to' section for each component. The framework was revised according to participant suggestions and validated through member checking. CONCLUSIONS: The revised Valuing All Voices Framework provides guidance for teams looking to employ trauma-informed approaches, intersectional analysis, and critical reflexive practice in the co-development of meaningful, inclusive, and safe engagement strategies. PLAIN ENGLISH SUMMARY: Patient engagement in health research continues to exclude many people who face challenges in accessing healthcare, including (but not limited to) First Nations, Inuit, and Metis people; immigrants, refugees, and newcomers; and people with lived experience of a mental health condition. We proposed a new guide to help researchers engage with patients and members of the public in research decision-making in a meaningful, inclusive, and safe way. We called this the Valuing All Voices Framework, and met with people who identify as members of some of these groups to help define the key parts of the framework (trust; self-awareness; empathy; and relationship building), to tell us what they liked and disliked about the proposed framework, and what needed to be changed. Input from participants was used to change the framework, including clarifying definitions of the key parts, adding another key part called "education and communication", and providing action items so teams can put these key parts into practice.

"I'll use it differently now": using dual-systems theory to explore youth engagement with networked technologies.

OBJECTIVES: Many young Canadians experience high levels of networked connectivity, which some suggest may negatively impact their health. Adult monitoring has not been shown to be an effective long-term strategy for supporting young people in healthy engagement with tech. In this study, we explore the benefits of empowering young people to set healthy goals and monitor themselves. We engage with Shapka's (2019) critique of dual-systems theory, and consider the relationship between the neurological and behavioural systems in relation to adolescent internet use. METHODS: Using a youth participatory action research approach, we co-designed a project with six adolescents to explore the ways that their use of networked technologies was affecting their lives by disconnecting and observing how the lack of networked connectivity changed their experiences. The youth used a media diary to track their use of devices both before and after disconnecting. RESULTS: The main benefit of disconnecting appeared to be having the opportunity to reflect on one's own use of networked devices. This enabled the participants to reconnect in a more intentional way. Findings support Shapka's speculation that dual-systems theory, with a focus on regulation, may not be the most useful way of supporting adolescents in developing healthy habits around their wired tech. CONCLUSION: Adolescent experiences of networked technologies are complex, yet they are able to navigate this landscape with intelligent strategies. Their self-directed exploration of disconnection helped them to become reflexive practitioners who were able to revisit their use of networked technologies with new insights and self-control.

RéSUMé: OBJECTIFS: Les niveaux élevés de connectivité réseau sont courants chez les jeunes Canadiens, ce qui pourrait avoir des effets nuisibles sur leur santé. La surveillance par les adultes n'est pas une stratégie efficace à long terme pour aider les jeunes à établir une relation saine avec la technologie. Nous explorons ici les avantages de donner aux jeunes les moyens de se fixer des objectifs sains et de s'autosurveiller. Nous abordons la critique par Shapka de la théorie des systèmes duels (2019) et considérons la relation entre les systèmes neurologique et comportemental en lien avec l'utilisation d'Internet par les adolescents. MéTHODE: À l'aide d'une démarche de recherche-action participative avec des jeunes, nous avons conçu, en collaboration avec six adolescents, un projet pour explorer les effets de l'utilisation des technologies réseau dans leurs vies en les déconnectant et en observant en quoi l'absence de connectivité réseau modifiait leur expérience. Les jeunes ont noté leur utilisation d'appareils en réseau avant et après la déconnexion dans un « journal médias ¼. RéSULTATS: Le principal avantage de la déconnexion semblait être la possibilité de réfléchir à sa propre utilisation des appareils en réseau. Les participants ont ainsi pu rétablir cette connexion de façon plus intentionnelle. Nos constatations confirment l'hypothèse de Shapka selon laquelle la théorie des systèmes duels, axée sur la réglementation, n'est peut-être pas le meilleur moyen d'aider les adolescents à acquérir de saines habitudes face à leurs appareils en réseau. CONCLUSION: L'expérience des technologies réseau chez les adolescents est complexe, mais avec des stratégies intelligentes, ils réussissent à trouver leur voie. Leur exploration autodirigée de la déconnexion les a aidés à devenir des praticiens réfléchis, capables de retourner à leur utilisation des technologies réseau avec plus de retenue et des vues plus larges.

Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study.

BACKGROUND: There are shortcomings in medical practitioners' capacity to adapt to the particular needs of people experiencing circumstances of social vulnerability. Clinical traineeships create opportunities for the acquisition of knowledge, competencies, attitudes, and behaviors. However, some authors question the learnings to be made through classical clinical training pathways. This article explores the learnings gained from a traineeship experience within a community-based clinical setting intended for patients experiencing social vulnerability and operating under an alternative paradigm of care. To our knowledge, there is little research intended to identify and understand what medical trainees gain from their experience in such contexts. METHODS: This exploratory qualitative study is based on twelve interviews with practicing physicians who completed a traineeship at La Maison Bleue (Montreal, Canada) and three interviews conducted with key informants involved in traineeship management. Based on Mezirow's theory of transformational learning, data were analyzed according to L'Écuyer's principles of qualitative content analysis. NVivo software was used. RESULTS: The main learnings gained through the traineeship are related to (1) greater awareness of beliefs, assumptions and biases through prejudice deconstruction, cultural humility and critical reflection on own limitations, power and privileges; (2) the development of critical perspectives regarding the health care system; (3) a renewed vision of medical practice involving a less stigmatizing approach, advocacy, empowerment, interdisciplinarity and intersectorality; and (4) strengthened professional identity and future practice orientation including confirmation of interest for community-based practice, the identification of criteria for choosing a future practice setting, and commitment to becoming an actor of social change. Certain characteristics of the setting, the patients and the learner's individual profile are shown to be factors that promote these learnings. CONCLUSIONS: This article highlights how a traineeship experience within a clinical setting intended for a clientele experiencing circumstances of social vulnerability and operating under an alternative paradigm presents an opportunity for transformative learning and health practice transformation toward renewed values of health equity and social justice. Our findings suggest medical traineeships in community-based clinical settings are a promising lead to foster the development of fundamental learnings that are conducive to acceptable and equitable care for people experiencing social vulnerability.

Reflexivity in Health Promotion: A Typology for Training.

Reflexivity has emerged as a key concept in the field of health promotion (HP). Yet it remains unclear how diverse forms of reflexivity are specifically relevant to HP concerns, and how these "reflexivities" are interconnected. We argue that frameworks are needed to support more systematic integration of reflexivity in HP training and practice. In this article, we propose a typology of reflexivity in HP to facilitate the understanding of reflexivity in professional training. Drawing from key theories and models of reflexivity, this typology proposes three reflexive positions (ideal-types) with specific purposes for HP: reflexivity in, on, and underlying action. This article illustrates our typology's ideal-types with vignettes collected from HP actors working with reflexivity in North America and Europe. We suggest that our typology constitutes a conceptual device to organize and discuss a variety of experiences of engaging with reflexivity for HP. We propose the typology may support integrating reflexivity as a key feature in training a future cadre of health promoters and as a means for building a responsible HP practice.

Rendering LGBTQ+ Visible in Nursing: Embodying the Philosophy of Caring Science.

Although health care institutions continue to address the importance of diversity initiatives, the standard(s) for treatment remain historically and institutionally grounded in a sociocultural privileging of heterosexuality. As a result, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities in health care remain largely invisible. This marked invisibility serves as a call to action, a renaissance of thinking within redefined boundaries and limitations. We must therefore refocus our habits of attention on the wholeness of persons and the diversity of their storied experiences as embodied through contemporary society. By rethinking current understandings of LGBTQ+ identities through innovative representation(s) of the media, music industry, and pop culture within a caring science philosophy, nurses have a transformative opportunity to render LGBTQ+ visible and in turn render a transformative opportunity for themselves.

Participatory action inquiry using baccalaureate nursing students: The inclusion of integrative health care modalities in nursing core curriculum.

Nurses, nursing educators and students support the inclusion of integrative health care (IHC) into nursing core curriculum as a way to create nurses who deliver nursing care to the full extent of their scope of practice and advance evidenced based IHC. Because of the holistic nature of IHC modalities, research to investigate appropriate teaching strategies and potential efficacy of learning IHC in the baccalaureate core curriculum requires a holistic approach. Therefore a phenomenological exploration using participatory action inquiry was conducted at a large Midwestern university. Eighteen first year nursing students were selected as co-researchers. Their experiences in learning and delivering three 15 min IHC interventions (foot reflexology, lavender aromatherapy and mindful breathing) in an acute care setting were captured using reflexive journaling and participation in structured and organic communicative spaces. Of the patients approached, 67% accepted to receive one or more IHC modalities (147/219). Using van Manen's model for holistic data reduction three themes emerged: The experience of presence, competency and unexpected results. Learning IHC modalities is best supported by a self-reflective process that is constructed and modeled by a nurse faculty member with experience in delivering IHC modalities.

Resolver problemas y tomar decisiones, esencia de práctica reflexiva en enfermería. Análisis de la literatura / Problem-solving and decision-making, essence of reflexive practice in nursing: A literature review / Resolver problemas e tomar decisões, essência de prática reflexiva em enfermagem. Análise da literatura

Dada la importancia de la formación de profesionales reflexivos, y en el marco de la búsqueda de una nueva epistemología de la práctica de enfermería, este artículo de revisión analiza diversas fuentes teóricas que representan evidencias científicas relativas a la resolución de problemas, toma de decisiones clínicas y su relación con las características de los recién egresados del pregrado, quienes al realizar servicio social (residencias), vivencian un proceso de transición: dejar de ser estudiante, pero a la vez enfrentarse a situaciones de ejercicio profesional que requieren habilidades para resolver problemas y tomar decisiones en situaciones inciertas y complejas. La revisión implicó búsquedas sistemáticas en bases de datos como Medline, CINAHL, Scielo, Lilacs, Cochrane, Cuiden y Redalyc, que permitieron localizar: 3 revisiones sistemáticas, 11 estudios con enfoque cuantitativo, 11 con enfoque cualitativo y 2 mixto, 14 artículos de revisión y 5 libros, publicados en los últimos 15 años. Aunque las publicaciones analizadas proceden de todos los continentes, predominan las de América en un 50%, seguidas por las europeas en un 22%. Se concluye que existen modelos que pueden apoyar el desarrollo de habilidades para los procesos cognitivos referidos, lo que coadyuvaría a un ejercicio profesional reflexivo y autónomo, en lugar de la adhesión a prácticas asistenciales rutinarias. También que las escuelas de Enfermería tienen el compromiso para incorporar en el currículo diversas estrategias deliberadas y progresivas que apoyen el desarrollo de dichas habilidades, así como de generar ambientes de aprendizaje áulicos y clínicos que las promuevan.

Considering the importance of forming reflexive professionals, and also within the frame of a new epistemology of nursing practice, this review explores diverse theoretical sources which represent scientific evidence related to problem-solving and clinical decision-making skills, and also to the characteristics of newly nursing graduates who, during their social service (residency), experience a process of transition facing professional realities which require them to use those skills within complex and uncertain situations. The review included systematic searches in databases such as Medline, CINHAL, Scielo, Lilacs, Cochrane, Cuiden, and Redalyc, and yielded: 3 systematic reviews, 11 studies with quantitative approaches, 11 studies with qualitative ones, 2 with mixed ones, 14 review articles, and 5 books published in the last 15 years. The analyzed publications came from all continents, but there was a higher prevalence of those from America (50%) and Europe (22%). This review suggested that there are models which can support the development of these important skills and thus help consolidate a professional performance which is autonomous-reflexive rather than repetitive. Moreover, the schools of nursing can consider incorporating these models into their curricula and also generate school and clinical environments which further support the development of these skills.

Dada a importância da formação de profissionais reflexivos e no quadro da busca de uma nova epistemologia da prática de enfermagem, este artigo de revisão, analisa diversas fontes teóricas que representam evidencias científicas relativas à resolução de problemas, toma de decisões clínicas e a sua relação com as caraterísticas dos recém-formados da pre-graduação, os quais ao fazer o estágio (residências), vivenciam um processo de transição: deixar de ser estudante, mas ao mesmo tempo confrontar-se a situações de exercício profissional, eles requerem habilidades para resolver problemas e tomar decisões em situações incertas e complexas. A revisão envolveu buscas sistemáticas em bases de dados como Medline, CINAHL, Scielo, Lilacs, Cochrane, Cuiden e Redalyc, que permitiram localizar 3 revisões sistemáticas, 11 estudos com abordagem quantitativa, 11 com abordagem qualitativa e 2 mista, 14 artigos de revisão e 5 livros, publicados nos últimos 15 anos. Ainda que as publicações analisadas procedam de todos os continentes, predominam as da América em um cinquenta por cento, seguidas pelas europeias em vente e dois por cento. Conclui-se que existem modelos que podem apoiar o desenvolvimento de habilidades para os processos cognitivos referidos, o qual contribuiria a um exercício profissional reflexivo e autônomo, em vez da adesão de práticas assistenciais rotineiras. Também que as escolas de Enfermagem têm o compromisso para incorporar no currículo diversas estratégias intencionais e progressivas que apoiem o desenvolvimento de tais habilidades, assim como para gerar ambientes de aprendizagem escolares e clínicos que as promovam.

Making sense of HUSK: practice implications for social change initiatives.

As an exemplar of bottom-up progressive social experimentation, HUSK provides opportunities to examine how innovative practice is supported and challenged in bureaucratic settings. In this analysis the author uses a sensemaking lens to identify critical issues and questions for those seeking to promote progressive change initiative in social welfare systems. Findings identify essential organizational and managerial supports needed to support service user voice and participation and reinforce the importance of reflexivity in practice and research.

Estudiando el proceso de configuración de multiscopic, una red on-line profesional de análisis de la práctica de educación física / Estudar o processo de configuração de multiscopic, uma análise profissional da rede on-line da prática da educação física / Studying the configuration process of multiscopic, a professional online network that analyses the physical education practice

Presentamos aquí algunos de los primeros resultados sobre el desarrollo de una red profesional en línea llamada MultiScopic (múltiples puntos de vista sobre un fenómeno), tratando de entender cuáles son las tensiones y limitaciones en torno al proceso de consolidación de una comunidad on-line de análisis de la práctica educativa. En este sentido, MultiScopic es una red social que involucra, entre otros, a maestros y profesores de Educación Física en activo y que ofrece un espacio, a través del intercambio, del diálogo, de la aplicación, reflexión y evaluación de diferentes prácticas pedagógicas, para compartir diferentes puntos de vista, intercambiar procedimientos de análisis y llevar a cabo una formación permanente reflexiva capaz de mejorar los procesos de enseñanza/aprendizaje. A la vista de los primeros resultados, concluimos que este proyecto permite generar significados compartidos en torno a la Educación Física y dotar al profesorado de procedimientos para el análisis y mejora de su práctica.

Apresentamos aqui alguns dos primeiros resultados sobre o desenvolvimento de uma rede profissional online chamada MultiScopic (múltiplos pontos de vista sobre um fenômeno), tentando entender quais são as tensões e limitações ao redor do processo de consolidação de uma comunidade online de análise da prática educativa. Nesse sentido, MultiScopic é uma rede social que envolve, entre outros, professores formados ou não em Educação Física, ativos e que oferece um espaço, através do intercâmbio, do diálogo, da aplicação, reflexão e avaliação de diferentes práticas pedagógicas, para dividir diferentes pontos de vista, intercambiar procedimentos de análise e levar a cabo uma formação permanente reflexiva capaz de melhorar os processos de ensino/aprendizagem. Tendo em vista os primeiros resultados, concluímos que esse projeto permite gerar significados compartilhados em torno da Educação Física e dotar o profesorado de procedimentos para a análise e melhora das suas práticas.

This article presents some of the initial results on the development of a professional online network called MultiScopic (multiple points of view of a phenomenon), in an attempt to understand what are the tensions and limitations surrounding the process of consolidation of an online analysis community in the educational practice. From this standpoint, MultiScopic is a social network that involves, among others, teachers and active Physical Educators and offers a space, through exchange, dialog, application, reflection and evaluation of different pedagogical practices, to share different points of view, exchange analysis procedures, and carry out a permanent reflexive formation, capable of improving the teaching-learning process. In light of the initial results, it can be concluded that this project generates shared meanings around Physical Education and provides educators with procedures for the analysis and the improvement their practice.

Pensamiento reflexivo: una aproximación inicial en el ámbito de la formación de fonoaudiólogos / Reflexive thought: an initial approach for the training of students enrolled in speech and hearing sciences programmes

El presente trabajo reviste un esfuerzo particular por iniciar el tema del "pensamiento reflexivo en Fonoaudiólogos formadores de Fonoaudiólogos". Se revisan los conceptos de "pensamiento reflexivo" y "práctica reflexiva" así como también marcos teóricos con un sistema de clasificación de niveles de reflexión de racionalidad técnica, práctica y crítica. Se propone además, la aplicación en el ámbito fonoaudiológico de un tipo de capacitación de desarrollo de la práctica reflexiva.

The present manuscript represents a specific effort on the commencement of "reflexive thought among speech pathologist who are involved in teaching students enrolled in Speech and Hearing Sciences Programmes". The concepts of "reflexive thought" and "reflexive practice" as well as a literatura review with a system of classification of levels of reflexion of technical, practical and critical rationality are addressed. Also, the utilisation, within the field of speech and hearing sciences, of a type of training on the development of the reflexive practice is proposed.