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Case 15
Creative Methods and Critical Reflection


Paul McIntosh






School of Interprofessional Studies, Faculty of Health, Wellbeing and Science, Suffolk College, Rope Walk, Ipswich, Suffolk IP 1LT, England.


Claire Webb


School of Radiography, Faculty of Health, Wellbeing and Science, Suffolk College, Rope Walk, Ipswich, Suffolk IP 1LT, England.


Paul Keenan




School of Nursing and Midwifery, Trinity College Dublin, Ireland.

15.1 Context

In September 2004, Suffolk College introduced a Postgraduate Certificate (PGC) / Postgraduate Diploma (PGD) / Master of Arts (MA) in Interprofessional Health Care Education. It was felt that this programme, aimed at people from a wide range of professional disciplines in the health services within the United Kingdom (UK) who have an educational role, required a balance in its modular format between the need to develop teaching, learning and assessment skills and reflective practice. As a result, the module, Reflexivity in Professional Practice, was developed, and this sits between two other modules within the PGC element of the programme: one developed around teaching and learning and the management of the learning environment, the other around assessment. The focus of this case study is on the Reflexivity in Professional Practice module and the assessment process.

Underpinning this module is the premise that practitioners often sleepwalk their way through the working day. Practice itself becomes mechanistic, but so also does the use of reflective models designed to facilitate a deeper understanding both of self and the situations practitioners find themselves in. In this view, the models themselves become reductionist, facilitating mainly superficial description. The Reflexivity in Professional Practice module seeks to take a more creative approach in its content, delivery, and assessment that focuses on reflection as a self-realising process, utilising the literary and visual arts as a means to this expression. Broadly speaking, the learning and assessment methods fall within a psychoanalytical domain, particularly the ideas of Carl Jung (2005) in relation to the development and interpretation of images as part of this self-realisation process, and the concept of ‘Practitioner Researcher’ (Fish1998) was used to refine these ideas within the context of health and social care.

The content of the module ties together philosophical constructs such as, phenomenology, with the philosophy of neuroscience, consciousness and unconsciousness, the literary, film, and visual arts, the use of metaphor, women’s studies, and feminist writing. Individual sessions are given over to explore these subjects. For instance, the use of poetic language, constructing and interpreting images, narratives, story telling and editorial control.

The participants are asked to develop a hypothesis of reflection at the beginning of the module (which is re-evaluated at the end of the module) and are asked to consider this within their critical commentary component of the assessment.

15.2 Learning Outcomes being Assessed

Assessed learning outcomes are:

The criteria for assessment are:

15.3 Assessment Procedures/Details

Assessment is constructed in two parts:

  1. The formative element of the assessment is the development and submission of a reflective portfolio based in the individually chosen media of the student. In the formative assessment, the term ‘portfolio’ is a loose description; it can include storyboards, photographs, poems and short stories, collage, sequential image frames, line drawings, music CD’s, DVD’s etc., or a mixture of media forming a patchwork text (Winter et al.2000).
  2. The summative element is the production of a 3,000 word critical commentary of the reflective portfolio, evaluating the reflective process produced through the portfolio development. Importantly, the summative assessment focuses not on the nature of the reflective event, but on the reflective process triggered by the portfolio development. Learners are asked not to restrict themselves to traditional health care reflective texts, but to seek out literature which explores their own insights, and which adds critical depth to their sense of self-realisation and understanding. It is only the critical commentary that is ‘marked’, however, feedback is also given in relation to the creative portfolio as a matter of courtesy and respect to the author of that work.

15.4 Strengths and Limitations

15.4.1 Strengths

There is a synthesis of teaching and learning with assessment. Although the module is ‘taught’, it is the learners who learn about themselves through the process of reflection and the subsequent critique of that process. It also allows latent creativity to be legitimised, even with those who feel ‘uncreative’.

15.4.2 Limitations

When confronted by such teaching and assessment methods, there can be resistance. Methods, such as these, do not fit easily within the tradition of healthcare worker’s education and, culturally, this is a seismic shift away from the safety of the learner’s sense of knowing. It is also possible that some personal tutors may not be familiar with, or convinced by this approach. Secondly, all education is transformative, and the aim of this module is explicitly so. This territory comes with significant ethical problems to be managed, both at a resistance level, but also at a potential for disclosure or re-emergence of forgotten or suppressed feeling. The emphasis on the author’s editorial control is fundamental to the module

15.5 Contributor’s Reflections on the Assessment

Initially there can be resistance as the participants may not see themselves as artists, poets or story-tellers. The participants may also question the value of arts-based learning for their practice, and the validity of the assessment method as it does not ‘measure’ competence. Initial evaluations at the end of the module were inconclusive, with most unsure of what the process had achieved. However, further along in time, the learners see the process as being significant to their working and personal lives.

This method has the potential to be used not only with professionals, but service users of all types as a means to exploring their sense of self and the context of their life.

15.6 Bibliography

15.7 Useful Resources