Facilitators and Barriers of Reflective Learning in Postgraduate Medical Education: A Narrative Review

BACKGROUND: Reflection in postgraduate medical education has been found to aid in the development of professional skills, improve clinical expertise, and problem solving with the aim of advancing lifelong learning skills and self-awareness, leading to good medical practice among postgraduate residents. Despite the evidenced benefits, reflection remains underused as a tool for teaching and learning, and few trainee physicians regularly engage in the process. Factors that affect the uptake of reflective learning in residency training have not yet been adequately explored. OBJECTIVE: The purpose of this review is to demonstrate the factors that influence the adoption of reflective learning for postgraduate students and their centrality to good clinical practice. METHODS: A review of the literature was performed using defined databases and the following search terms: ‘reflection’, ‘reflective learning’, ‘postgraduate medical education’, ‘barriers’ and ‘facilitators’. The search was limited to peer-reviewed published material in English between 2011 and 2020 and included research papers, reviews, and expert opinion pieces. RESULTS: Eleven relevant articles were included, which identified three main categories as facilitators and barriers to the adoption of reflective learning in postgraduate medical education. These included structure, assessment and relational factors. The structure of reflective practice is important, but it should not be too rigid. Assessments are paramount, but they should be multidimensional to accommodate the multicomponent nature of reflections. Relational factors such as motivation, coaching, and role modeling facilitate sustainable reflective practice. CONCLUSIONS: This review suggests that the same factors that facilitate reflection can be a barrier if not used within the right epistemic. Educators should consider these factors to increase the acceptance and integration of reflective learning in curriculums by both teachers and learners.