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Critical reflection

The ultimate goal of transformative education is to foster critical reflection and informed action. To demonstrate critical reflection, consider these two contrasting examples (Phelan & Ng, 2015):

Dr. Smith is a developmental pediatrician. In her practice, she sees many children who have school-based challenges requiring health-related support. In order to advocate for school-based supports for her patients’ attention and learning needs, she writes strongly worded clinical reports, either sending the reports directly to the schools, or via the children’s parents. Some of the other health professionals who work with Dr. Smith (e.g. Occupational Therapist) will often ask Dr. Smith to incorporate their recommendations into her reports, believing that the power and authority of a physician’s letter will prevail at the school. Unfortunately, unbeknownst to Dr. Smith, these reports often result in conflict at the schools. Parents take her recommendations very seriously, and when schools resist or question recommendations, a battle often ensues. Sometimes, the schools resist Dr. Smith’s strongly-worded recommendations because they have a different perspective of the child; other times, the schools lack the resources to implement all of the recommendations. No one from the schools has ever called Dr. Smith to discuss her reports. Dr. Smith sees her job as one of advocacy and grows increasingly frustrated, as well as discouraged, in relation to the public school system. Generally, families appreciate Dr. Smith’s efforts; however, the conflicts with schools continue to recur.

Dr. Brown is a developmental pediatrician. In her practice, she sees many children who have school-based challenges requiring health-related support. In order to access school-based supports for her patients’ attention and learning needs, she has written a generic letter to preface all of her clinical reports. The letter sets a tone of collaboration and partnership with the schools, listing her contact information and inviting dialogue. In her clinical reports, she uses a tone that invites clarification, input, and conversation if needed. As a result, Dr. Brown will, on occasion, hear back from local schools. She thus continually learns when her recommendations are confusing or infeasible, and thus adapts her approaches to report-writing and advocacy. Sometimes, she’ll change her recommendations as she gains insight from the school-based professionals. Dr. Brown has established a positive working relationship with families, schools, and school-based professionals that enables her to advocate for children when needed. However, as a starting point, Dr. Brown aims first to collaborate with schools and families to support the needs and goals of children. She only advocates with schools and families as needed, but finds this need is rare if everyone is working together.

Notice how in the first case, Dr. Smith lacks awareness and appreciation of the social position of others (e.g. use of strong language results in conflict, of which she remains unaware). In contrast, in the second case, Dr. Brown has cultivated a relationship that affords her awareness and appreciation of the school’s position and perspective. She then enacts material workarounds, (e.g. adapting her reports) in order to set up a collaborative and productive relationship. Dr. Brown is engaging in critical reflection, which is a necessary precursor to informed action; she is practicing as a critically reflective practitioner.

Critical reflection refers to thoughtful consideration of everyday experiences and social situations, with focused attention on issues of power, privilege, and social structure. Critical reflection leads to an imperative to think and act toward a positive change of the status quo. It is core to transformative education, and can be fostered through a range of teaching practices, which we will discuss next.


Ng SL, Mylopoulos M, Kangasjarvi E, Boyd VA, Teles S, Orsino A, Lingard L, Phelan SK. Critically reflective practice and its sources: A qualitative exploration. Medical Education. 2020;54(4): 312-9

Phelan SK, Ng, SL. A case review: Reframing school-based practices using a critical perspective. Physical & Occupational Therapy in Pediatrics. 2015;35(4): 396-411.

For further reading

  • Brookfield SD. The concept of critically reflective practice. In: Wilson AL, Hayes E, editors. Handbook of Adult and Continuing Education. San Francisco, CA: Jossey-Bass; 2000. p. 33-49.
  • Brookfield SD. Becoming a Critically Reflective Teacher. San Francisco, CA: Jossey-Bass; 1995.
  • Kemmis S. Knowing practice: Searching for saliences. Pedagogy, Culture & Society. 2005;13(3):391-426.
  • Kinsella EA, Caty M-È, Ng S, Jenkins K. Reflective practice for allied health: Theory and applications. In: English LM, editor. Adult Education And Health. Toronto, ON: University of Toronto Press;2012. p.210-28.
  • Mezirow J. Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco, CA: Jossey-Bass; 1990.
  • Ng SL. Reflection and reflective practice: Creating knowledge through experience. Seminars in Hearing. 2012;33(2): 117-34.
  • Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Medical Education. 2015;49(5):461-75.
  • Ng, S. L., Crukley, J., Brydges, R., Boyd, V., Gavarkovs, A., Kangasjarvi, E., … & Woods, N. N. (2022). Toward ‘seeing’critically: a Bayesian analysis of the impacts of a critical pedagogy. Advances in Health Sciences Education, 1-32.
  • Phelan SK. Constructions of disability: a call for critical reflexivity in occupational therapy. Canadian Journal of Occupational Therapy. 2011;78(3):164-72.
  • Raelin JA. Toward an epistemology of practice. Academy of Management Learning & Education. 2007;6(4):495-519.
  • Rowland P, Kuper A. Beyond vulnerability: how the dual role of patient-health care provider can inform health professions education. Advances in Health Sciences Education. 2017:1-7.
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