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The Divergence and Convergence of Critical Reflection and Critical Reflexivity

Implications for Health Professions Education

Ng, Stella L. PhD; Wright, Sarah R. PhD; Kuper, Ayelet MD, DPhil

doi: 10.1097/ACM.0000000000002724

As a field, health professions education (HPE) has begun to answer calls to draw on social sciences and humanities (SS&H) knowledge and approaches for curricular content, design, and pedagogy. Two commonly used SS&H concepts in HPE are critical reflection and critical reflexivity. But these are often conflated, misunderstood, and misapplied. Improved clarity of these concepts may positively affect both the education and practice of health professionals. Thus, the authors seek to clarify the origins of each, identify the similarities and differences between them, and delineate the types of teaching and assessment methods that fit with critical reflection and/or critical reflexivity. Common to both concepts is an ultimate goal of social improvement. Key differences include the material emphasis of critical reflection and the discursive emphasis of critical reflexivity. These similarities and differences result in some different and some similar teaching and assessment approaches, which are highlighted through examples. The authors stress that all scientific and social scientific concepts and methods imported into HPE must be subject to continued scrutiny both from within their originating disciplines and in HPE. This continued questioning is core to the ongoing development of the HPE field and also to health professionals’ thinking and practice.

S.L. Ng is director of research, Centre for Faculty Development, and Arrell Family Chair in Health Professions Teaching, St. Michael’s Hospital, scientist, Centre for Ambulatory Care Education and the Wilson Centre, and assistant professor, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.

S.R. Wright is scientist, Michael Garron Hospital, Centre for Ambulatory Care Education and the Wilson Centre, and assistant professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.

A. Kuper is associate professor of medicine and faculty co-lead in person-centred care, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Funding/Support: The Arrell Family Chair in Health Professions Teaching, University of Toronto and St. Michael’s Hospital.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Stella Ng, St. Michael’s Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8; telephone: (416) 864-6060, ext. 77363; email:; twitter: @StellaHPE.

© 2019 by the Association of American Medical Colleges