A reflective practice learning experience with higher education exercise physiology students

ABSTRACT

Accredited exercise physiologists are higher education qualified health professionals who prescribe exercise as a preventative and treatment modality for individuals diagnosed with chronic conditions. Reflective practice is integral to the exercise physiology discipline, however its integration into curriculum requires further development and research. Utilising clinically based scenarios, final year students (N = 21), participated in a three-week reflective learning experience using the 6 step SPROUT acronym, represented as Situation, Past experiences, Read and refer, Other influences, Understanding and Taking it forward. Students completed the Reflection in Learning Scale (RLS) and responded to questions about confidence. Reflective scripts were reviewed, and clinical supervisors were interviewed. For the RLS, students scored higher on planning, knowledge integration and mental processing and lower for topic interactions, mindful summarising and coping with negative feelings. Students (75%) indicated that they were mostly or very confident in the use of reflective practice. Qualitative responses showed that using SPROUT did reinforce clinical learning. Time constraints and the separateness of higher education from the ‘real world’ were also points of view. Analysis of student scripts revealed a range of developing reflective ability. Supervisors focused on the importance of reflective practice and the contribution, that SPROUT had made to the overall experience.

KEYWORDS:

• Reflective practice
• clinical practice
• exercise physiology
• lifelong learning
• reflection

Introduction

To reflect is to think deeply and carefully. When a person reflects a metacognitive process is enacted where awareness and understanding of one’s own thoughts and actions is created (Schon, 1987). The development of reflective practice occurs via a critical analysis of experiences (Williams & Lowes, 2001) and is understood as learning that occurs as a part of professional practice (Gibbs, 1988; Hong & Chew, 2008). Within clinical disciplines, the ability to reflect is an essential element in the development of professional relationships between practitioner and client and also with colleagues (Clouder, 2000; Lane & Roberts, 2022).

Reflection is characterised by self-awareness, enabling individuals to describe events, evaluate them, and develop new thinking (Lutz et al., 2016; Mamede & Schmidt, 2004). According to Schon (1987) critical thinking in reflection occurs in two ways: during the action, when thinking is engaged while experiencing a situation, and post the action, when contemplation and thoughts are focused on the events that have already taken place.

Gibbs (1988) presents reflective practice within a circular framework centring around an event, where individuals engage in the skills of description, analysis, the aligning of thoughts and feelings, and subsequent action and change. This approach is widely applied in the discipline of medicine, focusing primarily on the development of practitioner competency (McNeill et al., 2010). Moreover, experience and reflection are intricately interconnected, with their interaction being essential for meaningful learning to take place (Driessen et al., 2006). The process is described as a transformation that emerges during experiential learning (Clouder, 2000; Cox, 2005).

Reflection is an exploration of previous experiences, a process that requires consideration of the self and practice (Williams & Lowes, 2001). Further to this it is considered that the concept often means different things to different individuals (Hong & Chew, 2008) and on a continuum could be just ad hoc sharing or discussing and even more formal approaches. Current methods can include the use of diaries and journals, essays, discussions, group sessions and any occurrence of thinking about one’s practice.

To date, approaches to the evaluation of reflective practice ability have been qualitative (Maaranen & Krokfors, 2007), quantitative (Sobral, 2001) and mixed methods (Killeavy & Moloney, 2010). Utilised have been interviews and discussion (Luttenbery & Berger, 2008), essays (Maaranen & Krokfors, 2007), portfolios (Tigelaar et al., 2006), the posting of messages such as blogs (Shoffner, 2009), ethnographic field notes and observations (Ottesen, 2007).

Reflective practice is described as diverse and non-homogeneous (Hodges, 2015). Despite this, within clinical disciplines the skill is uniquely and deeply linked to the development of competence (Lane & Roberts, 2022). Further to this, perceptions about reflective practice also reveal that it may not be well understood, such that there is limited understanding of the theories and philosophies that underpin the concept (Hodges, 2015). Additionally, it is stated that there is not a great deal of guidance available regarding how students might learn this skill (Gibson et al., 2011).

Boud et al. (1993) described reflective practice as a synthesis of concrete experiences and knowledge. Further to this, within the caring professions, as presented by Ritt and Ridge (2023) the skill is ‘doing and learning, reflecting, and making sense of one’s actions and practice’ (p 142). For reflection to be meaningful, both theoretical understanding and ‘wisdom’ from experience are described as facilitating the bridging of the ‘theory practice gap’ (Rattray et al., 2023), where reflective practice encompasses the knowledge acquired through experiential learning. This particularly occurs in clinical arenas, where theoretical or previously studied concepts are being applied.

However, limited resources appear to be offered to the educators who are tasked with teaching each new generation of health professional (Williams & Lowes, 2001). Suggestions have been made that there is a need for greater consistency and deeper understanding of reflective practice as a concept. Furthermore, it is recommended that investment be directed towards research that examines best practice and the assessment of actual outcomes in order to enhance learning effectiveness (Gibson et al., 2011).

It is widely acknowledged that reflection necessitates the utilisation of higher order skills such as analysis, synthesis, and evaluation (Bloom, 1956). Therefore, the focus exists in understanding how students acquire the ability to effectively incorporate reflective skills (Gibson et al., 2011). Research with nursing students has highlighted a need for more actual conversations and importantly the provision of a clear framework that shows learners what to do. Hong and Chew (2008), with nursing students, were able to show that, whilst acknowledging that students were being given an opportunity to express themselves, they did also want further guidance and even sample scripts. These identified strategies were deemed to be essential in motivating and facilitating a deeper level of engagement in reflective practice.

With a focus on the importance of lifelong reflective skills, it is considered that what is being taught by education institutions may at times, differ from what is experienced in the clinical practice arena. Research with nursing has been able to establish the existence of a ‘theory practice gap’ (Vosoughi et al., 2022). It is also suggested that any ‘disconnect’ does have impact, resulting in individuals experiencing feelings of insecurity and helplessness and even early leaving of the profession (Haghanie, 2012) and ultimately criticism of service provision (Saifan et al., 2021).

Reflective practice across clinical disciplines is a ‘prerequisite’ and is fully endorsed by national credentialling professional organisations such as the Australian Health Practitioner Regulations Agency (AHPRA) and Exercise and Sport Science Australia (ESSA). The skill is required and embedded into accreditation standards and is integral and essential to the acquiring of professional expertise and therefore the ‘right’ to become a practitioner (Australian Health Practitioner Regulations Agency, 2021; Exercise and Sport Science Australia, 2021).

In Australia, twelve national boards of Allied Health practitioners share a Code of Conduct in which one of the principles states that, in order to minimise risks to patients, professional capability should be developed through self-reflection (AHPRA, 2021). A similar approach is adopted by the Health and Care Professions Council (HCPC) of the United Kingdom where reflective practice is integral for the meeting of professional standards of practice and endorsed by 15 allied health professions (Health and Care Professiona Council, 2022). Integration and structured working relationships between education and healthcare providers is therefore relevant (Vosoughi et al., 2022).

With a particular focus on clinical disciplines within allied health and nursing in Australian settings, the concept of reflection and how this is being taught is the overall focus of this research, albeit specifically with one discipline, that of Exercise Physiology. As part of becoming a practising clinical professional, students of exercise physiology are required to be competent in the application of reflective practice (Cropley & Knowles, 2014; Exercise and Sport Science Australia, 2021). Regulatory standards are designed with a focus on” high level concepts which focus on providing a strong base of transferable knowledge, skills, and reflective practice to support lifelong learning and adaptability to different and evolving practice contexts and evidence base”. (p 3).

The rapidly evolving nature of healthcare and the increasing complexity of patient need (Ng et al., 2022), has for the exercise physiology profession, prompted healthcare professionals to be ready to adapt to evolving new challenges that require the integration of multifaceted knowledge into practice (Exercise and Sport Science Australia, 2021). Competency in reflective practice, as a lifelong skill, is therefore crucial to ongoing professional development and assurances of high-quality patient care. Research by Hong and Chew (2008) has shown that students are asking for further guidance with the practical aspects and ‘know how’ of reflective practice.

Supportive of the development of clinical professionals who are deemed competent, reflective, and capable of adapting to the dynamic nature of healthcare, reflective practice was embedded directly into learning activities. This research, specifically tailored to the learning needs of higher education exercise physiology students, aimed to explore and evaluate an efficacious approach to the application of reflective practice. Utilising the perspectives of both students and clinical educators to evaluate the outcomes this mixed method approach focuses on relevant experiences and concomitant teaching and learning outcomes.

Materials and methods

Participants were final year clinical exercise physiology students (N = 21) and five clinical education supervisors who were directly involved in an on-campus student led clinical practice conducted during the 14-week teaching session. Students were allocated a range of clients, who were mostly diagnosed with a chronic condition and requiring exercise assessment, prescription and ongoing exercise management. The students were completing a 4-year Masters of Clinical Exercise Physiology program. This group were specifically chosen due to their imminent transition from academic learning to professional practice, emphasising the critical nature of reflective practice skills at this juncture of their career. The five clinical education supervisors were accredited and currently practising clinical exercise physiologists.

With a focus on the learning of reflective practice, all students (i) participated in a face-to-face classroom discussion experience, (ii) submitted a written reflection based on a 300-word case study, and (iii) engaged in follow-up application of a reflective practice methodology during 14 weeks of clinical work with clients. The research concluded with evaluations conducted when all activities were completed.

Prior to the commencement of the research, students and clinical supervisors received an information statement and provided informed consent. It was emphasised that participation in the research was voluntary and would not impact any assessments or study outcomes. The research protocol received ethical approval from the Southern Cross University ethics committee (Approval no.2022/045).

In order to encourage the students to follow a reflective practice process, the SPROUT acronym (Irwin & Coutts, 2017) was utilised for the learning experience. As a mnemonic SPROUT represents six actions or steps of a reflective process. It is a schema for written and oral reflections and has application in multiple learning contexts and the potential to support professional and personal development and ongoing learning (Irwin & Coutts, 2017). This research was the first-time students had been introduced to the SPROUT acronym.

SPROUT was utilised for the experience due to its comprehensive yet adaptable framework, fitting well within the complex and dynamic field of clinical work with clients. It was considered as being able to aid in structuring reflective thoughts and bridge theoretical knowledge with practical application.

The first step of the mnemonic requires focus firstly on the target Situation, where learners are asked to describe any related factual and relevant information. The next step directs their attention to related Past Experiences, including any previous learning. Read and Refer is the third step where the learner is encouraged to focus on knowledge: sources of information that are peer reviewed and represent perspectives related to the experience. Learners are then asked to focus on Other influencing factors which focus on those internal, such as beliefs and values that may influence perspectives and also external; aspects that also contribute to overall understanding. The fourth stage is Understanding where the learner brings their perspectives together to form new thinking. With the final stage Taking it Forward participants apply their new knowledge and share learnings with relevant others.

Prior to the commencement of the learning activities, students were allocated a 300-word clinical exercise physiology scenario from a set of predefined situations. Each received a written document that gave a full explanation of the scenario, all of which were based on situations that can occur in exercise physiology practice. The title and emphasis for each is presented in Table 1.

Table 1. Scenarios – one randomly allocated to each student prior to the commencement of the learning activities.

Ongoing harm had been caused following the provision of exercise to a knee replacement patient – a lawsuit in the making. Prescribing nutrition supplements – an approach not within the exercise physiology scope of practice. Clinical records - a situation where a confidentiality breach had occurred. Obese client becomes frustrated and cancels her exercise sessions. Coping with progressing a client to independent exercising. Coping with provision of exercise to a client with a condition not well known to the profession. Client reluctance to complete exercise prescription. Personal achievements and successes with a particular type of client. Coping with clients who cross personal boundaries. Professional disagreements with colleagues.

During classroom activities, students were firstly familiarised with the SPROUT acronym, including examples related to the variety of ways that the stepped process could be applied. The allocated scenarios and the application of SPROUT were discussed in groups. In their own time, students then completed their individually written reflective assessment. They were encouraged to focus on the application of all steps of the SPROUT acronym.

Concurrently, all students were participating in an on-campus student-led clinical exercise physiology placement. Clinical supervisors were also mentored in the application of SPROUT and were requested to incorporate the process and thus support the students to also utilise reflective practice with their clients.

Instruments and evaluation

Reflection in learning scale and further specific questions

At the conclusion of the teaching session students completed an adapted version of the Reflection in Learning Scale (RLS) (Sobral, 2000, 2001, 2005). The RLS consists of 14 items that require self-rated responses, grounded in the understanding that reflection is a cognitive strategy (Sobral, 2005). The instrument demonstrates good internal consistency. Previous research with medical students has established significant correlations between RLS scores and measures of self-efficacy for self-regulated learning, perceived meaningfulness of the learning experience, self-confidence as a learner, and adoption of a deep approach to learning (Sobral, 2005). Further to this, consistency of measurement was also established, with the emphasis placed on the students’ use of the process of being reflective.

The instrument was adapted to align with the specific context of developing exercise physiology practitioners, ensuring that the modifications were contextual in nature and focused on capturing the utilisation of reflection within this professional domain. See Appendix A for adapted Scale of Reflection-in-Learning. Students were asked to respond to each of the 14 statements, using a 1–4 Likert scale where 1 implies Never, 2 Almost Never, 3 Almost every time, and 4 Every time.

Two further items were added. One focused on a response about their experience using the stepped process of SPROUT. This question asked them to describe, using written language, their experience of applying the acronym.

A final question asked them to self-rate their confidence in relation to their ability to utilise reflective practice in clinical exercise physiology. They were asked to choose one statement from the following four: I am not confident, I am developing my confidence, I am mostly confident, and I am very confident.

Review and analysis of student reflective scripts

The submitted written reflections, centered on their given scenario and utilisation of the SPROUT framework were reviewed and assessed by the research team. Each script was allocated a level from a purpose-developed three-category classification system, adapted from the methodology established by Jaiswal et al. (2021). The three categories were novice, aware or reflective practitioner.

Novice Practitioner was selected if the student had made attempts to apply learning experiences, however, did not seem able to demonstrate depth. This category was also selected if the approach lacked informed explanation and clarity and was limited in the application of connections between learning experiences both personal and external.

The second category was Aware Practitioner and selected if the written scripts showed evidence of reflection on personal learning and clear analysis of the scenario, however overall lacked depth. Some connections between the experience and past experiences and goals were demonstrated, however solution-based consideration of new modes was not fully evident.

For the Reflective Practitioner category, the script needed to include in depth descriptions that indicate a meaningful engagement with the scenario. The reflection needed to go beyond simple description and fully explain how it contributed to an understanding of self, others, and study knowledge. It would also include questioning and solution-based modes of thinking towards new perspectives.

Based on the learning outcomes and the Jaiswal et al. (2021) levels, the three researchers firstly conducted their assessment of each of the written reflections separately, entering their selection of either novice, aware or reflective into a spread sheet. Once this was complete, a moderation activity (Jackel et al., 2017) was conducted. The overall selections were reviewed and any disparities that had occurred were discussed until a consensus, as to what was the most considered and appropriate outcome, was arrived at.

Interviews with clinical supervisors

Clinical supervisors were asked to attend a focus group where they provided feedback about reflective practice and working with the students. They were asked to respond firstly to the importance of reflective practice when working in clinical exercise physiology. With a focus on SPROUT as a methodology, they were asked to provide any further feedback about the process as presented by the acronym. In summary they were asked if they could add anything further in terms of the teaching of reflective practice to clinical exercise physiology students. The discussion was recorded and transcribed verbatim. Data was de identified and disassembled into codes. Codes were them combined into categories and themes focused on the views of the clinical supervisors.

Results

Responses to the reflection-in learning scale and further questions

Students (N= 21) completed learning activities focused on the application of reflective practice. These included discussion and practise in class, individually completed written reflections and practice during clinical exercise physiology placement. At the conclusion of the activities each student completed the contextually adapted Reflection in Learning Scale (RLS). Data from one student was removed due to not being complete. Scores for each student were totalled and the range of responses for each item recorded.

The total possible score for the RLS was 56. The scores for this group of N = 20 students ranged between 42 and 56 with a mean total score of 46.35. This is 77.41% for self-reported reflective ability. Mean response scores were calculated for each of the statements.

Higher scoring items related to clinical practice were the careful planning of tasks (m = 3.65, response range 3–4) and the integration of knowledge gained from study (m = 3.65, response range 3–4). Acknowledgement that they have engaged in mental processing about what they knew and what they needed to know was also a high scoring item (m = 3.60, response range 3–4).

Lower scoring items were the seeking of interrelations between topics to create more complex notions (m = 3.00, range 2–4), mindfully summarising their learning on a day-to-day basis (M = 3.05, range 2–4) and coping with negative feelings associated with aspects of their clinical learning (m = 2.90, range 1–4).

Written responses from the students

To our knowledge this group of students had not had, within their current higher education experience, any previous focus on being a reflective practitioner. They described the use of the acronym as being ‘new to them’. Many did acknowledge that it

had been ‘helpful’ in learning to be reflective. One student wrote: ‘SPROUT in class as well as in the clinic has helped me reinforce my learning on reflective practice. Through prioritising reflective practice through the SPROUT method, I continue to gain a greater understanding of strengths weaknesses and possibilities’.

Some wrote that they had benefitted from being able to use an ‘effective framework’ However, some of the students described using the 6 steps as ‘time consuming’ such that it ‘takes too long’, with one student saying: ‘No I don’t find this applicable in the clinical work placement due to time constraints’. They did not appear to see the value of allowing themselves time to think about their practice on a deeper level.

There was a clear delineation between their education experiences and what they would be doing as a qualified practitioner. Therefore, they appeared to isolate the use of SPROUT to just their time in higher education, stating that it was a ‘great experience’, however, they were unsure if they would use it once they were qualified which they called the ‘real world’.

Difficult to reflect as time has passed. SPROUT was a helpful tool however time consuming to use in the real world. I see myself using it initially, but I think over time as I gain experience, I would probably stop using the full SPROUT acronym. I will always self-reflect and discuss with colleagues though.

They continued to be clear that their higher education experience was different from what they would be doing once they were eventually a practising exercise physiologist, such that: ‘Great experience whereas I could see my professional practice in a different perspective’. One student further explained this, stating that they felt they were not yet experienced. However, once they were more experienced, they had some doubt about whether they would continue to use it. ‘SPROUT- I believe it was time consuming and I did benefit from it. Would I use it as a structure in my life as an EP (exercise physiologist) – maybe’.

Many of the group acknowledged that using the process did, overall, give them a deeper understanding of their clinical experiences. A small group of them were able to predict that they would not use it much, describing it as being something in their head rather than an activity. This suggests that they saw the whole application more as just an assessment rather than a skill they could develop, finesse, and integrate into their career as a clinical professional. ‘It’s an effective process but is very time consuming. I wouldn’t use this framework in real life. It works well for a university topic but would take too long in the real world’.

Self-reported confidence

Students (N = 20) responded to a statement about their confidence in the use of reflective practice in clinical exercise physiology. 15% of the group acknowledged that they were developing their confidence, 55% indicated that they were mostly confident and 25% were very confident.

Analysis of student reflective writing scripts

Each student completed and submitted a 500-word written reflection. The use of the stepped process of SPROUT was encouraged. N = 21 students submitted a response. The researchers each reviewed the scripts according to the prescribed categories. For 9 out of the 21 scripts (43%) of the researchers agreed on an individual rating from one of the three categories. There was also agreement between 2 out of 3 of the researchers for 12 of the 21 (57%) of scripts.

Following consensus, researchers highlighted their ability to differentiate between students who demonstrated a deep level of reflection. These students went beyond merely describing or completing an activity, showcasing evidence of heightened awareness, emotional engagement, and providing specific plans for future application. The researchers actively engaged in discussions regarding their selected ratings, recognising that the process served as a valuable learning experience for themselves as well. Collectively, they agreed that the student responses exhibited variation, with only a minority demonstrating depth across all aspects.

Certain students were characterised as ‘superficial’, lacking insight and thoughtful consideration of the scenario. While some students displayed depth in certain steps, they fell short in other aspects of their reflections. Most students demonstrated competence in the ‘Read and refer’ step, providing satisfactory descriptions. However, only a small number of students offered comprehensive explanations of how they would further expand their knowledge in this area. In terms of ‘Taking it forward’, the majority of students showed consideration; however, a few failed to provide specific details on how they would effectively communicate their newly acquired knowledge to their community of practice.

The researchers reached a consensus that only a limited number of students had exceeded expectations by demonstrating a willingness to engage in thoughtful and productive reflection through various approaches. They collectively described the activity as enlightening, highlighting the importance of educators and clinical supervisors also developing an understanding of effective methods to teach reflective skills.

Supervisor perspective

Following data analysis of the clinical supervisor discussion, 4 themes emerged. These were focused on the overall importance of reflection and commencing the learning of this skill early. A further two themes focused on the relevance of the stepped nature of SPROUT and the importance of reflection for clinical supervisors. The four themes are presented.

Reflection is important for students

There was overwhelming support from the supervisors that reflective practice is useful for students, and they ascribed various reasons for this. All agreed that reflection reinforced student learning and likened the process to self-assessment, one supervisor reasoned that the practice could assist students to determine ‘how well they perceive they have gone’ (Mandy). Following this line of thinking, reflection was perceived by some as useful to improve poor practice rather than affirming good skills and knowledge. The following excerpt from David captures this: ‘So if they’ve got the insight to be able to have that reflection on themselves as to all the improvements they may make’.

Michelle’s comments acknowledge the cyclical nature of their work, and the role reflection has in developing student knowledge towards improving client care.

So, for the students particularly, it helps them to focus their directive a little bit so they know it’s quite a changing environment each day with a client that they need to change it up, and it helps them plan a little bit better in their future sessions with the person and also the sessions on for the next day.

SPROUT provides structure for reflection: reflection provides structure for practice

All the supervisors agreed that SPROUT provided the students with a simple structure that assisted them in the process of delivering care. Mark explained that ‘SPROUT as a methodology I think is quite good for the students. Just to you know, clear their mind about where they’re headed with their reflective practice. Having it laid out as an acronym does help’. Mandy initially commented that SPROUT was ‘too textbooky’ though went on to admit that ‘SPROUT is a good model, I think that for students initially coming into the clinic and maybe meeting clients for the first time. I think it’s good for structure. It gives them a baseline to work off’.

One particular supervisor admitted to not using SPROUT with students and opted to relying on previous strategies to facilitate learning and explained that ’If we’re doing our job, and the students are, they’ll come and ask us the questions, or they’ll come and ask the advice’. The observations made by Nicholas however may override a supervisor’s nonengagement with the students’ contemporary reflective practices noting that:

Maybe a handful of them [students] are regularly utilising reflective practice and they’re constantly questioning us and coming into us before and after their consults as well. And it’s pretty interesting to note that it seems the students that are doing that regularly are better students and they engage better with the clients, and it seems like they’re getting more out of the experience, and I think that’s passing on to some of those other students that perhaps weren’t doing it. (Nicholas)

It’s important to start early

The supervisors agreed that to further support reflective practice, SPROUT could be offered to students earlier in their program of study. Homing in on the possibility of improvement in future practice, one supervisor noted that SPROUT ‘probably was a little bit jerky for them to start off, but as they keep practicing this it will get more fluent. So I think it works well for the students’ (Nicholas).

Mark suggested that:

It would be good to throw that (SPROUT) into the undergrad a bit early on before they come into the clinic … we’d see more value out of that process in here than trying to throw it into to them as they’ve come into the clinic.

Michelle supported this noting the skills of reflective practice should be well developed by graduation; highlighting the need for this ‘especially as a new practitioner say at the start of this final year, as to what they transition to at the end of the year. Yeah, it’s of big importance for sure’.

Reflection is important for supervisors too

All the supervisors expressed that they practice reflection as part of their work activity. Prior to this study, they were not familiar with SPROUT however expressed that ‘we do our normal process as we are using it anyway without knowing it’ (Mark). Supporting this notion of reflection being an intuitive practice rather than an intentionally learned skill, Mandy offered the following:

I don’t use an acronym as part of my process. It’s something that we do naturally. It might not be in the same process or methodical method as what’s going on here, but I think that’s what we do and what we have done for quite some time naturally.

Michelle however was open to using SPROUT as a strategy to support teaching reflective practice and commented that:

I guess you know with a little bit more practice that will get a bit more fluent, and even for us as supervisors, because this is something that I haven’t used before either. So, I was sort of learning on the go a little bit too, but as you went along, you got to know the questions that you needed to ask.

Discussion

The findings of this research demonstrate the successful integration of reflective practice into learning activities for exercise physiology students. The mean score of 46.35 (77.41%) on the RLS indicates that students reported a high level of reflective ability. Notably, higher scores were observed in items related to clinical practice, such as careful task planning and the integration of acquired knowledge. Conversely, lower scores were observed in items that involved making interconnections between topics to develop more complex understandings, mindful summarisation of daily learning, and effectively managing negative emotions associated with clinical learning. One possible explanation for students’ self-reported higher level of confidence in reflective practice was the integration of this approach into their learning activities.

By practising reflection regularly, students may have developed a sense of comfort and familiarity with the process, allowing them to feel more confident in their ability to apply it in a clinical setting. Additionally, using the SPROUT framework may have provided students with a clear and structured approach, which may have helped to enhance their confidence in reflective practice. However, the fact that some students found the SPROUT framework time-consuming and challenging to apply in real-life situations suggests that there may be a need for further training and support to help students effectively apply the skill.

With trainee sport and exercise scientists, Huntley (2021) explored reflective practice engagement and development. The research utilised a blend of qualitative and quantitative methods and confirmed that reflective practice is a complex, highly individualised, and context-dependent process. Importantly, the research highlighted that reflective practice workshops had positively impacted confidence and competence in being reflective, suggesting there may have been a decrease in habitual action or ‘acting without thinking’. Over time effects were described as becoming more pronounced, indicating long-term benefits from enacting reflective skills.

However, Huntley’s findings also indicate challenges for being reflective, particularly in real-world applications and these align with observations from our research, where students describe the SPROUT framework as time-consuming and challenging to apply in real-life situations. Rather than a one-size-fits-all, Huntley’s work underscores the necessity for varied and individualised approaches to reflective practice.

Another possible explanation, also supporting previous research by Mann et al. (2009), is that reflective practice may have helped students better understand their clinical learning. By reflecting on their experiences, they may have gained further insight into their strengths and weaknesses as developing practitioners and discovered a greater appreciation for the complex nature of clinical practice. This deeper understanding may have helped to build confidence in their ability to effectively navigate the challenges of the clinical setting.

Additionally, developing self-awareness and critical thinking skills through reflective practice may have contributed to the students becoming more independent and effective learners, which, as also previously found by (Cox, 2005), did contribute to the self-reported perception of their confidence. Overall, the present study’s findings suggest that integrating reflective practice into educational programs may have significant benefits for the development of healthcare professionals.

With a focus on the benefits of the use of reflective practice by health professionals, the results of this present teaching and learning project are consistent with research by Irwin and Coutts (2017). Both studies indicate that reflective practice can promote self-awareness, critical thinking, and lifelong learning, vital competencies for healthcare professionals. However, unlike Irwin and Coutts (2017), who recommend the SPROUT framework for teaching reflective practice in nursing, this study focused on incorporating the framework into learning with exercise physiology students.

The findings underscore the importance of incorporating reflective practice into educational programs for exercise physiology students and highlights the benefits and the need to apply the skills in real-life clinical practice situations. Instructors could encourage students to engage in reflective practice regularly and provide them with appropriate tools, such as the SPROUT framework. It is crucial to note that reflective practice may be time-consuming and challenging to apply in real-life situations, as some students in this study noted. Therefore, instructors could help students develop strategies for overcoming these barriers and provide the necessary support to develop their reflective learning. Ultimately, integrating reflective practice into educational programs for exercise physiology students can help them develop the necessary competencies to become effective healthcare professionals.

We acknowledge the limitations that would inhibit the transferability of the results of this research. Not diminishing the importance of research within clinical exercise physiology, enrolments in this discipline are limited, therefore, a one group design was conducted. Hence, also our rationalisation for the utilisation of a varied mixed methods approach with particularly the views of the supervisors being collected via interviews and a qualitative methodology. However also acknowledged was our decision not to collect baseline data for the Reflective Learning Scale. This group of students were completely new to the concept of reflective practice and in addition at the commencement of the research they would have only experienced one week in clinical practice, suggesting that they would have been limited in their ability to apply knowledge and understanding about the questions. Their self-reported responses were more informed at the conclusion of the project and considered by the research team as descriptive only. Our recommendation for future research is to conduct the project with other allied health students and nursing where larger groups of participants can be included.

Reflective practice is a valuable tool for enhancing exercise physiology students’ professional development and clinical skills (Cropley & Knowles, 2014). As such, it is recommended that educators are encouraged to incorporate reflective practice learning methodologies into their learning activities. One approach that has been shown to be effective is the integration of reflective practice into clinical placements, where students can apply their knowledge and skills in real-life situations and then reflect on their experiences. Educators can guide students on how to effectively apply reflective practice in these settings, such as through frameworks like SPROUT, and can also provide opportunities for students to receive feedback on their reflective practice.

It is relevant to emphasise the importance of reflective practice and its potential benefits for students’ professional development and clinical skills (Clouder, 2000). By providing guidance, educators can support students to become more effective and competent healthcare professionals. In addition, and importantly, the recognition by educators that reflective practice can be time consuming and challenging for students to apply in real-life situations (Gibson et al., 2011) requires focus. In a practical sense, educators could provide support and resources to help students develop their reflective skills by utilising examples of effective reflective practice or offering workshops (Kinsella et al., 2012).

In conclusion, the results of this study suggest that the application of reflective practice in exercise physiology can enhance students’ self-reported reflective ability and confidence in using reflective practice in clinical exercise physiology. The SPROUT framework was an effective tool for reflection, although some students found it time consuming and challenging. Integrating reflective practice into learning activities for exercise physiology students is a promising approach to enhance further professional development and clinical skills.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Rosanne Coutts

Rosanne Coutts is an accredited exercise scientist, sports scientist, and exercise physiologist. Across the higher education sector, she makes a strong contribution to the national research and pedagogical agenda with many years as an acknowledged educational leader.

P. Irwin

Pauletta Irwin is considered a leader in pedagogy and has received several awards for her innovative approach to teaching and learning. With over 30 years clinical experience as a Registered Nurse, she is also an experienced qualitative researcher dedicated to strengthening and informing health pedagogy.

L. Del Vecchio

Luke Del Vecchio is a work integrated learning academic and a clinical exercise physiologist with over 20 years of experience. He is also a skilled researcher in the field of clinical exercise physiology.