Professionals think in a number of ways that are unique to their professions. An important part of professional education is to learn from professionals how they think in their own professions and one way to attain this is through the practice of reflection.

The practice of reflection

It is possible to model the practice of reflection during a lecture, tutorial or meeting while engaging the audience in the understanding of an underlying concept. One can do this by a rhetorical form of Socratic dialogue (i.e. talking about it to an audience while going through it in one's mind). This helps to mirror for the listeners your own thought processes as you go through the three phases of reflection- definition, divergence and convergence-that will be described in detail further in this article. To demonstrate the process of reflection, specifically in the context of an Embryology lecture, the basic concept I would like students to understand is "The ribs are notched because an artery is narrowed". However, instead of walking through this process on a specialised topic, I would like to start off with a more general statement "The notes are sour because the seams are split".

Textual connections

The sentence appears to be made up of 2 separate facts which at first glance appear to be unconnected, even dissonant. The first phrase about notes being sour requires some reflection. Do the notes refer to bank notes, the notes of a song, or perhaps the written notes on a piece of paper? It may even be the name or a type of fruit that can taste sour, but which we have not come across.

Let us consider the things that we do know of first and see if anything makes sense. Pieces of paper are unlikely to have a sour taste unless some chemical has been spilled onto them. Can notes of a song be sour? We do hear of people singing sweetly, so it is likely that the notes can be sour if the singing is out of tune.

Let us take the second phrase which seems a little more straightforward as seams refer to edges of an object like a shirt or a box. Their separate pieces or sides are held together at the seams. What's held together, can be torn apart, which is presumably what the splitting of the seams is referring to.

Juxtaposing this idea with that of the first about something being not in tune, we get from the notion of singing to the idea of the object being an instrument producing the tune. If we think of this instrument as a wind instrument, it will contain air when it is played. The repeated playing of the instrument leads to a tearing at the seams which brings to mind the fraying of a piece of cloth.

There are of course different ways of making connections to think through this sentence, such as visual connections, where icons or imagery are used, or kinesthetic connections. Each way will help different groups of people in the audience to engage their minds more easily, either sequentially through textual connections, simultaneously through visual connections, or kinesthetically through motor connections in the brain.

The process of reflection

Let's go back to our first example ("The ribs are notched because an artery is narrowed").

Most medical and dental practitioners will recall the condition of coarctation of the aorta, where the narrowing of the large artery forces blood to flow through other arteries that bypass the site of obstruction. Some of these enlarged arteries are situated just below the ribs. As the condition is a congenital one occurring while the bones are forming in the foetus, the affected ribs appear to be hollowed out in their lower portions, giving rise to the appearance of notching on an X-ray.

In order to make meaningful sense about the sentence, it is necessary to go through the three different phases of reflection-definition, divergence and convergence. First, students should be guided through an initial phase of definition to establish parts of the sentence that are true or already understood. For example, highlighting the differences between a vein and an artery will help students learn that veins generally have valves that regulate blood flow in one direction while blood in arteries can flow in either direction depending on the differences in blood pressure at different parts of the arteries.

At the stage of divergence where various possibilities are considered, these definitions are used as bases to broaden students' scope of thinking. X-ray images and illustrations of various arterial pathways can also be used to indicate the numerous routes that arterial blood from the aorta could have flowed in order to bypass the obstruction. The elimination of various possibilities should gradually result in a convergence towards a possible solution.

In the process of reflection, we went through 3 different phases of thinking using Tips, Hints, Icons or images, Notes, and Keys (THINK). One of the tips used was to evaluate the type of notes under consideration, such as bank notes or the notes of a song. Suggesting the possibility of a wind instrument is an example of a hint being given. It is not important to determine whether something is a hint or a note, or that all of them should be used together.

What is relevant is that they are brought in at various stages (Figure 1) to guide the audience through an initial phase of definition, where the parts of the statements that are known to be true or already understood, are used as the basis to broaden the scope of thinking. This is the stage of divergence where various possibilities are considered. Further development of the theme in different directions and the elimination of various possibilities should gradually result in a convergence towards a possible solution.

Figure 1. Phases in the process of reflection

The principle

The underlying principle on which the preceding practice and process of reflection is based is that the neurons or nerve cells in the neocortex, the outer parts of the brain that humans use for cognition, are arranged in layers with connections to related regions that functionally enable the human brain to create patterns, classify, store and then match the patterns during the learning process.

Figure 2. The six layers of neurons in a region of the neocortex

Figure 3 illustrates the internalisation of information in the human mind. When information is internalised in us, we begin to know new material (i.e. we learn or acquire knowledge). Further application of that knowledge leads to mastery and eventually wisdom.

Figure 3. The internalisation process

It is the internalisation process that we are concerned with here. The practice of reflection allows for the formation of various possibilities and for mistakes to be made, considered and compared. This enables the neural circuits and pathways between the different learning centres in the brain to form different patterns. Where there is reciprocal feedback between the various brain centres, it allows for pattern matching and prediction (what is technically known as auto-associative memory formation). The end result is the development of new patterns in the neocortex. Learning has taken place and the new knowledge gained can then be applied to new situations.