Professional thinking and clinical reasoning are underpinned by the integration of reflective practice into evidence-based practice. Its application in the field allows for professionals in the veterinary world to think in a well-rounded and rational way that revolves around a patient and has the best outcome in mind. Hand in hand with evidence-based practice, is usually reflective practice. The dynamics between the two allow for a practitioner to be retrospective of their current practice and be influenced by the relevant evidence to advocate for the best patient welfare.  There are several models of reflective evidence-based practice, in veterinary and healthcare the Gibbs reflective model is the one that seems the most prevalent (Jasper, M. 2013).

gibbs

Figure 1. The Gibbs reflective model

Evidence in practice can come from a range of sources, which can be divided into roughly four groups, research, clinical experience, patient and experience and information from the local context such as national policy, social networks and performance data (Rycroft-Malone, J. et al, 2003). These all have their own impact into evidence-based practice, and subsequently reflective practice.

EBM pyramid

Figure 2. Evidence based medicine pyramid (Students for best evidence, 2014).

When combining reflective practice with EBP, it is necessary to utilise the best type of evidence to support your development, looking at figure 2, there is a range of different types of evidence and the quality of evidence used increases as you go up the pyramid. However, it is important to consider that even the highest quality evidence is subject to mistakes and publication bias, so appraising the evidence used will aid in better practice.

Evidence based practice may have its greatest effect at the analysis, conclusion and action plan stages of the Gibbs reflective model. When reflecting upon an event, it requires an individual to think in depth about the good and bad areas of it, and when moving on to evaluating this, looking at sources of evidence such as case studies may indicate how to handle a situation such as a treatment or drug prescription. One source of evidence that is commonly presented to practitioners is anecdotal evidence, a source of evidence which has little to no scientific base  and may be due to post-hoc fallacy, where a chance correlation causes the patient or client to believe that a second event was due to the first one (van Veggel, N. 2017). When presented with anecdotal evidence, the practitioner’s ability to conduct evidence-based practice is key as it promotes the use of research papers, case studies and other credible evidence to support decisions that ultimately benefit the patient.

In the analysis stage of the Gibbs reflective model, it requires you to think about what sense can be made from the event, assessing what lessons could be learned from it (Toolshero, 2018) and this is a good time to look at evidence such as case studies, a useful source for practitioners, to see how events similar to yours have been handled by others.  Additionally, evidence-based practice is not just about using sources of academic or government produced evidence, but also incorporating the views of the patient, and veterinary medicine, the clients needs. As well as using sources, it is important to reflect on whether the personal requirements of the client are met, for example prosthetics in animal amputees. An animals’ life may be thought to be sustainable with 3 legs but with what quality of life would it have. A highly active individual may not achieve the same emotional quality of life with less limbs despite there being there being a “good” prognosis physically (Mich, P. 2014). In this case, reflecting on what you would do in these situations by using both evidence and the needs of the client. As one article suggests, evidence-based practice shouldn’t be used as a blueprint for practitioners, but rather be combined with the clinician’s knowledge and experience as well as what is essential to the client.

In drawing a conclusion using the Gibbs reflective model, it is necessary to emphasise the variability of real-life practice to the training that is provided, and sometimes the need to turn to something other than the textbooks. One of the main points of making a conclusion in the Gibbs reflective model is deciding what could be done differently should a similar event occur again. Reflecting using sources of evidence including clinical trials, where new methods are developed, and clinical guidelines. Often it can be thought that reaching a conclusion using the Gibbs models a change, but as one paper suggests, using evidence to enhance clinical practice may allow for the affirmation that your current methods are correct and encourage you to continue using them. By going through the stages of the Gibbs reflective cycle, your conclusion may highlight a gap in research which can then be used as a prompt to other professionals that development in that section of the industry needs developing and/or updating.

One other important aspect that impacts professional thinking is continuing professional development (CPD). It aids in reflective processes as well as allowing for improved evidence-based practice. Similar to reflective practice, CPD activities, such as online courses and seminars, should be undertaken regularly and facilitate for skill development. One advantage of integrating CPD with EBP and the use of Gibbs is that evidence, such as textbooks, have the drawback of being current to the time of publication, but journals and clinical evidence that CPD providers use is up to date. In one paper, it is suggested that the interaction between EBP and CPD not only allows for increased accountability of the practitioner but also has the possibility to increase public confidence in judgement. This can be related back to the anecdotal evidence, and the value in reassuring clients of the reasoning behind your method of practice.

In conclusion, integrating reflective models like Gibbs with evidence based practice has the main advantage of allowing a practitioner to keep up to date with current developments in their relevant sector as well as being able to merge this evidence with the other aspects of the event they are dealing with to provide appropriately tailored care to a patient. It is important to use the right kind of evidence, appraising it appropriately though your reflection as not all evidence is good quality evidence.

 

Bibliography

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Bannigan, K; Moores, A. (2009) A model of professional thinking: integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy, 5(76), pp. 342-350.

Barredo, R.V. (2005) Reflection and evidence based practice in action: a case based application. The Internet Journal of Allied Health Sciences and Practice, 3(3).

E-learning network (2018) Gibbs reflective cycle model (1988) [online] https://www.eln.io/blog/gibbs-reflective-cycle-model-1988. Accessed on: 03/12/2019.

Jasper, M; Rosser; M; Mooney, G. (2013) Professional development, reflection and decision-making in nursing and healthcare, 2nd edn, John Wiley and Sons, United Kingdom.

Kings College London (2003) Integrating evidence based practice with continuing professional development: a seminar report [online] https://www.kcl.ac.uk/sspp/departments/politicaleconomy/research/cep/pubs/papers/assets/wp15.pdf. Accessed on: 03/12/2019.

Mich, P.M. (2014) The emerging role of veterinary orthotics and prosthetics (V-OP) in small animal rehabilitation and pain management. Topics in Companion Animal Medicine, 29(1), pp.10-19.

Mulder, P. (2018). Gibbs Reflective Cycle by Graham Gibbs [online]. https://www.toolshero.com/management/gibbs-reflective-cycle-graham-gibbs/. Accessed 03/12/2019.

Rycroft-Malone, J; Seers, K; Titchen, A; Harvey, G; Kitson, A; McCormack, B. (2003) What counts as evidence in evidence-based practice? Journal of Advanced Nursing, 47(1), pp. 81-90.

Steves, R; Hootman, J.M. (2004) Evidence-based medicine: what is it and how does it apply to athletic training? Journal of Athletic Training, 39(1), pp.83-87.

Students 4 best evidence (2014) The evidence-based medicine pyramid! [online]. https://www.students4bestevidence.net/blog/2014/04/29/the-evidence-based-medicine-pyramid/. Accessed 05/12/2019.  The e-learning Network (2018) Gibbs – reflective cycle model (1988) [online] https://www.eln.io/blog/gibbs-reflective-cycle-model-1988. Accessed 23/11/2019.

van Veggel, V. (2017) “But it worked for my mother’s cat”. Some misconception about anecdotal evidence. Veterinary Nursing Journal, 32(8), pp. 239-240.