Adding “criticality” to reflective practices: Exploring students’ experiences in reflecting on power, privilege and equity in the classroom

A qualitative study approach aimed to explore first-year physiotherapy students’ experiences learning about critical reflexivity in the classroom. 

Three online surveys were conducted on the same student cohort. The surveys aimed to understand students’ experiences completing two lecture modules and three tutorials with critically reflexive exercises at an Australian University. Teaching content included activities to foster students’ reflections on their bias, assumptions, and power dynamics when considering their verbal and non-verbal communication skills in different physiotherapy scenarios. The surveys were conducted in class, immediately after each tutorial. For data analysis, a reflexive thematic analysis was utilised  underpinned by a social constructivism paradigm to acknowledge interpersonal interactions and social norms heavily influence students’ experiences. 

Forty-four responses were received across the three surveys. The analysis identified four main themes: 1) Critical reflexivity evokes emotional reactions, 2) Challenging assumptions and fostering change, 3) Critical reflexivity involves empathy, and 4) Guided, realistic, practical activities are paramount in creating critically reflexive students. Learning about critical reflexivity was confronting and filled with strong emotions such as sadness, anger, and guilt. The content challenged students’ assumptions and biases, raising awareness of their privileges and inspiring some of them to reduce power imbalances in future patient interactions. Empathy seemed a key component to achieving a safe and trusting environment to reduce such imbalances. Finally, students perceived role-playing scenarios to be an effective preparation for becoming critically reflexive physiotherapists. However, students thought some activities were complex and needed more directions and examples of “ideal patient-physiotherapist interactions”, especially when dealing with patients from  diverse backgrounds.

Critical reflexivity may be a valuable tool in physiotherapy education for students to identify and reduce implicit bias when treating patients. Gaining a glimpse into student experiences when learning about critical reflexivity may form the case for the need of having physiotherapy students attuned to power and privilege to better address health disparities in their role as future healthcare professionals. 

Physiotherapy educators should consider incorporating critical reflexivity into their practices, enabling students to examine their own biases, assumptions, and privileges, thus preparing them to address health disparities as future healthcare professionals.