988368

Introduction
Reflective practice entails a cognitive process that involves thoughtful contemplation of one’s experiences, enables individuals to learn from mistakes, recognize their strengths and skills, and generate alternative approaches and strategies for attitudinal change and future success. By connecting reflections with actions, reflective practice fosters critical thinking, leading to the acquisition of new knowledge and insights while facilitating lifelong learning and professional development.
Reflective practice is an individual’s ability to imitate his actions and to remain indulged in a progressive learning process [1].
The reflective practice aims to investigate feelings and understanding that cross the line separating one’s profession from the outside world. This method of inquiry and investigation makes a relationship between two fields. It is beneficial to combine a professional’s technical knowledge with their interpersonal and emotional skills. Although emotions can be a source of understanding, the notion is unique in today’s world. The reflective practice facilitates a professional approach and enhances the synergy between primal inclinations. When emotions and thoughts are engaged, actions gain considerable potency.
This strategy is essential not only for personal grooming but also for progressive professional development. Therefore, moreover, the reflective practice focuses on analytical concentration on empirical values and knowledge that provide day-to-day actions through thoughtful analysis of one’s practice.
This may exceed progressive intuition. The principle for reflective practice is that knowledge alone does not necessarily lead to learning, deliberate reflection on experience is essential [2].
The concept of reflective practice is the most basic. In the early 20th century, John Dewey was one of the writers who inscribed his experience, cognition, and interaction about reflective practice. In 1983, Donald Schon published his book the reflective practitioner, in which he presented the idea of reflection-on-action and reflection-in-action. He explains how professionals fulfill challenges by overcoming their infirmities [3].
Reflective practice serves as a significant means of learning in practice-based professional settings, wherein individuals acquire expertise through their practical experiences, rather than relying solely on conventional modes of learning and knowledge transfer.
This systematic approach, on the one hand, helps in professional development and on the other hand, makes a person able to run theory and practice in parallel [4].
Professor David Boud and his associates interpret that “reflection is a significant human action, by which people recognize their skills and make judgments about their internal talents and capabilities [5]. It is an ability that enhances with experience and is crucial to the continuous learning process”. It is discovered that the concept of reflection in learning may be linked to Aristotle’s discussions of practical judgment and moral action in his ethics. 
The reflection process is complex, encompassing interactions and close relationships between emotions and intellect. Negative emotions, particularly those directed towards oneself, can serve as significant barriers to learning. They have the potential to distort perceptions, lead to inaccurate conclusions about events, and undermine the resolve to persist. Positive emotions and moods can significantly improve learning; they can keep the learner focused and can act as a stimulus for future learning [5].
Health professional education programmers often provide fieldwork or practical education as a key element of their curricula. Clinical experts are presumed to prepare novice practitioners to be competent in practice, make them ready to enter a particular field, and meet the demands of effective practice. Becoming and embodying clinical expertise is a progressive and ongoing developmental process. This voyage of growth and evolution as a clinical expert requires active learning approaches integrated with reflection on one’s practice [6].
Previous studies focused on finding the reflective practice of experienced physical therapists, while this study helps to compare the self-perception regarding the reflective practice of novice physical therapists graduating from the governmental and private sectors. The current study, unlike the available literature targeting other healthcare disciplines, only provides the physical therapy population.

Materials and Methods
This study was a comparative cross-sectional study. Data were collected from the physiotherapy department of the governmental and private clinical setups in Lahore City. A non-probability convenience sampling method was used to collect data.
A total of 138 participants were included in this study. An established and structured reflective practice self-assessment instrument was utilized to collect the data. This instrument is valid and reliable to assess individuals’ self-perception regarding the application of reflective practice in both personal and professional domains.
The inclusion criteria included male as well as female physical therapists working in clinical and academic setups for the last 2 years, aged between 23 to 35 years, novice practitioners working in governmental and private sectors regardless of academic institutes either governmental or private, novice physical therapists having either honorary or on job status at their respective workplace. The exclusion criteria included subjects who did not want to participate in the study. Informed consent of physical therapists with a degree other than physiotherapy was also obtained from the study participants. Every step will be taken to ensure the privacy of the participants. A self-administered questionnaire was used to gather basic demographic information, including age, gender, and marital status. The data was collected using a reflective practice self-assessment questionnaire containing five sections with six questions. A questionnaire was given and received from the subjects as handouts. After data collection, it was saved in a secure place to prevent and avoid any issues or biases.

Data analysis
The data were analyzed using a spreadsheet of SPSS software, version 20. Frequency tables or histogram were used for demographic variables. Descriptive statistics (Mean±SD) were used for variables. An independent sample t-test was used as the data is normally distributed.

Results
This comparative cross-sectional study included men and women who met the inclusion criteria and were willing to participate. A total of 138 participants were included, 60 men and 78 women (Table 1).


The age range of the participants varied from a minimum of 23 years to a maximum of 30 years. Of the 138 participants, 69 have graduated from the government sector, while the remaining 69 had graduated from the private sector (Table 2).


Among the participants, 97 were working in clinical setups, while 41 were working in academic setups (Table 3).




To compare between variables of the governmentsl and private sectors, a t-test was utilized. The analysis revealed differences in the Mean±SD of each variable derived from the reflective practice assessment scale for graduates of the government and private sectors. However, upon conducting an independent t-test to compare the variables, it was found that none of the variables reached statistical significance because all the variables had P>0.05 (Table 4).



Discussion
In clinical practice, reflection on thinking, standard behavior, and skill development are effectively linked with systematic critical inquiry, analysis, and clinical decision-making. This typically belongs to the methods of perception and clinical reasoning [7].
Reflective practice is fundamental education for professional development which provides both assessment and feedback for the betterment of practitioners [8].
A total of 138 subjects between the ages of 23 and 30 years participated in this study. The highest frequency of participants was observed in the age group of 26 years, accounting for 28.3% of the total sample. The lowest frequency was found among participants aged 30 years, with only 1 individual representing 0.7% of the sample. The study included men and women, with a frequency of 78 women (56.6%) and 60 men (43.5%).
The sample included an equal number of participants who graduated from governmental and private sectors, with 69 individuals (50%) in each category. Regarding the participants’ professional settings, the majority were clinicians, with a high frequency of 97 individuals (70.3%), while a smaller proportion worked in academic settings, with 41 individuals (29.7%).
The study was conducted to compare the reflective practice of practitioners who graduated from the governmental and private sectors. The total scores obtained from the reflective practice assessment were 37.34 for governmental sector graduates and 37.26 for private sector graduates. These scores indicated no significant difference in the results between the two groups.
Five major elements existed in the reflective practice self-assessment scale with six sub-items. Major elements included reflection on events, reflection methods, other points of view, questioning of assumptions, and the ability to reflect.
Each major element score is categorized on a scale of 0-6 showing the need for potential development for reflective practice gained by the subjects. Scores range from 7 to 12 showing good potential in fair use of reflective practice if the subject falls in this range.
Each sub-element has a score of 2 with a total score of 60. Subjects falling in the range of 0-20 indicate low interest in reflective practice. Subjects with scores in the range of 21-40 show good potential to use reflective practice and subjects falling in the range of 41-60 have strong potential to use reflective practice [9].
The results of this study showed good potential for the use of reflective practice because most scores obtained by every practitioner either graduated from the governmental or private sector and works as a clinician or in academic centers range between 21 and 40.
The P for every variable is <0.05 showing no remarkable difference in the use of reflective practice self-assessment graduated from the governmental and private sector. This is the result of confirming the null hypotheses because no significant difference is observed in the scores of participants of both sectors.
The results of this study showed that the reflective practice of practitioners has no significant dependence on the educational sector. Both groups showed good potential for the use of reflective practice because the total score of government sector graduated practitioners is 37.34 with a minimal difference in the score of private sector graduated i.e. 34.26

Conclusion
This study shows no significant differences in the use of the reflective practice and self-assessment methods of novice practitioners regardless of their educational institute. Practitioners who graduated from any sector have an almost similar reflection on events, reflection methods, considering another point of view, questioning of assumptions, and ability to reflect on any issue. According to this study, it is concluded that the educational sector does not have a major impact in developing reflective practice and self-assessment among the students, but it may be an innate ability to use reflective thinking and reflection methods linked with clinical reasoning and decision-making power.

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest.

References

1. Osterman KF. Reflective practice: A new agenda for education. Education and Urban Society. 1990; 22(2):133-52. [DOI:10.1177/0013124590022002002]
2. Bolton G. Reflective practice: Writing and professional development. Los Angeles: Sage publications; 2010. [Link]
3. Dewey J. How we think. A restatement of the relation of reflective thinking to the educative process. Boston: Heath; 1960. [Link]
4. Cowan J, Goldhaber D, Theobald R. Massachusetts teacher preparation and licensure: Performance Review Program for Initial Licensure study. Washington, DC: American Institutes for Research; 2018. [Link]
5. Boud D, Keogh R, Walker D. Reflection: Turning experience into learning. Abingdon: Routledge; 2013. [Link]
6. Higgs J, McAllister L. Educating clinical educators: Using a model of the experience of being a clinical educator. Medical Teacher. 2007; 29(2-3):e51-7. [DOI:10.1080/01421590601046088] [PMID]
7. Donaghy ME, Morss K. Guided reflection: A framework to facilitate and assess reflective practice within the discipline of physiotherapy. Physiotherapy Theory and Practice. 2000; 16(1):3-14. [DOI:10.1080/095939800307566]
8. Hargreaves J. So how do you feel about that? Assessing reflective practice. Nurse Education Today. 2004; 24(3):196-201. [DOI:10.1016/j.nedt.2003.11.008] [PMID]
9. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education. 2009; 14(4):595-621. [DOI:10.1007/s10459-007-9090-2] [PMID]