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Year : 2010  |  Volume : 23  |  Issue : 3  |  Page : 285

Teaching Reflection: Speech & Language Therapy Students Using Visual Clues for Reflection

Hanze University, Groningen, The Netherlands

Date of Submission09-Dec-2008
Date of Acceptance16-Sep-2010
Date of Web Publication30-Nov-2010

Correspondence Address:
M A Schaub-de Jong
Eyssoniusplein 18 9714CE Groningen
The Netherlands
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Source of Support: None, Conflict of Interest: None

PMID: 21290354


Introduction: Reflection is an essential tool for the development of professional behaviour. Central to all reflection methods is language, either written or spoken. As the use of language is not easy for all students, especially those learning in a language other than their native tongue, it is essential that teachers use alternative methods to stimulate reflection.
Aim: To identify the benefits that speech and language therapy students perceive in an educational approach that combines pictures and drawings as a stimulus for reflecting on professional experiences.
Method: During an international course twenty-two students of various nationalities participated in a two-hour session and reflected on professional experiences. To stimulate reflection, drawings and pictures were used. All the students were asked to evaluate this educational approach by responding to five open-ended questions. Their responses were coded and analyzed.
Results: Students' comments fell into three categories of perceived benefits: (1) educational approach benefits; (2) personal benefits; and (3) professional benefits. Almost all the students reported that the nature of the reflection exercises helped them verbalize their experiences after the profession-related exercises.
Conclusion: This study provides evidence that visualizing as a first step towards verbalizing experiences can foster learning through reflection. It provides students with greater opportunities to verbalize awareness, especially within a group of students who may have difficulty expressing themselves in a non-native language.

Keywords: Reflection, teaching, evaluation, professional behaviour

How to cite this article:
Schaub-de Jong M A, van der Schans C P. Teaching Reflection: Speech & Language Therapy Students Using Visual Clues for Reflection. Educ Health 2010;23:285

How to cite this URL:
Schaub-de Jong M A, van der Schans C P. Teaching Reflection: Speech & Language Therapy Students Using Visual Clues for Reflection. Educ Health [serial online] 2010 [cited 2022 Jan 27];23:285. Available from:


The ability to reflect on experiences is a prerequisite for developing appropriate professional behaviour1. A person reflects in response to personal experiences and those of others. The individual then critically analyzes these thoughts and feelings in the context of his/her existing knowledge2.This reflective process can generate self-awareness and a deeper understanding of personal behaviour, which can in turn improve professional behaviour.

Students usually learn the reflective process in small-group sessions or by writing reflective reports based on experiences from professional practice3,4,5. Central to all of these methods is language, either written or spoken. With the growing international exchange of students, language can sometimes be a barrier to engaging in reflection. The first step is especially difficult—-clarifying the experience—because typically this requires a deep level of abstraction and is quite difficult to verbalize. It would be useful to have alternative methods which do not explicitly centre on language when helping students clarify their experiences to begin the reflection process. Visualization offers an opportunity, since drawing and choosing appropriate pictures have previously been used successfully as a method in professional development6.

This study identifies the benefits students perceived when asked to use reflection with visual aids such as pictures or drawings. A qualitative analysis based on written evaluations was undertaken. The following research question was formulated:

What benefits do learners perceive when pictures and drawings are used to stimulate reflection?


Context of the study and participants

The study was carried out among speech and language therapy students who participated in an international programme over two weeks. This programme is a project specifically geared towards Speech Language Therapy (SLT) and Audiology students. In a two-hour group session, twenty-two students from twelve European countries participated in “the educational approach: expression, voice and reflection”. Two speech and language teachers and one teacher specially trained in reflective learning participated in the session.

The session started with a mindfulness exercise. Students were asked to pay attention to and be aware of their feelings and thoughts in a guided mindfulness exercise. After that, students participated in two profession-related exercises – one on expression (clarifying the intent of your message) and one on voice (training voice skills useful for SLT treatment). After each of these exercises, students were invited to reflect. After the expression exercise the students had to pick a picture from a set of pictures that best fit their experience. After the voice exercises students were asked to draw a picture to express their experiences. The students thus expressed a visual reflection of an experience that all the students participated in, meaning that there was no need to explain the experience. They were free to concentrate on expression and awareness of feelings and thoughts without needing to directly verbalize them. At the end of the session the reflection teacher invited the students to discuss in English the reasons for their choices of pictures and drawings in order to increase their self-awareness.

After the session, students evaluated what they learned in responding to five questions about the benefits they perceived in the educational approach (Table 1). Participation in this evaluation was voluntary. Students were informed about the research question we were addressing and that their anonymity was guaranteed.


The first author conducted a qualitative content analysis of the written evaluations and developed the coding scheme. The data were coded using open coding techniques7, which entailed assigning names to items reflecting perceived benefits and combining related items into categories. To minimize personal bias a second individual who was working as a teacher in a professional development course independently coded ten evaluations. Differences in coding were discussed until agreement was reached. These findings were then discussed with the second author.

Table 1:  The evaluation questions



All students (n=22) participated. All written evaluations (n=22) were analyzed. The length of the evaluations varied from half a page to one page. The coding process yielded three categories of perceived benefits: (1) educational approach benefits; (2) personal benefits; and (3) professional benefits (Table 2).

Educational approach benefits

Almost all students reported that the nature of the reflection exercises helped them express what they had felt during the profession-related exercises.

Student 15: It was easier to be aware of my feelings and thoughts and how they are related to the professional problem. So that one can see more perspectives…

Five students reported that although they experienced increased awareness they had difficulties in verbalizing their experiences. They were able to choose a picture or make a drawing as a stimulus for reflection. Verbalizing their thoughts or feelings in English (the spoken language during the session) remained difficult. Five students had difficulties with producing drawings. They felt uncomfortable with this kind of exercise. Although they mentioned difficulties with expressing themselves through drawing a picture, they participated in the discussion at the end of the session.

Personal benefits

Most students mentioned that after the exercises on reflection they were able to be more explicit about their feelings/thoughts. Nineteen students reported that the pictures or drawings helped them think more deeply about themselves.

Student 8: It makes me calm and then it allows me to look inside without being distracted by everything else.

Professional benefits

Students also reported on the benefits with respect to increased awareness of professional functioning. Eighteen students reported that the combination with profession-related exercises and reflection increased their awareness about themselves as SLT therapists. They saw that this awareness can contribute positively to their interaction with clients.

Student 1: It will be easy to be more empathetic with your clients, or . . .

Student 20: It is important to evolve and reflect to be able to help others . . .

Table 2:  Students’ perceived benefits of the educational approach

Conclusion and discussion

This study was conducted to gain insight into the ways students perceive the benefits of reflection on professional experiences when alternative methods are used as a stimulus for reflection. Twenty-two speech therapy students from twelve European countries mentioned benefits from the alternative reflection methods and also mentioned personal and professional benefits.

The combination of profession-related exercises and reflection is closely linked to the students’ interest in becoming professionals and thereby enhanced their willingness to reflect and stimulated their professional awareness8. Additionally, the use of different stimuli for reflection takes into account the diversity of language possibilities and the learning needs of the students in the given group. The combination and diversity of teaching methods for reflection meets the needs of a wide range of students and provides students with greater opportunities to start the reflection process9. Reflective activities therefore should not be restricted to a category of exercises with a focus on starting with verbalizing2,6.

Although this pilot study is limited in scope, its results indicate that positively linking different reflection methods directly to professional content can foster learning through reflection. We also learned that when language is a barrier for students, alternative stimuli for reflection can possibly make it easier to engage in reflection. We suggest that it is worthwhile extending this method to professional development and reflection.

Ethical approval:  In accordance with national practice in the Netherlands where this study was carried out, ethical approval is not required for educational studies and surveys. However, we can confirm that participants cannot be identified from the material presented and that no reasonably foreseeable harm to participating individuals can arise from the study.


I would like to thank my colleagues, Lies Akkerman and Marijke Grotenhuis, for their contributions during the development of the educational programme and for their contributions during the session. I would also like to thank the students of the International Programme for their openness during the session and Prof RMH Schaub for his critical revisions on the manuscript.


1. Aukes LC, Geertsema J, Cohen-Schotanus J, Zwierstra RP, Slaets JPJ. The development of a scale to measure personal reflection in medical practice and education. Medical Teacher. 2007; 29(2):177-182.

2. Boud D, Walker D. Promoting reflecting in professional courses: the challenge of context. Studies in Higher Education. 1998; 23(2):191-206.

3. Caroll M, Curtis L, Higgins A, Nicholl H, Redmond R, Timmins F. Is there a place for reflective practice in the nursing curriculum? Nurse Education in Practice. 2001; 2:13-20.

4. Tigelaar DEH, Dolmans DHJM, Meijer PC, de Grave WS & Vleuten CPM van der. Teachers’ interactions and their collaborative reflection process during peer meetings. Advances in Health Sciences Education. 2008; 13(3):289-308.

5. Schaub-de Jong, MA, Cohen-Schotanus J, Dekker H, Verkerk MA .The role of peer meetings for professional development in Health science education: a qualitative analysis of reflective essays. Advances in Health Sciences Education. 2009;14:503-513.

6. Schaub-de Jong, MA. Effecten van reflectieonderwijs in een competentiegericht curriculum[What students learn from training reflective skills in a competence-based curriculum: a qualitative study]. Tijdschrift voor Hoger Onderwijs. 2007; 24:229-238.

7. Miles MB, Huberman AM. An expanded Sourcebook. Qualitative Data Analysis. 2nd ed. London: Sage Publications;1994.

8. Driessen EW, Tartwijk J van, Overeem K, Vermunt JD & Vleuten CPM van der. Conditions for successful reflective use of portfolios in undergraduate medical education. Medical Education. 2005; 39:1230-1235.

9. Schön DA. The reflective practitioner: How professionals think in action. New York: Basic Books:1983.


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