Reflective Narratives by Student Physical Therapists on Their Early Clinical Experiences: An Inductive and Deductive Analysis—The Use of a Reflective Framework

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Written narratives are used to develop reflective skills in health care students during clinical education. The purpose of this study was to explore the effectiveness of using a framework in narrative writing to facilitate reflection in physical therapy students during their initial short-term clinical experiences.


Each of 20 written narratives by physical therapy students was explored during their first clinical short-term experience.


Data analysis was an iterative process consisting of eight individual researchers and cross-group researcher analyses for the development of themes and levels of reflection. Descriptive statistics, percent agreement between pairs of researchers, was calculated based on the number of times the identical rating was assigned to a narrative by pairs of raters. The strength of agreement between researchers was measured using inferential statistics.


Five themes emerged; these were patient-centered care, professional role, ethical issues, critical thinking, and student and clinical instructor relationship. Researchers determined that all 20 narratives contained reflection compared with a previous study in which only 64% of the narratives examined contained reflective writing. Analysis showed percent agreement between eight researchers ranged from 60% to 85%, with a mean of 73%. The weighted Kappa scores ranged from fair to substantial agreement, with the exception of one rater who demonstrated poor agreement relative to the consensus.


The results of this study support the use of a framework in narrative writing to foster reflection in physical therapy students during their initial clinical experiences. Consistent levels of reflection occur through the use of a model that helps students connect specific experiences with their thoughts and feelings about those experiences. There was moderate agreement among researchers in choosing levels of reflection across narratives.

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