‘Patchwork text’ reflective assessment


When did you first introduce the innovation?

More than 24 months ago

Please describe the innovation you have developed

We developed a 20 credit unit within our MSc in Professional Practice titled ‘Valuing People and Celebrating Diversity in Professional Practice’. We sought an assessment method that evidenced the learner examining their own values system to arrive through a perspective transformation at a new informed position.

The assessment was designed in two parts:

Part 1 the student provides 4 or 5 patchworks, which are reflective accounts that illustrate how their values and past experiences underpin their professional practice. Pictures, poems life events, books can be included as illustrations /appendices to strengthen the creative narrative of each patchwork 2,000 words.

Part 2 the student provides evidence based analysis of the themes appearing or absent within their 4 or 5 patchwork texts. This reflexive analysis leads to a perspective transformation and to new learning to inform future practice 2,000 words.

What prompted you to develop this innovation?

As values have become more apparent through policy and the concern re lack of compassion, we wished to develop an education experience which caused the learner to challenge and develop their own values system. The exploration stemming from the patchworks could then illustrate how the student ‘becomes to know’. We wanted an evidence-based approach to learning which recognised the ‘interactional’ philosophical position of the health professional as they made sense of their own identity and their identity within a professional role. Also to acknowledge how knowing is a continually changing facet.

In your view, what is it about this innovation that makes it different/important?

The student experiences revealed that their patches often reveal early socialisation and value formation that has never been challenged or reviewed. Therefore the unit deliver (20 hours taught) takes the students collectively through a learning experience which has resulted in some powerful perspective transformations which are fundamental to professional practice.

These reflexive accounts are excellent for professional revalidation as designed by the NMC 2015.

To what extent does your innovation make use of existing approaches, resources or technologies?

The use of patchwork texts foster a creative writing style, that can cause some students a sense of unease as they find this is not simply a traditional academic assignment exploring a given dilemma.

The student begins to realise that multiple data sources merge within their lives to shape who they are and how they practice. They then require to use their own stories as data, in a form of qualitative analysis. They the turn their analytical skills on themselves to identify key factors within their development. Literature, research and other theories are then discussed to support their self- analysis to provide an alternative stance on which to base their future professional practice.

To what degree has this innovation led to changes in education or clinical practice?

We provide 2 main examples

1. A Teacher has identified a ‘blind’ area in her teaching practice and confronted and examined this issue. Resulting in an enriched ability to teach the potentially sensitive area of the politics of health and healthcare.

These new insights are a work in progress, and will continue to develop practice for several years to come. An early example of change in practice includes: A proposal and adoption of changes in lesson design throughout levels 4, 5, and 6 teaching to raise awareness of the political climate; health in the news and how the political climate influences policy and therefore healthcare.

At each level in the module suite the lecture will open with a short discussion of the week’s health news both national and international. The theory discussed in each taught session will then link back and weave threads through the current affairs discussed earlier. Thus enriching students’ awareness of the impact of political decision making in public health, and the importance of influencing these decisions as professionals.

This teacher says that this proposal and new confidence in managing political aspects of teaching is as a result of making links through her patchworks back to early life influences and being able to examine her motivating forces.

2. How a midwife responds to the question ‘Do you have any children’ from birthing mothers, having suffered the tragic loss of her own son.

Midwife’s response to question:
‘It is over a year since I completed the patchwork text and coming up for a year that I wrote the published article and so I have had time to reflect on them both.

I have discussed the patchwork assignment many times with colleagues, tutors and fellow students and the word that always springs to mind is cathartic. In order to achieve the learning outcomes of the unit, I had to really look deep inside myself and almost deconstruct my own personality. I engaged enthusiastically with the process and learnt things about myself through reflection that I had never understood before.

By delving into where my values came from growing up, and how they have developed through adolescence, adulthood and professionally I used each patch to illustrate a certain period or event. The recognition that I have developed a unique personality with my own values that don’t absolutely replicate those of my parents, school teachers or peers is a revelation. I see my differences, my tolerances and my attitudes and appreciate I have cherry picked the best bits from everyone.
The patchwork text led to the publication of an article in a professional journal concentrating on one of the patches – the death of my son. This gave me a further opportunity to explore how it has affected my professional life and I came up with some startling admissions. I realised that my professional outlook and practice had shifted slightly as I no longer felt as comfortable sharing a childbirth connection that had been the basis for my chosen career in the first place and dreaded the question ‘Do you have children?’

By using Gibbs’ reflective cycle, I could see that I not only had to reflect on how I felt but form an action plan about what I would do if the situation arose again. And it would happen again- frequently. I concluded that I had to find ways of answering the question honestly and being authentic with the women in my care.

Since that acknowledgement I have not reflected if my practice and tactics has altered until now. I am relieved to say that it actually has changed! I still dread the question, but feel more prepared to answer truthfully when it comes. I will often preempt the question by intimating I have experienced childbirth in conversation, giving me control over the situation but still sharing the bond that I value. I have started teaching at parent education classes again, which again allows me to share how much I want to rather than being taken by surprise.

The main change in my practice is that I have become a member of the Pregnancy Loss group and have attended 3 study days this year already. Trying to find a positive out of tragic circumstances has led me to become more active within this field as I feel I have a dual perspective – that of a professional, dealing with a situation, but also as a bereaved parent and being able to share that most horrible bond’.

What evidence do you have of the impact of the innovation?

This session design has been adopted by the module suite team as a learning mechanism throughout the module suite through levels 4,5 and 6.

To what degree has the innovation been disseminated in your organisation or elsewhere?

Student developed insights from patchwork text in to publication.

Kelly S1 Do you have any children? Pract Midwife. 2014 Dec;17(11):24-6.

Please provide details of any plans you have to disseminate the innovation in the future.

I am considering writing a book based on the students and my own learning through reflective experiences re. patchwork texts and autoethnography.