Received: 10 August 2020 | Revised: 18 October 2020 | Accepted: 26 October 2020 DOI: 10.1111/eje.12623 ORIGINAL ARTICLE Reflection before and after clinical practice—Enhancing and broadening experience through self-, peer- and teacher-guided learning Michael Botelho | Sangeeta Y. Bhuyan Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China *Correspondence Michael Botelho, Room 3b19, The Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong. Email: botelho@hku.hk Abstract Introduction: This paper explores a novel pedagogy surrounding students’ clinical practice sessions. Before each clinical session, student clinical groups meet and each student presents their treatment planned for that session. The teachers question their understanding and explore “what-if” and other management scenarios. Peers in the clinical group observe the presentation and learning dialogue. After the clinical session, students gather on the clinic to debrief their performance with the tutor. Peers observe this dialogue, the shared clinical experience. This paper explores students’ perceptions of reflection before action and reflection on action surrounding their clinical practice. Methods: Focus groups were conducted to explore this phenomenon and to create a questionnaire, which was administered to the whole class. Transcriptions of the focus groups and open-ended response in the questionnaire were subjected to a thematic analysis to identify emerging themes and supported by closed-ended question responses. Results: Briefing sessions before clinical sessions helped students identify problems and clear doubts before entering clinics. Students were able to recall and rehearse the clinical procedural knowledge and felt well prepared and confident for patient care. Student sharing of knowledge with peers provided a broader learning experience and helped gain confidence. Students also reported to learn from the teacher facilitating their preparation for the session. Debriefing sessions after the clinical session allowed reflection and learning including error correction on their own and peer experiences. Students learnt personally, from peers and from the teacher, and emphasised the importance of the student-teacher relation. Conclusions: Briefing and debriefing sessions were highly valued by students for preparation and learning on clinics and in learning from peers. Briefing sessions cleared misunderstanding, prevented errors, broadened procedural knowledge and improved both confidence and clinical experience. Debriefing sessions facilitated reflective practice, error correction and prevention, and helped gain insights from teachers’ own experience and perspectives. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ. 2020;00:1–8.  wileyonlinelibrary.com/journal/eje | 1 2 | BOTELHO and BHUYAN KEYWORDS briefing, clinical experience, debriefing, peer learning, reflection 1 | I NTRO D U C TI O N The aim was to allow sharing of knowledge and experience between students by learning through observing one another's presentations Clinical treatment sessions for students’ learning is a resource-inten- or reflections, thereby broadening and enriching the learning experi- sive, high-stake, stressful learning environment.1,2 Students have an ence. In a seminar room immediately before the clinical session, stu- obligation to be prepared for patient care such that they have the re- dents in turn present to their clinical teacher and group mates their quired knowledge and performance skills necessary to carry out the supporting and procedural knowledge of what treatment they are treatment.3 Likewise, teaching staff need to know whether students going to perform in that session—reflection before action (Figure 1). have the supporting and procedural knowledge ensuring their capa- Students present their planned treatment before every session, and bility to conduct the treatment on their patients.4 Clinicians and stu- depending on the case, they may present mounted study models, dents are expected to be reflective practitioners, and this is included laboratory work, radiographs and clinical pictures. This short pre- in competency guidelines by dental organisations and is included in sentation involves questioning by the teacher to ensure the student portfolios and assessment tools used in the healthcare curricula.5 demonstrates sufficient background knowledge and understanding Schön introduced the value of reflection with respect to profes- of the clinical procedure and may include possible “what-if”–type sional knowledge and defined reflective practice as “the capacity to scenarios, management scenarios and possible advice from the reflect on action so as to engage in a process of continuous learn- teacher. This allows the teacher to know that students are prepared ing.”6 In reflection on action, an individual looks back on how they and are safe to provide care to their patients for that session. In acted and reflects on their action in order to learn how it can lead to addition, from the associated dialogic discourse between teacher 6 the attained outcome. However, there is another perspective that and one student, peers learn from the student presentations of the can be considered particularly for beginners to new or challenging treatment planned for that session and reinforce or acquire new situations: reflection before action.7 Reflection before action, some- knowledge. The student presentations are not assessed. The brief- times referred to as “anticipatory reflection,” can be considered a ing sessions have one teacher per group of students (8–10 students) type of mental preparation and is a kind of combination of prepara- and are time-tabled to start at the beginning of each clinical session tion and planning, in which forward thinking reflection and proce- (09:00AM and 02:00PM) for 30 min. Students immediately proceed dural knowledge are combined.8 to the clinic and work individually on their patients during the ses- Since 1998, briefing and debriefing sessions have been con- sion with possible support from a dental nurse. ducted as routine before and after student clinical treatment ses- After the end of the treatment session (2.5 h), there is then a sions at the Faculty of Dentistry, University of Hong Kong. These debriefing, where the students gather together on the clinic to dis- sessions were designed as a means to support and enhance the cuss how their treatment session went, what was learnt, what could student learning experience both individually and collaboratively. have gone better and what considerations for improvements may F I G U R E 1 Proposed learning cycle and interaction of triad roles (self, peer and tutor) relating to reflection before, in and after action | BOTELHO and BHUYAN 3 be enacted. The duration of debriefing sessions (approximately Twenty-seven items were created for the questionnaire with a 25- 15–30 min) depends on individual tutors and the need for in-depth item Likert-scale response and two open-ended questions (Table 1). discussion dependent on case complexities and available time. This The open-ended questions were also analysed using an inductive usually occurs by students presenting one by one their treatment thematic analysis. outcomes or experience to the teacher and group mates who then These questionnaires were uploaded on the learning manage- may question the student about the treatment session. This allows ment system (Moodle) and made available to the class of 2020 in students to formally verbally reflect on their session in front of their their 5th year. A descriptive statistical analysis of the questionnaire peers again allowing a broader experience for peers to learn from was performed. the analysis of a particular feature of their performance—reflection on action (Figure 1). The aim of this study was to explore the briefing and debriefing sessions and to perform an evaluation of this learn- 3 | R E S U LT S ing phenomenon by using student focus groups and a questionnaire with open- and closed-ended questions, which was informed by the From the 2020 class of 55 students (26 female and 29 male), 53 stu- focus groups. dents consented and completed the evaluation questionnaire (96%). Likert-scale responses were conflated into agree and disagree. 2 | M E TH O DS From the analysis of the focus groups (FG) and the questionnaire responses (QR) of students, thematic analysis revealed the following overlapping themes: Ethical approval was obtained from the Institutional Review Board Clinical briefing sessions of University of Hong Kong/ Health Authority Hong Kong Wester Cluster (# UW 16-262). This study was conducted in the Faculty of 1. Preparation for clinics Dentistry, the University of Hong Kong (HKU). To join this study, 2. Learning from peers participants would be a BDS (bachelor of dental surgery) student. 3. Learning from tutor Participants were recruited through emails and by contacting class 4. Affective aspects—confidence, stress and concentration representatives, who circulated our invitation to students. An informed written consent was obtained from each participating stu- Clinical debriefing sessions dent. Two student focus group interviews with seven students in each were conducted to help explore and understand the usefulness 1. Student self-learning of the briefing and debriefing sessions and to gather data and help 2. Learning from peers construct a valid questionnaire. A question guide was used to direct 3. Learning from tutor the discussion, which was constructed by the research team and col- 4. Student-teacher relationship leagues to determine the aspects to be covered. Focus groups were conducted in English in a quiet meeting room in the hospital without interruptions. The focus groups lasted 30–45 min and were led by an experienced focus group moderator (MB). The moderator kept a 3.1 | Clinical briefing sessions neutral and non-judgemental stance and was fully aware not to ask any leading questions. The moderator encouraged all participants to 3.1.1 | Preparation for clinics view freely, and ensured the discussion was not dominated by any particular member. Students were asked to share their experiences Students reported briefing session helped prepare for challenges and also reassured that all opinions collected would be kept confi- and clarified doubts before entering clinics, “although we have read dential and anonymous. All interviews were audio-recorded with the about that (procedure) from the books but actually the real situa- participants’ written consent. tion is a bit different so the student can use the chance to ask the Focus groups were transcribed verbatim, and thematic analy- tutor so that less unexpected things would happen in the clinic” (FG). sis was conducted. Themes were developed through an inductive Students also mentioned the briefing sessions helped “identify prob- method (ie as they emerged from the data). The evaluation ques- lems before they actually happen” and enabled them to “correct mis- tionnaire was devised by the research team from themes based on conceptions before treatment starts” (QR). In particular in context students’ comments and divided into two sections: “briefing—before of patient safety, “sometimes we miss out some points that are quite the clinical session” and “debriefing—after the clinical session.” The essential, and for the patient's sake, it is a good idea to have brief- designed questions were critiqued by two colleagues and four stu- ing that help us prepare more” (FG) and to “minimise clinical risks” dents to ensure clarity and understanding with field notes taken to (FG). This is supported by the questionnaire results with over 90% of facilitate amendments to the questionnaire. Subsequent to this, the students reporting briefing sessions helped identify any confusion revised questionnaire was again piloted on students and revealed or misconceptions about the clinical procedure and allowed clarifi- no significant issues with understanding of the questionnaire. cation for treatment (92.5%, QR4, 6). Briefing discussions facilitated | 4 BOTELHO and BHUYAN TA B L E 1 Student learning experience evaluation questionnaire response (QR) Likert scale from strongly agree, agree, disagree, strongly disagree and not applicable Questions Agree/ Strongly agree (%) Disagree/ Strongly disagree (%) Not applicable (%) 1 The clinical briefing discussion allows me to present my knowledge and express procedural understanding of the patient care that I will be performing during the clinical session. 90.6% 7.5% 1.9% 2 The preparation time I take prior to the briefing session for my case presentation helps my learning and clinical understanding of the procedure(s) I will be performing. 94.3% 5.7% 0.0% 3 The presentation of my case to my group mates during the clinical briefing session makes me feel more prepared? 96.2% 3.8% 0.0% 4 The clinical briefing discussion allows any localized misunderstanding I may have about my patient's care or treatment procedure to be clarified. 92.5% 5.7% 1.9% 5 I learn from my colleague's presentations of their patient's care or treatment procedures during the clinical briefing sessions. 92.5% 7.5% 0.0% 6 The briefing discussions are useful in helping to identify any confusion or mis-conceptions I or my colleagues may have about the clinical procedure or associated knowledge that is about to be performed. 92.5% 7.5% 0.0% 7 Hearing my group mates present their clinical cases helps refresh or revise my own knowledge, experience and procedural skills than I would just on my own. 88.7% 5.7% 5.7% 8 Hearing my group mates present their clinical cases helps me acquire a broader range of knowledge and experience about clinical knowledge and skills. 92.5% 7.5% 0.0% 9 The briefing discussions are useful as they can fill in gaps of knowledge I may have about clinical matters. 90.6% 3.8% 5.7% 10 My case presentation on the clinical briefing session improves my clinical confidence for that session. 88.7% 1.9% 9.4% 11 Gaps in knowledge or procedural understanding exposed during the briefing presentation can become useful learning issues for future sessions. 92.5% 3.8% 3.8% 12 During my presentation and associated tutor questioning, I learn from any mis-conceptions or wrong ideas I may have. 94.3% 3.8% 1.9% 13 I think all of the clinical sessions should have a briefing session. 94.3% 1.9% 3.8% 14 There would be benefit to reduce the length of time for the briefing sessions during the clinical skills periods after module 4 to allow more clinical time for patient care. 47.2% 47.2% 5.7% 15 Briefing sessions that are significantly longer than 30 min adversely affect my clinical time for patient care. 79.2% 20.8% 0.0% 16 The presentation of my patient case during the clinical briefing is stressful. 54.7% 41.5% 3.8% 17 I find concentrating or listening carefully to my group mates’ presentations difficult during the briefing until I have finished my own presentation. ie I am distracted until I have presented my own case. 49.1% 50.9% 0.0% 18 The questioning by the tutor of my knowledge helps my understanding in the briefing session. 92.5% 5.7% 1.9% 19 I learn more from the debriefing than the briefing. 47.2% 49.1% 3.8% 20 I learn more from hearing a group debriefing (ie hearing others debriefing and feedback) with the clinical tutor than a one-on-one debriefing. 71.7% 24.5% 3.8% 21 During group debriefing discussion I learn from the identification and exploration of mis-conceptions or accidental errors that I may have made. 84.9% 9.4% 5.7% (Continues) | BOTELHO and BHUYAN TA B L E 1 5 (Continued) Questions Agree/ Strongly agree (%) Disagree/ Strongly disagree (%) Not applicable (%) 22 During group debriefing discussion I learn from my peers misconceptions or accidental errors that may have been made. 86.8% 11.3% 1.9% 23 I learn/remember more if I have to work out or find out an answer to a question rather than being explained it by the tutor. 66.0% 26.4% 7.5% 24 Hearing my group mates debriefing discussion helps me acquire a broader range of knowledge and experience about other clinical knowledge and procedural skills. 90.6% 7.5% 1.9% 25 The questioning by the tutor of my knowledge helps my understanding in the debriefing session. 83.0% 11.3% 5.7% Open-ended questions Which is more useful for students’ learning, the briefing at the start of the clinical session or the debriefing at the end? Please explain why. In what way do the briefing and debriefing sessions offer different learning experiences? learning by helping students to “recall knowledge and clinical pro- only the operator but also other group mates get an idea of what cedures needed for the treatment and the understanding of them” he or she will perform and we can share the case with others so (QR). that we can have a clear understanding” (FG). The questionnaire Student preparation prior to their case presentation in the brief- results found that students strongly agreed that they learn from ing sessions was reported to stimulate students to “learn more about their colleague's presentations (92.5%, QR5), and these presenta- your case” and help “revise and we can remind if the patient has any tions helped revise their knowledge and broaden their experience allergy to the drugs or any medical complication” (FG). Briefing ses- (88.7%, QR7). sions also helped students understand the “rationale of the treatment” (QR). As students prepared for their briefing session, they reported to “spend more time on preparing the whole procedures 3.1.3 | Learning from tutor and also read up some more about the theory behind” (FG). The briefing discussions helped students feel well prepared for their Students reported tutor questioning in the briefing sessions helped performance in clinics and patient care. The briefing “in-depth dis- them to verify their knowledge: “questions raised by the tutors cussions” provided an “opportunity for student to think/rehearse” about the procedures and theories behind those steps makes sure before entering clinics (QR). Briefing sessions allowed students a we not only know the procedures but also have a sound knowledge” “preparation and execution strategy of a particular clinical proce- (FG). Tutor questioning also helped in knowledge reinforcement and dure” (QR). This is supported by the questionnaire response, with error identification and correction; tutors “help us to remember the students strongly agreeing that briefing discussions allowed them to procedure more clearly so…, we won't be too confused”; and tutors present and express their procedural knowledge to be performed in help “point and identify… mistakes” and “clear misconceptions” (FG). clinic (90.6%, QR1). The process of preparation for these presenta- Students also reported benefits from tutors sharing knowledge and tions was reported by students to help in their learning and clinical experience; students reported, “we are very inexperienced and the understanding of the procedure(s) (94.3%, QR2). tutor can share experience with us and then we know which step we may need to be extra careful… and …if something goes wrong” (FG). The questionnaire results found that the majority of students 3.1.2 | Learning from peers agreed that tutor questioning of their knowledge helped in their better understanding (92.5%, QR18). Students also strongly agreed Students reported to learn from peers during the presentation of that briefing discussions identified and filled their gaps of knowledge their case and acquire a greater depth of clinical experience and (90.6%, QR9) and that all clinical sessions should have a briefing ses- knowledge in the briefing sessions. A student shared, “we learn sion (94.3%, QR13). something that we haven't learnt before, we haven't done before” (FG) and are “…expose to more different situations” (FG). This is supported by the questionnaire response in which students reported to acquire a broader range of clinical knowledge and ex- 3.1.4 | Affective Aspects—confidence, stress, concentration perience from group mates’ clinical cases (92.5%, QR8). Also, hearing group mates’ presentations helped students get a better The questioning approach by tutors in briefing sessions helped stu- understanding of their clinical cases and clinical procedures, “not dents gain confidence and having “gone through that challenge… you 6 | BOTELHO and BHUYAN say that, oh actually I am confident in doing…” (FG). Furthermore, a you have already committed some error I will be more aware… and student shared, “if there is no briefing session, I will have less con- remember that…” (FG). Student responses showed that students fidence in doing my job because during the case presentation you learn from exploration of their own misconceptions and errors made will present and visualize what you will be doing in the clinical pro- in clinics (84.9%, QR21). cedures” (FG). Students also reported to feel “unsafe if there is no briefing” (FG). The is supported by the questionnaire results with a large majority of students feeling that presenting their cases dur- 3.2.2 | Learning from peers ing the briefing session helped them improve their confidence for the clinical session (88.7%, QR10). However, the process of present- Students reported to share, enjoy and learn with peers after clinics, ing in the briefing was perceived to create some stress, a student “we learn as a group” and “we would like to share with others and to shared, “In the briefing session, it tenses me more,” “I feel like I am learn some new techniques and new skills” (FG). Students specified more stressful when I have the briefing because I am afraid of what the importance of sharing knowledge, “it is useful for us to know the tutor might ask me knowledge wise” (FG). This is supported by more about not just our own patients but also about classmates” the questionnaire response with 54.7% students felt stressful dur- (FG). The questionnaire results found that students learn more from ing their own clinical case presentation (QR 16). In reaction to this, hearing from group debriefing than a one-on-one debriefing (71.7%, students also reported to have difficulties in concentrating on peer QR17). Students reported to acquire a broader learning experience case presentations “because I have my own case to concentrate on” from their group mate's debriefing discussions about clinical knowl- (FG). The questionnaire results found that approximately half of the edge and procedural skills. A student shared, “if you listen to oth- students reported to be distracted and difficulty concentrating on ers presentations and learn from other patients or learn from other their group mates’ presentations until they had finished their own group mates’ …procedure then you will learn little bit more than and presentation (49.1%, QR17). not limited to your patient” (FG). Like learning from personal errors, students reported to “learn by listening to other colleagues’ mis- 3.2 | Clinical debriefing sessions takes” (FG), in particular hearing peers “common problems…and how they can be solved in correct way” (QR). This is supported by the questionnaire response with students agreeing to learn more from 3.2.1 | Student self-learning the peers’ misconceptions or accidental errors that may have been made in clinics (86.8%, QR22). Students reported different perceptions of the briefing and debriefing sessions. Some students specified that “briefing is more useful” as they are “more attentive before they carry out a clinical proce- 3.2.3 | Learning from tutor dure.” Students also reported to be “more focused due to its fixed time duration,” whilst in debriefing, students are “too busy” and “in Students appreciated the debriefing discussions as the “tutor can a hurry…trying to complete their paperwork, patient case etc” (QR). give feedback to their performance,” “what we have learned today” Students reported the briefing helped in “basic knowledge and case and described them as “kind of evaluation of what you have done preparation” whilst debriefing sessions were “more on problems as- right or wrong and it is the major learning part outside the clinical sociated with their clinical work” (QR). Conversely, some students time” (FG, QR). described debriefing sessions as “more practical,” “a bit more effec- Students also reported in context of their own mistakes that the tive” and “better” than the briefing (FG). Some students felt the de- tutor would “teach us not to do that again” (FG) and “pin point the briefing to be most important on learning, students shared “when things that we should really improve” (FG). you take away the debriefing sessions, then that means there is nothing to take away from that clinical session” (FG), and the discussion allows “reflection on the mistakes” (QR). These different views 3.2.4 | Student-teacher relationship were reflected in the relative even split on preference on learning in the briefing or debriefing sessions with 47.2% reporting to strongly Students recognised the impact of a student-teacher relationship agree on learning more from the debriefing, whilst 49.1% preferred in their learning experience and reported working with different the briefing sessions (QR19). Some students acknowledged that teachers “a bit of a struggle” as “different tutors have different “both (briefing and debriefing) aim differently, so not appreciate to style” (FG). Students preferred to have “same tutor…for the whole compare which is more useful.” module” (FG) and enjoyed and preferred sharing with a familiar Similar to the briefing sessions, a majority of students acknowl- group, it was “fun when it was in the same group” and “want to edged that tutor questioning of their knowledge helped their under- share clinical experiences with our group mates” (FG). Also, stu- standing in the debriefing sessions (83.0%, QR25). In the context of dents were aware of differences in staff knowledge in conduct- personal errors, students reported the impact of learning from these ing the session discussions: “what is lacking here now is the clear and how to reflect and improve. A student shared, “in the debriefing aims objectives for conducting the briefing and debriefing for the | BOTELHO and BHUYAN 7 F I G U R E 2 Four stages of Kolb's experiential learning cycle student ie the part-time and full-time clinical teacher are not well- exploring alternative ways or planning improved treatment proce- informed/aligned” (QR). dures to attain better outcomes in the future. Central to reflective practice is the belief that experience alone 4 | D I S CU S S I O N does not lead to learning, but rather the deliberate reflection on that experience.13 In this study, students mentioned their sharing before and after the clinic helped students to evaluate and reflect on their This study examined the perceptions and value of briefing and de- own and peer learning. This process of analysis and making meaning briefing sessions that were used to support students’ clinical learning from experience by reflection has been reported as an integral com- in the context of reflection before action and reflection after action. ponent of experiential learning.13 Reflection after action has been The two sessions served different yet valuable functions in support- reported as thinking back on an experience and deciding how the ing student preparation and reflection when learning on the clinics. situation could have been handled differently.14,15 In the briefing, students were able to identify and clarify problems This forms the foundation and key principle of the experiential as they reflected (reflection before action) before entering clinics. learning model by Kolb.16 This model describes how experience pro- The student presentations in the briefing sessions helped peers gain vides a primary source of learning and development through a four- knowledge and multiple perspectives for a broader learning experi- stage process (Figure 2). This process facilitates individual learning by ence and learn from teachers that helped in building self-confidence. making sense of and learning from their experiences to add new ele- Reflection before action is considered to allow students to think ments of learning for future use. However, this learning model uses a about various alternatives, plan a course of action and consider po- first-person, student-centred approach that does not include environ- tential outcomes.9 Reflection before action is necessary for students mental influences. From the examination of our experiential model of to examine previous knowledge and experiences, understand what clinical learning before and after clinics, we have demonstrated a triad is being asked of them and prepare for their clinical performance.10 relation on student learning including self, peers and the tutor (Figure 1). Student engagement in reflection before action is considered to allow Also, we have highlighted the importance of reflection before action, students to analyse and structure the clinical situation prior to it tak- which includes preparation and the briefing presentation. The actual per- ing place.11 The process of declaring this knowledge and having it formance relates to reflection in action and usually occurs between one explored and challenged by teacher questioning is said to affirm and student and the tutor, this has not been explored in this research. In the support students’ knowledge and preparation and in doing so provides reflection after action, there is again a triad relation of self, peer and self-confidence. It is presumed students find the briefing more helpful teacher in the debriefing dialogue to support learning and reflection. as they get affirmation of their proposed treatment and advice on how This model demonstrates a collaborative three-way partnership in stu- to manage any problems. This makes students feel more confident dents’ clinical learning for reflection both before and after action. after the briefing discussion. More research is required in this context. In this study, students identified the importance of sharing of The debriefing sessions (reflection after action) allowed students knowledge and learning as a group. Students also reported to learn to examine critical issues related to their own clinical experience, re- by observing peer treatment presentations and discussions in both late theory to practice whilst acquiring critical thinking skills and prac- sessions, gaining a broader learning experience and strategies for tise a process of self-awareness, self-assessment and goal setting. The approaching different clinical situations. It has been reported that debriefing has been reported as a time to reflect on any mistakes by students use experiences of their peers to learn for themselves and helping students to explore alternatives for improvement.6,12 Similar internalise what is said during discussions and reflect on how these findings were reported in this study with students presenting and actions can be translated into their own situations.17,18 Students 8 | BOTELHO and BHUYAN may feel stressed on their briefing presentation, and this can be at- ORCID tributed to several reasons as the presentation requires a spoken Michael Botelho https://orcid.org/0000-0003-4077-4716 presentation of their case, which they will be questioned and receive feedback on, which may impact their self-esteem. Further research REFERENCES is needed to identify the cause of this, and staff training may be a 1. Botelho M, Gao X, Bhuyan S. 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The development of reflective thinking and its influence on patient care skills in third year dental students. Columbia University; 2017. 15. Edwards SL.Learning from practice: the value of story in nurse education; 2013. 16. Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. Upper Saddle River, NJ: FT press; 2014. 17. Roberts D. Vicarious learning: a review of the literature. Nurse Educ Pract. 2010;10(1):13-16. 18. Yeadon-Lee A. Reflective vicarious learning (RVL) as an enhancement for action learning. J Manag Dev. 2018;37(4):363-371. way to reduce the stress of the treatment presentation moment. The teacher also has a critical role in the briefing and debriefing sessions. In the briefing presentation, the teacher explores that the student has sufficient knowledge and preparedness for safe patient care and by their questioning allows affirmation of student readiness and makes students feel more prepared and confident. In the debriefing session, the teacher facilitates reflection of individual students in their performance and how to self-evaluate helping in error correction and error prevention for future goal setting. This vicarious observation allows students to learn more. Teachers also share their own knowledge and experience such that students can learn from the “expert.” This needs further exploration. The limitations of this study include that the sample was drawn from a single dental institution with particular and individual characteristics. Therefore, whilst one realises the findings cannot be directly extrapolated to other dental schools with different teaching and clinical training models, it is expected that many themes will be similar. Also, this study includes a small number of students for the focus group interviews. However, even with these limitations, this study confirmed the value of reflective practice in supporting student experience and learning. Further studies are desirable to expand the understanding and role of experiential learning and reflective practice in dental student education. Future research can be conducted to determine how students can be encouraged to continue reflecting on their clinical work on a day-to-day basis. 5 | CO N C LU S I O N Students highly valued both briefing and debriefing sessions and perceived them as supportive in their preparation and learning on clinics. Both sessions facilitated personal and vicarious learning and helped link knowledge and experience. Briefing sessions cleared misunderstanding, prevented errors, and broadened procedural knowledge and clinical experience. Debriefing sessions facilitated reflective practice, error correction and prevention, and helped gain insights from teachers’ own experience and perspectives. C O N FL I C T O F I N T E R E S T How to cite this article: Botelho M, Bhuyan SY. Reflection The authors declare no conflict of interest in this publication. before and after clinical practice—Enhancing and broadening experience through self-, peer- and teacher-guided learning. DATA AVA I L A B I L I T Y S TAT E M E N T Eur J Dent Educ. 2020;00:1–8. https://doi.org/10.1111/ The data that support the findings of this study are available on re- eje.12623 quest from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.