The concepts of metacognitive reflection, reflection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive reflection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive reflection in the concept of metacognition and moving beyond it to engage in cycles of reflection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive reflection works is elusive. Debates address whether metacognition drives reflection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related reflection, to self-reflection, and finally to metacognitive reflection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive reflection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive reflection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.

Despite the accumulated body of research on teachers\' professional development few have offered a relationship between professional development and knowledge sharing or reflective practice. We investigated whether Iranian Teaching English as a foreign language (TEFL) teachers\' reflective teaching and their knowledge sharing can predict their professional success. To answer the research questions a quantitative approach was utilized. Then, 264 faculty members through available sampling were recruited using three questionnaires, namely reflective teaching measurement scale by Akbari et al. (System, 38(2): 211-227, 2010), teacher professional development scale by Soodmand Afshar and Ghasemi (J Teach Lang Skills 37: 169-210, 2018), and Teachers\' knowledge sharing behavior by Ramayah et al. (Eval Rev 38(2): 1-28, 2014). Findings showed that knowledge sharing has a significant relationship with professional development (P < 0.001). In addition, teachers\' reflective practice has a significant relationship with professional development (P < 0.001). Based on the findings we suggest that TEFL teachers should promote their knowledge sharing and reflection to improve their professional development.

Interprofessional collaboration between dentistry and pharmacy has great value but is often lacking in didactic and experiential education, particularly in dental hygiene programs.
A case-based interprofessional assignment was implemented into the dental hygiene curriculum. Students reflected on their experiences and completed the International Collaborative Competencies Attainment Survey (ICCAS) to assess changes in self-reported interprofessional competencies following the activity.
Reflections revealed knowledge gain themes, with medication-related oral health concerns most frequent (53), followed by systemic adverse effects of medications (31), impact of systemic health on oral health (21), drug-drug interactions (17), and drug information (2). Additionally, students identified both future plans to collaborate with a pharmacist (25) and application of clinical knowledge gained (25). Scores from the ICCAS increased significantly in most of the domain statements following the interprofessional activity.
This interprofessional education (IPE) activity increased student knowledge of the pharmacy profession and provided an experience with interprofessional communication. Students identified the impact of medications on oral health, as well as the value of interprofessional collaboration and communication.
This IPE activity positively impacted student perceptions of interprofessional collaboration with pharmacists.

The Affect Regulation Checklist (ARC) was designed to capture affect dysregulation, suppression, and reflection. Importantly, affect dysregulation has been established as a transdiagnostic mechanism underpinning many forms of psychopathology. We tested the ARC psychometric properties across clinical and community samples and through both parent-report and youth self-report information. Clinical sample: Participants included parents (n = 814; Mage  = 43.86) and their child (n = 608; Mage  = 13.98). Community sample: Participants included independent samples of parents (n = 578; Mage  = 45.12) and youth (n = 809; Mage  = 15.67). Exploratory structural equation modeling supported a three-factor structure across samples and informants. Dysregulation was positively associated with all forms of psychopathology. In general, suppression was positively associated with many forms of psychopathology, and reflection was negatively associated with externalizing problems and positively associated with internalizing problems.

With technology becoming an essential component in classrooms, it is becoming more crucial for pharmacy faculty to explore innovative active learning strategies that engage students inside and outside the classroom. This manuscript discusses how two fourth-year students and their preceptor developed interactive patient cases using an open-source software application called Twine (www.twinery.org).
Two different cases were developed in Twine. The first patient case story was created by the fourth-year students and will be implemented in the future. The second patient case, consisting of two Twine stories, was created by the faculty preceptor and was implemented during new student orientation.
Resources for development as well as advantages and disadvantages of developing and implementing Twine stories into the curriculum are discussed. Implementation of the faculty\'s Twine stories into the pharmacy curriculum is also discussed.
Twine is a user-friendly application and has the potential to be utilized in healthcare programs as an effective and engaging teaching strategy that both professor and students enjoy.
While development of a Twine story could be time-consuming, the benefit of increasing student engagement outweighs the cost. Active learning is an essential component in the classroom, and finding new and innovative ways to enhance student learning is imperative.

The Center for the Advancement of Pharmacy Education 2013 Affective Domain mandates students develop self-awareness of personal attributes affecting professional growth. Students should self-identify needs, create and implement goals, and evaluate success. This case study describes the qualitative and quantitative findings of an intentional reflection assignment prompting students to engage in a cycle of goal writing - monitoring - reflection - new goal writing, during an immersive clinical practice experience. A blinded review of 144 student assignments is presented in the context of a curricular review of the Reflective Practitioner Program (RPP), a longitudinal reflective thread spanning four years of professional pharmacy training. Evidence gathered in the assignment review indicates that students are sufficiently capable of establishing meaningful goals and describing why the goal is important to their professional development. In contrast, students struggle with articulating strategies for goal achievement and emotions experienced during goal monitoring. In consideration of these findings, RPP faculty identified three major themes when discussing key aspects of the RPP curricular design: 1) students need to articulate strategies for goal achievement in addition to stated aims, 2) students hesitate to identify emotions when reflecting, and 3) reflection needs to be both retrospective and prospective in nature. This case study has resulted in meaningful changes to RPP curricular design and illustrates how programs may approach assessment of the Affective Domain via common curricular elements.

Commercial video games are popular entertainment media and part of students\' media reality. While commercial video games\' main purpose is not learning, they nonetheless could and should serve as objects of reflection in formal educational settings. Teachers could guide student learning and reflection as well as motivate students with commercial video games, but more evidence from formal educational settings is required. We conducted two mixed methods case studies to investigate students\' reflection processes using commercial video games in regular formal high school teaching. In a double lesson, 29 students of a 10th-grade biology course (Study 1) and 17 students of a 12th-grade advanced course on history (Study 2) played and discussed a commercial video game related to the current curricular topic. We examined the reflection processes of students in terms of their reactions to the teachers\' game-related statements and questions. Regarding teachers\' statements, students discussed several topics related to game enjoyment and the games\' representation of topic-related content. Regarding teachers\' questions, students discussed multiple goals in each game, how the games represented topic-related content, and how the games could be appropriate for learning. In Study 2, students additionally discussed emotions, stereotypes, violence, and the narrative related to the digital history game. We found that the discussions provided students opportunities to reflect on their game experiences and the current curricular topic as well as to practice media criticism. We further provide quantitative results on students\' perceived topic knowledge, on several facets of their learning motivation, and on their acceptance of video games. Overall, our findings illustrate the educational value of using commercial video games as objects of reflection.

BACKGROUND: Learning in the workplace maximises relevance to clinical practice and facilitates the education of the whole multiprofessional team. Provision of structured teaching is becoming increasingly challenging with shift pattern working and staff shortages. This article describes a simulation course designed to facilitate team learning to improve the care of nephrology patients, and presents outcome data over 2 years.
METHODS: A full-day course, using high fidelity manikins, was designed for nephrology specialty trainees and nurse specialists. Nineteen learners (eleven specialty trainees and eight nurse specialists) and nine multidisciplinary team faculty members attended. Evaluation used pre- and post-course assessments, with a 1-year follow-up questionnaire.
RESULTS: Following the course, improved knowledge scores, 56% to 72% (P<0.05), and confidence scores, 57% to 71% (P<0.005), were demonstrated. Qualitative analysis found \'intra-disciplinary interaction\', \'reflection\' and \'practical skills\' were the greatest enablers of learning. In the 1-year follow-up questionnaire, specialty trainees reported that the course improved clinical practice and helped preparation for consultant roles.
CONCLUSIONS: This course improved knowledge and confidence in managing nephrology scenarios across the multidisciplinary learning group, and the model could be used in other hospital specialties.

In the UK, the quality of post-diagnostic care and support for people with dementia and their family carers is variable and depends on the availability of services in each person\'s local area. This article considers the support services available for families affected by dementia and discusses how telephone helplines can assist those who may have no access to other types of support. It presents a case study describing a call to the Admiral Nurse Dementia Helpline, a service run by nurses with expertise in dementia care and provided by the charity Dementia UK. This is followed by a reflection on the call from the nurse\'s perspective. The case study-based reflection demonstrates the complexity of providing support through a helpline and the specialist knowledge and skills required to provide the appropriate level of support.

This study explores the reflective processes of Scottish artist, Norman Gilbert, as he created twenty-five drawings depicting his wife, Pat Gilbert, as she lay dying following an Alzheimer\'s-related stroke. Norman, ninety-one, had drawn Pat regularly over their sixty-five-year marriage. One week after Pat died, Norman was interviewed by a family friend to chronicle his reflections on the drawings. The drawings along with the interview transcript are analyzed qualitatively as a case study. Norman\'s Hospital Drawings of Pat transform what was initially a private experience into a shared comprehension of end of life and bereavement.