Refining a definition of reflection for the being as well as doing the work of a physician

BACKGROUND: Reflection is core to professional competency and supports the active, constructive process of professional identity formation. AIMS: Medical educators thus grapple with operationalizing and effectively integrating reflection as a foundational construct within health care professions education and practice. METHODS: Core elements of reflection including role of emotions and awareness of self, other and situation, do not appear within various working definitions of reflection. RESULTS: This observation as well as noted recent shift in medical education toward emphasis on the "being" as well as "doing the work" of a physician led to the author's proposed refining of Sandars' reflection definition and expansion of Nguyen et al.'s reflection model. CONCLUSIONS: A refined reflection definition is offered for a more inclusionary approach. A caveat regarding potential for expected reflective learning outcomes (given reflection as a process) is provided and the integral role of mentor-enhanced reflection is discussed. Reflection as a continuum is highlighted and exemplified within Wald et al.'s REFLECT rubric and Nguyen et al.'s reflection model.