Student paramedics' experiences of reflection: A systematic integrative literature review.

BACKGROUND: Reflective practice is an essential skill to possess as a healthcare professional and is a fundamental part of all registered United Kingdom health professions, including paramedics. Whilst reflective practice has been studied in a variety of settings, little is known about how student paramedics experience reflection. METHODS: A systematic integrative review of literature was conducted to answer the research question 'How do student paramedics experience reflection?' Bibliographic databases were systematically searched in November 2024 and again December 2025. Inclusion and exclusion criteria were applied to identify nine studies to be used for thematic analysis, with an additional three studies added from the December 2025 search, for a total of 12 studies used for analysis. RESULTS: Thematic analysis was carried out on the 12 studies and identified one overarching theme 'Becoming a reflective practitioner' with four contributing subthemes: 'Developing reflection as a skill'; 'Experiences that trigger reflection'; 'Emotional insight and learning'; 'Importance of facilitation for reflection'. DISCUSSION: Reflection is often assumed and underexplored in paramedic student literature. Many studies are based in simulated environments, limiting the transferability of reflective tools to practice-based learning. Alternative strategies, such as peer-to-peer debriefing, show promise but their viability in placements remains unclear. Facilitation is consistently identified as essential, with mentors playing a significant yet complex role in supporting reflection. Overall, the evidence base remains incomplete, highlighting the need for further research into student understanding, reflective experiences, and facilitation within practice-based learning.