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Reflective Practice

• January 10, 2020

Reflective practice is the exercise of analysing events that have been significant during your learning, training or employment in medicine. Not only is this an important technique to reflect on your own behaviours, but it will also be expected for revalidation, which we explained in a previous blog. In this article we will cover the topic of reflective practice, why it’s important and how you can do it. We should note that this article just offers an overview of the information provided by the GMC, and that for a more detailed explanation of reflective practice, you may refer to the GMC website.

What is Reflective Practice?

The practice of reflecting in the UK has been endorsed and developed by the Academy of Medical Royal Colleges (AoMRC), the Conference of Postgraduate Medical Deans (COPMED), the General Medical Council (GMC) and the Medical Schools Council (MSC). It is considered an important way for doctors to look after their own wellbeing, as well as improve their practice for future patients. Medical students and doctors in training are expected to demonstrate their reflections in order to prove that they have developed good coping techniques to deal with the multitude of situations they are placed in. It is also necessary for revalidation, in which you are required to show the GMC that you are up to date and fit to practice.

Reflective practice is the act of setting some time aside to analyse and look back on an event that has had a significant impact on you. This could have been something that took place during your learning, training, or whilst you have been employed. It is important to note that the events you reflect on do not have to be negative in nature, they can be positive too, the main focus is on an event that made an impact on you, that changed your perspective or the way you practice. Equally, it could also be an event that confirmed a certain belief for you that reinforces the way you practice.

The events you reflect on don’t necessarily have to be situations you were directly involved in, you may reflect on an event you observed, a clinical interaction, a complaint or feedback you, or someone else received, reading or research, a meeting you attended, a conversation you had with a patient or colleague or even something you experienced during your training or studies that had a strong impact on you.

Why is Reflective Practice Important?

Reflecting is important for a number of reasons.  First and foremost, reflection helps doctors to assess how well they are performing in their practice. By identifying a situation where perhaps, they could have acted differently, they could work to improve how they react to a similar situation in future, which will be beneficial for both the patient and the doctor. Many specialities actually incorporate reflective practice into their curriculums in order to help doctors start practicing reflection early in their medical career. 

Reflection should also act to examine certain beliefs you may have about your practice. If an event challenges your beliefs, it can help you to approach a certain type of scenario in a new way.

By practicing reflection, you will also demonstrate to colleagues and to future employers that you take a professional approach to your career development and that you value self-improvement. Not only can this prove beneficial to your relationships in your current working environment, but it will also reflect well on you in future interviews and job applications.

Finally, as previously mentioned, it will be massively helpful for your own wellbeing. Reflecting on a difficult situation that you felt negatively about will help you to process your thoughts and feelings about the situation and hopefully, move on from it, and reflecting on situations that were positive will help to strengthen and build your confidence.

How Should I Practice Reflection?

The GMC states that reflection should be part of a doctor’s everyday practice. The more often you do this, the more comfortable you will be with the concept.

You should record your reflections in the event that you need to refer to them or share them, whether this is with an educational supervisor or a panel in significant events.

Some e-portfolios will have spaces where you can record your reflections, or you could simply keep a record in a reflective diary or journal. It is recommended that you find somewhere to keep all of your reflections in one place, rather than recording them separately, this way they are well organised and easy to refer to.

Some doctors like to make short notes immediately after an event to record the main details, and then come back to them and reflect fully on them later when they have the time and space to do so. You should try to set some time aside, if possible, to reflect without disruptions or distractions.

When recording your reflections, try to be open and honest about an event, and particularly about how you felt. The content of the event itself does not need to be a detailed account of the situation, and importantly, it should not seek to place blame, as the purpose of reflection is not to document the factual information surrounding the event, as if it was a Significant Incident, it should be reported and the facts will be recorded elsewhere. Instead, you should focus on how you felt about the situation, any feedback you received, what you learned, and any changes you plan to make as a result of this event. 

Some hospitals will have groups where you can practice reflection together, and you should be supported in being able to take the time and space to do this.

An important thing to keep in mind when practicing reflection is that you will need to ensure that your reflections are anonymised, this is to adhere to confidentiality and information governance requirements. Any information about patients, relatives of patients and colleagues should be fully anonymised, as well as the location, time and date.

The AoMRC, COPMED, MSC and GMC have provided a useful toolkit to help doctors learn how to reflect, and offer examples of reflections which you can read here.

To give a brief overview though, they provide a framework of What? So What? Now What? To help structure the way you approach reflections.

• What? – This first part is where you should analyse your thoughts, actions and decisions at the time of the event, and how those three things had in impact on one another. The question they recommend you ask yourself is “what was I thinking when I took the actions or made the decision that I did?”
• So What? – For this second step, you should think about the significance of the situation that took place, as well as the feelings and values evoked by the event. They recommend you consider “how did I feel at the time or after the experience? Why was it important?”
• Now What? – For this final step, you should consider the opportunities and steps that can help you learn from the experience and alter or affirm future actions and development. It’s recommended that you ask, “what can I learn from or do differently next time?”

Do I need to Provide My Reflections to Anyone?

When it comes to Revalidation, the GMC will expect you to be able to evidence that you are practicing reflection. That said, the GMC will usually not request documentation, just evidence that you are effectively reflecting on events. The reason they require this is to ensure that you are maintaining Good Medical Practice.

In rare events, courts may acquire reflective notes if they feel that they are relevant to a case, but the GMC does not automatically ask doctors to provide their notes when investigating complaints or cases, only if they feel that a doctor’s reflective notes could offer real insight into the situation.

Reflective notes must be disclosed if ordered by a judge or court officer or by statue.

A final note on reflective practice is that there is no one way to do it, it is a personal experience, so you should find the best way that works for you. As long as you record this information and anonymise the details, and set some time aside to practice reflection, everything else is personal preference.

This article has offered an overview of the advice and information provided on the GMC website, for further advice and tools, please refer to their website.

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References

Oxforddeanery.nhs.uk. (2020). Advice on Reflective Practice. [online] Available at: http://www.oxforddeanery.nhs.uk/trainees/advice_on_reflective_practice.aspx [Accessed 10 Jan. 2020].

Oxforddeanery.nhs.uk. (2020). [online] Available at: http://www.oxforddeanery.nhs.uk/pdf/Reflective%20Practice%20Toolkit.pdf [Accessed 10 Jan. 2020].

Oxforddeanery.nhs.uk. (2020). [online] Available at: http://www.oxforddeanery.nhs.uk/pdf/The%20reflective%20practitioner%20guidance.pdf [Accessed 10 Jan. 2020].

Oxforddeanery.nhs.uk. (2020). [online] Available at: http://www.oxforddeanery.nhs.uk/pdf/Summary%20of%20The%20reflective%20practitioner%20guidance.pdf [Accessed 10 Jan. 2020].

Wessexdeanery.nhs.uk. (2020). Reflective Practice. [online] Available at: http://www.wessexdeanery.nhs.uk/trainee_revalidation/reflective_practice.aspx [Accessed 10 Jan. 2020].

Copmed.org.uk. (2020). Reflective Practice - Conference Of Postgraduate Medical Deans. [online] Available at: https://www.copmed.org.uk/publications/reflective-practice [Accessed 10 Jan. 2020].