WestMidlandsPaeds

General Principles -

The GMC suggests to us that we “regularly reflect on our own performance”1 and it is thought that this reflective approach to learning helps to prepare us for lifelong learning.  The emphasis is for ‘students’ to determine their own learning needs, set up their own learning goals, and monitor this on a continuing process. 2

A simple explanation of reflective learning can be made using a famous psychological and educational theory; Kolb’s Learning Cycle.  This describes a learning event as starting with “An experience”, followed by “Reflection on the experience”, followed by “Learning from the experience”, then “Trying out what you have learned”.  This is an ongoing cycle and can be repeated many times. 3 In essence, reflection is a practice in which we look closely at why we do what we do, and examines what could be done differently to improve outcomes. 4

 

While reflection can be challenging to do, there are potential benefits; the main of which is that it will help you to identify how best you learn making you a more effective learner.  It also helps to develop critical thinking, an important skill in any medical practice.  Finally, it can be a tool in demonstrating your learning in an appraisal or ARCP. 5, 6

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How to do it -

There is no absolutely correct way to reflect.  There is little evidence on the best way to do it and the evidence that exists is largely theoretical. 5,6 We will try to outline some basic principles below that could be utilised in your reflective practice:

 

Choice of reflective event:

The event in question does not have to be clinical, or just “when something went wrong”, it can be anything that caused you to question why something happened and how it has helped you.

You could reflect on a peer review session, a supervision meeting, a mentoring session, a multi-disciplinary meeting, a teaching session, a presentation, the choices are endless.  Remember, any event where you have thought “I could learn from that”, could be included.

 

Focus of event:

As explained above, the aim of a reflective event is not simply to describe what happened, rather to describe what was learned.  Therefore the details of any clinical information should be kept a minimum.

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Content of reflection:

There are a few points you may want to consider when writing your reflection:

• Try to consider the experience from multiple perspectives

  • What did you think? What did the parent think? What did the nurse think? etc…

• State the lessons learned

  • Try to end the reflection with a simple and concise list of the main learning points.

  • These can then be used as the learning outcomes for future learning events

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General Tips:

• Try to jot down ideas for reflections as you go through your day.  This could be on a note pad or on your phone (be sure to keep it anonymous).

• Adapt the proforma to suit your needs.  The online form on Kaizen cannot be expected to be suitable for every event, so use your common sense to adapt it as needed.

• Discuss your reflection with a peer or supervisor.  This may help elicit other learning points you may not have considered.

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Confidentiality in reflections -

Recently, educational bodies have had to remind portfolio users to consider confidentiality.  This is clearly important for patients, but also to doctors to ensure that educational portfolio material does not form any sort of “patient record” that could be requested by hospital trusts or legal bodies.  There have been a few examples of this recently and so to avoid this consider the advice below:

 

 

1: The clinical descriptive details should be as non-specific as possible.  There will be very few reflective episodes where the precise age of the patient, the location, or even the specific medical condition will be of importance to the reflection.

 

For example, you may wish to reflect on an episode that you could describe as follows:

 

Example 1 - “A two-year-old boy with a lower respiratory tract infection was acutely resuscitated during the night shift in the accident and emergency department.  He presented with his grandmother who described concerns about coughing and temperatures over the previous few days.”  This example contains several details of the patient that, when combined with a date, could identify them.

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The actual learning points from this episode may not be directly linked to the patient.  Therefore, when it comes to writing your reflection, the description of the case could be as follows:

 

Example 2 - “I was a member of the on call team responsible for the resuscitation of a young patient with an acute respiratory complaint….”.

There would be no extra benefit gained from recording the precise details of the case.

 

2: The precise date of the episode is not important.  One option is to record the date of the ‘event’ as the date that you create the reflective episode.  The actual reflection is the important point and having a non-specific date helps to further keep the clinical episode anonymous.

 

3: Don’t be reluctant to reflect on incidents that you feel could have gone better.  The GMC will expect you to reflect on all challenging episodes in practice and this should continue to be the case.

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References:

1 – Good Medical Practice, General Medical Council, 2013, www.gmc-uk.org

2 – Appraising and assessing reflection in students’ writing on a structure worksheet. Pee, B. Woodman, T. Fry, H. Davenport, E. 2002. Medical Education. 36, 575-585.

3 – Experiential learning: Experience as the source of learning and development (Vol 1). Kolb, D.A. 1984. Englewood Cliffs, NJ: Prentice-Hall.

4 – Guide to reflection. Royal College of Paediatrics and Child Health. www.rcpch.ac.uk/system.files/protected/page/Reflection_guide%20for@20paediatricians%20final.pdf. Accssed on 1st July 2016.

5 – Reflection: Tick box exercise or learning for all? Macaulay. Winyard. British Medical Journal. 2012, November.

6 – Reflection and reflective practice in health professionals education: a systematic review. Mann, K. Gordon, J. MacLeod, A. Advances in Health Sciences Education. 2009. 14:595-621.

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