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Reflection

​​The GMC requires us to reflect on our practice, but what exactly is reflection and how do you do it?​
What is reflection?

"the process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible"
Reflective Practice Toolkit (AoMRC & COPMeD, 2018)​
Appraisals should also be used to reflect on the most important things learned or changed over the past year.
Why reflect?

"Reflecting helps an individual to challenge assumptions and consider opportunities for improvement."
How to reflect?

"There are no hard and fast rules on how to reflect - it is personal.

Both positive and negative experiences can generate meaningful reflections.

Thinking should be structured to capture, analyse and learn from the experience."
​How to capture the reflections?

"[Reflective] notes should focus on the learning identified and any planned actions arising from their actions.

Factual details should not be recorded in appraisal or learning portfolios.​"
Confidentiality


​​Reflections may be done verbally during the appraisal discussion - they will be captured and recorded by the appraiser in the summary.
​
"Ten key points on being a reflective practitioner:

1. Reflection is personal and there is no one way to reflect.
A variety of tools are available to support structured thinking that help to focus on the quality of reflections.

2. Having time to reflect on both positive and negative experiences – and being supported to reflect – is important for individual wellbeing and development.

3. Group reflection often leads to ideas or actions that can improve patient care.

4. The healthcare team should have opportunities to reflect and discuss openly and honestly what has happened when things go wrong.

5. A reflective note does not need to capture full details of an experience. It should capture learning outcomes and future plans.

6. Reflection should not substitute or override other processes that are necessary to record, escalate or discuss significant events and serious incidents.

7. When keeping a note, the information should be anonymised as far as possible.
 
8. The GMC does not ask a doctor to provide their reflective notes in order to investigate a concern about them. They can choose to offer them as evidence of insight into their practice.

​9. Reflective notes can currently be required by a court.
They should focus on the learning rather than a full discussion of the case or situation.
​Factual details should be recorded elsewhere.

​10. Tutors, supervisors, appraisers and employers should support time and space for individual and group reflection."
The Reflective Practitioner ​(AoMRC, COPMeD, GMC & MSC, 2021)


​Brief examples: ​
​The three "whats" of reflection
​
​What?
-I read an article
-I went on a course
- An urgent referral was delayed 
So what?
-The guidelines have changed
-Never prescribe X with Y
-Urgent referrals must be sent within 24 hours​
Now what?
-I'll update my colleagues at our next meeting
-I'll audit patients taking X and Y
​-I'll dictate urgent referrals during the consultation

Brief examples:
​Inputs and outputs
The GMC says, "CPD should ​focus on outcomes or outputs rather than on inputs.
​You must reflect on what you have learned from the activity and how this could help maintain or improve the quality of your practice."

Your appraiser will be looking for evidence that you are applying your learning to your practice. For example:
​Input
I completed an on-line learning module on disease Y.
​Learning
​Drug A should not be prescribed with drug B.
Output
I asked a member of staff to run a computer search for patients taking both drugs.

​The staff then invited each patient identified to have a medication review.​
Input
I attended a meeting about hospital bed pressures.
​Learning
There is a new clinical service for patients with disease X.
​Output
I shared the details of the new service with my primary care team via email.

Models of reflection

The Reflective Practice Toolkit (AoMRC & COPMeD, August 2018) provides different template options that can be used, depending on the aspect of learning to be captured and individual personal preference.

Some tools lend themselves to immediate personal reflection whereas others are more useful when some additional perspective has been gained, either through the passage of time or discussion with others.
​
Even though these templates encourage written reflection, you may reflect orally during appraisal discussion. 
Examples of anonymous reflection.
Reflection on a significant incident (NHS SSW, March 2018)
Reflection on a prescribing issue (NHS SSW, March 2018)
Reflection on a complaint ​(NHS SSW, March 2018)