- Reflection is a core feature of medical practice as well as an ethical duty, outlined in the GMC's Good medical practice.
- Formal reflective writing is an increasingly important aspect of medical training and professional development.
- Reflection can help to consolidate learning and identify opportunities to improve patient care or address patient safety concerns.
The Academy of Medical Royal Colleges, the Conference of Postgraduate Medical Deans (COPMeD), the General Medical Council and the Medical Schools Council have together produced guidance on reflection for doctors.
The reflective practitioner addresses why reflection is important, how to demonstrate reflection and the disclosure of reflective notes.
Recognise the benefits
Introspection is commonly seen as a distraction from patient care, but is actually an essential and beneficial part of professional practice.
The joint guidance states that reflection on your experiences - both good and bad - is vital to a doctor's personal wellbeing and development, as well as to improving the quality of care for patients.
Make it relevant
In the course of your professional practice, there are lots of different situations and experiences you could potentially reflect on, but try not to focus on a particular number or type of reflective notes.
Instead, reflect on those experiences that relate to your professional practice and offer the potential for you to develop, learn lessons and gain insight.
Develop a process
You will likely develop your own individual style of learning, but your reflection is not just a piece of descriptive writing and it makes sense to develop a systematic approach.
This reflective practice toolkit from the Academy of Medical Royal Colleges and COPMeD includes links to resources to help effective reflection, including templates and examples. The guidance also includes a simple framework that poses the following questions to prompt reflection:
- What was I thinking when I took this action or make this decision?
- How did I feel at the time and after this experience and why was it important?
- What can I learn from the experience or do differently next time?
Be prepared to discuss your reflections
Reflection is a core requirement for revalidation, so you may need to discuss the experiences you have reflected on as part of your appraisal. You'll find this easier if your reflective notes set out your learning clearly and concisely.
The joint guidance says that 'tutors, supervisors, appraisers and employers should support time and space for individual and group reflection.'
Keep your reflections anonymous
The GMC doesn't ask doctors to disclose their reflective notes when it is investigating a concern, but it might be in a doctor's interests to do so. However, the courts can still request disclosure of documents that are considered relevant and the GMC says information must be disclosed 'if it is required by statute, or if ordered to do so by a judge or presiding officer of a court.'
Anonymising a case in reflective notes means your reflection will still be a valuable experience but you can avoid any difficulties if the note is disclosed. The Information Commissioner's Office considers data to be anonymised if it 'does not itself identify any individual and that is unlikely to allow any individual to be identified through its combination with other data.'
On this basis, just removing the patient's name, age, address or other personal identifiers is unlikely to be enough, but the new guidance points out that a reflective note doesn't have to capture full details of an experience - it should capture learning outcomes and future plans.
Reflection is not a substitute for investigation
As well as reflecting on an incident, you should also take part in processes for recording and investigating clinical incidents and be open and honest with patients when something has gone wrong.
Don't just file away your reflective notes after an appraisal as they should also inform your personal development. It's often helpful to return to your reflections later to see how your practice has developed.
The MDU can advise you on completing reflective notes after something has gone wrong or responding to requests to disclose a reflective document. If you need to, contact us here.
This guidance was correct at publication 07/08/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.