How do I reflect? – a reflective diary

Here, a medical student explains why their diary helps them get the most out of reflection.

'In today’s medical world, we have people telling us we need to reflect all the time. Seen something going wrong? Reflect. Had a conversation with an interesting patient? Reflect. Merely set foot in a hospital? Reflect.

Reflection is important, yes. Very important in fact. However, reflection has become a tick-box exercise, an assessment, or something that is only done for major incidents. As a medical student, it seems clear to me that this image of reflective learning has been brought about by how it is imposed upon students and doctors. We are made to reflect on a regular basis and are encouraged to think up particularly "interesting" cases full of ethical conflicts, professional challenges or big mistakes. Once complete, the piece is read and assessed by someone else, totally eliminating privacy.

Because of this, we are in a position now where many people write their reflections on practically fictitious patients and scenarios. By focusing so much on reflection, we are no longer reflecting at all.

Unfortunately, I doubt the tick-box assignments will be abolished any time soon. However, analysis of current reflective practice and its downfalls might help us design better forms of reflective practice for the future. For example, Schwartz Rounds are a kind of reflective safe space that have met with great success. Two important features facilitate this: they are optional, and they are not in any way assessed.

What other features would we like to see in reflection? Privacy is important to be able to open up fully to one’s own thoughts and emotions, and one of the key principles of good reflection is that it should be a habit, not something to do only when told. "When do I privately reflect, out of habit?" I asked myself. The penny dropped – I write a daily diary.

...one of the key principles of good reflection is that it should be a habit, not something to do only when told. "When do I privately reflect, out of habit?" I asked myself. The penny dropped – I write a daily diary.
 

It initially began as an idea from a combination of two things, completely unrelated to medicine. First, as a child I had been in awe at my grandmother’s diaries, full of exciting stories and life events that spanned several decades. Second, about a year into a relationship, my girlfriend at the time recalled a couple of anecdotes from when we had just begun dating which, much to my distress, my memory completely failed to recognise. I started the diary that New Year’s as a way to preserve important memories, and to be a fun way to look back on the sorts of things I had got up to at the end of each year – it was designed as something for my future self.

But before long, I saw my diary influencing the present. Whenever I had a tough day, or something difficult had happened with friends or in the hospital, it gave me a deeply personal space where I could explore "What? So what? Now what?" This has continued to be the case six years on, and it is something I intend to continue indefinitely, having been extremely beneficial in both my personal and professional life.

So, some food for thought: What do you think of giving every medical student a private diary from Day 1?'