Becoming a reflective practitioner
What is reflection?
In Achieving good medical practice, we say:
"At its core, reflection is thinking about what you’ve done, what you did well and what you could do better next time. To do this, you need to think about what effect your actions have on yourself and on others, including patients and colleagues, across all aspects of your education and training. For example, if you have an interaction with a patient or a colleague that didn’t go as planned, you should explore how you approached the situation in a critical light to see if you can learn from what happened and use that learning to improve the way you approach similar situations in the future. "
Achieving good medical practice, 2016 (para 4)
Reflection can be used in response to experiences that have made you think or question your ideas or values. If something goes really well on a project or in an interaction with a patient, use it to think about what you did to make it a success, so you can repeat those actions later. Reflection can help you to plan your learning in relation to an imagined future.
Reflection also plays an important part in improving the services provided to patients. Improvements are made in the health service as a result of students, clinicians and teams thinking about the processes they undertake every day and how they can make them better.
The opportunity for reflection to not only improve my own practice, but also to improve the systems we study and work in for better patient care, make it a hugely important skill in my view.
Reflection stimulates intrinsically motivated learning which, in turn, is more likely to lead to retained, integrated learning.
Why is reflection important?
Achieving good medical practice sets out guidelines on professional behaviour for medical students. But it also makes it clear that being a true professional is not just about following a set of rules. It is about striving for excellence.
The guidance says that to do this you will need to:
- develop healthy ways to cope with stress and challenges (resilience)
- prioritise your time well and ensure a good work-life balance
- apply ethical and moral reasoning to your work
- work effectively in a team, including being able to give constructive and honest feedback
- manage your own learning and development
- be responsive to feedback
- deal with doubt and uncertainty
- promote patient safety and be able, where appropriate, to raise concerns
- work collaboratively with patients and other professionals
- deal with and mitigate against personal bias.
Achieving good medical practice, 2016 (p7)
The guidance acknowledges that these are challenging things to do and that your medical school will be there to support you to develop these skills and behaviours. It also recognises the importance of reflection in helping you do these things.
There are two outcomes set by the GMC in Outcomes for graduates that specifically mention reflection as a medical student which also point to why it is so important. A medical student, by the time they graduate, must be able to:
"explain and demonstrate the importance of engagement with revalidation, including maintaining a professional development portfolio which includes evidence of reflection"
Outcomes for graduates, 2018 (para 2t)
"develop a range of coping strategies, such as reflection’ to demonstrate awareness of the importance
of their personal physical and mental wellbeing"
Outcomes for graduates, 2018 (para 3c)
The first outcome indicates that you need to develop skills to reflect effectively while you are at medical school - it will support your learning as a student and prepare you for working as a doctor in the UK health service. Doctors in training are expected to provide evidence of reflection to progress through training. Reflection also plays an important part of the process of revalidation, which all registered doctors go through every five years to ensure that they can maintain their registration with the GMC.
The second outcome shows that reflection is an important part of self-care and helps you to maintain and improve your wellbeing.
Reflection can help you to come up with innovative solutions to problems by applying learning from your experiences to new situations. It can also be useful in setting goals for your own learning and career planning and assessing your areas of strength and relative weakness.
There is an old saying that experience is making the same mistake with increasing confidence! None of us want to be that sort of clinician, but how do we avoid it? Reflection is part of the preventive strategy. I like to teach students to take a moment and think again when things aren’t going as expected – reflection-in-action. We can also take some time after something unexpected happened to think through why we felt, acted and communicated as we did, and give ourselves some feedback for next time – reflection-on-action.
Based on my Masters research project to understand mechanisms which promote authentic reflection in differing learning contexts, analysis of student interviews suggest reflection is likely to be most valuable when it is meaningful. Imposing structure can help to draw out meaning, but rigidity in approach can be counterproductive. In seeking approaches which help our students strive for a deeper meaning, we may be more likely to achieve what has been thought of as authentic reflection.
Read why a doctor decided to develop a course on emotional intelligence, and the benefits she and her course attendees have gained from it.