Being a reflective practitioner – guidance for doctors and medical students

The Academy of Medical Royal Colleges and COPMeD define reflective practice as ‘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’. [1]

Why being a reflective practitioner is important

Reflection empowers medical students and doctors to:

  • demonstrate insight by identifying actions to help learning, development or improvement of practice, developing greater insight and self-awareness
  • identify opportunities to improve quality and patient safety in organisations.

There is a strong public interest in medical students and doctors being able to reflect in an open and honest way.

Approaches to reflection

There are no hard and fast rules on how to reflect – it is personal. Both positive and negative experiences can generate meaningful reflections. The approach taken to reflective practice may be influenced by the nature and scope of individual practice, and personal style of learning. [2,3]

Thinking should be structured to capture, analyse and learn from the experience. A range of different experiences can be reflected on, including clinical events or interactions, complaints or compliments and feedback, reading a research article, attending a meeting, having a conversation with a colleague or patient, team debriefs, or exploring a feeling or emotional reaction.

Teams and groups improve patient care and service delivery when they are given opportunities to explore and reflect on their work together [4]. These interactions often lead to ideas or actions that improve care across organisations. Group reflection activities should be encouraged by employers and training providers as they provide mechanisms to identify complex issues and effect change across systems.

Time should be made available, both for self-reflection, and to reflect in groups. Supervisors and appraisers also need time to facilitate reflection.

A toolkit to support reflection

The Academy of Medical Royal Colleges/COPMeD's Reflective Practice Toolkit describes the principles for effective reflective practice and includes a number of templates and examples [5]. This should be considered alongside this guidance.

What? So what? Now what?

There are many approaches to reflection. The What? So what? Now what? framework is one example of a simple way to structure reflections, whether it be of a single event or of a period of time [6,7]. It could include personal experience, interaction or observation of others and formal/informal learning events.

Key elements in this framework that might be helpful to consider:

  • What? focuses on thoughts at the time of an experience. It explores thought processes when a particular action or decision was taken and how those may have impacted on actions and feelings. eg ’What was I thinking when I took the actions or made the decision that I did’
  • So what? involves considering the significance of what happened as well as the values and feelings at the time of and prompted by the experience, and why these may influence future learning or actions.  eg ‘How did I feel at the time of and after the experience, why was it important?’
  • Now what? looks at the processes and opportunities that can help learning from the experience and identifying future actions, reflection on those actions, and how to use these to develop further. eg ’What can I learn from or do differently next time’
Cyclical diagram - text reads "what?" then "So what?" then "Now what?"