5 Tips on Medical Reflections - how to improve your own practice!

This is some quick tips to get on with reflections!

5 top reflection advice

Caution – There are two key areas to be cautious of. 1) Confidentiality – a daft one, but one please remember to keep it confidential.

Careful what you reflect upon - There is no harm in drafting a reflection away from your portfolio especially if it is to do with a complaint or a difficult case that will likely take further action.

1) Use a structure and don't forget Christmas:
a. Pick the way you reflect – you might not have an option, but make sure you have the three broad steps
b. GMC use this one - https://www.gmc-uk.org/-/media/docume...
c. What? Keep it short and sweet
d. So what? How did it make you feel, go into detail, what action did you take about this to either rectify the situation or what answers has it left.
e. Now what? This is where you earn your money. What is the plan now, how are you going to bring this into your usual practice?

2) Why are you doing this?
a. This one is about staying on track for the wider year. Do you have a curriculum to follow? Generally this will be on a wide range of skill set of skills. So for the RCGP you will have a range of ‘curriculum headings’ that you will need to manage and then capabilities
i. Normally the curriculum is a broad area ‘paediatrics’, emergency care
ii. The capability demonstration then is the ability to make you a good clinician. Such as ‘working in a team’, ‘dealing with complex patients’.
iii. If you can’t physically ‘link it an item’ make sure you reference this.
iv. (https://www.rcgp.org.uk/-/media/Files...)

3) Practice makes perfect
a. Art example – an artist is teaching a class and sets two people off, in the first group she asked them to make a pot and they had a month. The other group had to make a pot a day for the 28 days. Who made the better pots?
b. Be comfortable with failure and that it isn’t going to be perfect. That is fine! Don’t let excellent be the enemy of good. As you get more reflections under your belt your style will develop and you will be able achieve this quicker.
c. Use the high numbers to try reflecting on other bits – so not all patient encounters, use radio and TV examples.
d. Make sure at regular intervals you are getting your supervisor to feedback to you so that you can start to tailor your reflections i.e. more like this one, less like this one.
4) Set a day – stick to it
a. I used to ALWAYS do a Monday/ Tuesday
b. That way I would mentally have the rest of the week to do ‘another’ reflection
5) 48 hour rule
a. If something happens that you think ‘I must reflect on that’, give yourself 48 hours. If you are feeling really good – try to do it that day. The mobile app on fourteenfish
b. Insert clip from mobile
c. This allows you to ‘do it on the go’

Finally – bonus:
Get multiple reflections from the same experience!

Do not be afraid to get multiple reflections from the same point. So for example, you get told off by a consultant for not knowing something about a patient. Now the what could be relatively easy – ‘I was on a ward round and I didn’t know about 200 causes of clubbing, I got shouted at and humiliated in front of the patient’

Now this raises two points – one is the ‘knowledge gap’ or the Doctor Educational Need, the other is to do with the way the consultant treated you and ‘educated you’, both are two very different points and separate them out.

The other way to get multiple is how you progressed your knowledge. So, if you learnt something say that you must do a (initial reflection) then as your ‘now what’ you decided to do an audit on

Worked example:
What?
I watched a video on reflective practice. It covered 5 basic tips for reflection.

So what?
I took some really good points. I learnt about that there are different styles of reflection out there and I had never considered the So What.... example. It was interesting that this is what the GMC recommend and it made me think about whether to change my style. I also really liked the way that he said about setting a time and giving yourself 48 hours to do. I often struggle with reflections and so this is a great way to get used to it.

Now what?
I will make sure that I get a lot of reflections done to hone my craft! I will do this by ensuring I set a day (Monday) and will aim to do one that day. Once I have this done, I will then sit down with my supervisor at my next meeting to ensure that they are happy with my reflective style and that I am hitting the desired curriculum.


Thank you
Dr David Hindmarsh
[email protected]