Reflective practice and reflective writing - PowerPoint Presentation

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Reflective practice and reflective writing for paediatric medicine www.esneft.nhs.uk/reflection

Janet Bayliss Assistant Librarian,Ipswich Hospital Library, ESNEFTTel. 01473 702544 ext. 1544www.eel.nhs.uk/esneftEmail: hospital.library@esneft.nhs.uk

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What is reflective practice

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

’.

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Requirements for doctors

The

Gold Guide

suggests that educational supervisors should help develop the skills of self-reflection and self-appraisal that will be needed throughout a professional career. This can be reviewed as part of the ARCP process.

Revalidation.

GMC has produced guidance for reflection for doctors - reflections have been used in court cases e.g.

Bawa-Garba

case (2015).

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Revalidation and confidentiality

Revalidation. Requires all licensed doctors participate in regular appraisals. GMC’s guidance explains reflection core requirement – experiences should be discussed with the appraiser.

Confidentiality. Anonymised information should be more than just removing the patient’s name, age, address or other personal identifiers. GMC have issued guidance on this.

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Reflective notes can currently be required by a court

Don’t record actual details in reflective discussions – should be recorded elsewhereSeek advice from a supervisor or appraiser if in doubt about the contentThe GMC does not ask a doctor to provide their reflective notes in order to investigate a concern about them.

Disclosure

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How and when to do it

Make reflection a daily habit

Reflection is personal – there is no one way or framework to reflect

Clarify the purpose of your reflection and reflect when you are most ready – it can be uncomfortable.

Allocate time for it

Create reflective records

Respect the rights and privacy of others

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Types of Reflection (Schon 1991)

Reflection in Action(during the event)

Reflection on Action (after the event

)

The Experience itself

Thinking about it during the eventDeciding how to act at the time

Acting Immediately

Reflecting on something that has happened

Thinking about

what you might do differently if it happened againThinking about how new information could have influenced feelings and actions

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Reflective models and frameworks

Gibbs’ reflective cycle (1988)

Johns’ model for structured reflection (1994)

Rolfe’s framework (2011) – an adaptation of

Borton’s

questions (1970):

“What? So What? Now What?” – this is the model adopted in the GMC guidance

Being a reflective practitioner.

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What?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 whenI took the actions or made the

decision that I did’.

1. What? So What? Now What?

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2. What? So What? Now What? So What?

So what? Involves considering the significanceof what happened as well as the values and feelings at the time of and promptedby 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?’

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3. What? So What? Now What? Now What? implies an action plan for the future to improve your knowledge, ability and competency

and sums up your entire experience and reflective piece.What specific training, shadowing, knowledge do I require?What areas of development should I prioritise?Even if positive – how could I improve it more, and what steps do I need to reach this?What else could I do to be more prepared in the future?

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5. What? So What? Now What? .

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Exercise

Read and listen to the role play and scenario.Using the What? So What? Now What? framework think through the scenario.Complete the What? So What? Now What? framework using the accompanying handout as guide.5 minutes – then report back.

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Audio – to listen to

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What?

DescriptionFirst describe the situation in detail. What happened. Stay to the point and keep it simple.FeelingsThoughts and feelings of the people involved (before, during and after) Evaluation Was the experience good or

bad?

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So what?

EvaluationWhat was positive and negative about this situation? What could be learnt?Analysis/explorationWhat sense can you make of the situation?Why was the event positive/negativeTries to explain the causes and consequences of things that happened during the event.

What could have been done to avoid negative consequences or improve positive consequences.

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Now what? Conclusions

Following evaluation, you can draw conclusions about what happened. What did the doctor learn about themselves, (negative and positive)What skills does he/she need in order to avoid or improve the outcome of a similar event.

What could/should he/she have done differently.

What are the barriers for doing this.

Strengths and weakness of his/her practice

Did it meet any competencies or learning objectives?

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A few thoughts on the audio.

Missed talus fracture which meant longer time in ED;Adult has clearly not been kept informed during the time;Doctor does try to speak to child but does not answer all of adult’s questions;Explanation made of problems with drugs adult suggests but safeguarding issues not addressed;Adult allowed to refuse treatment for child;Did not attend – DNA – should have been was not brought;Doctor did spot problem second time around and wants to do further exploration but does not explain why;At the end, doctor clearly at a loss.

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A written example using What? So What? Now What?

https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/breaking-bad-newsThis could be used later – also please see handout.

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Other modelsThere is no one “right way” to do reflection, use the tools and models and styles that work best for you.In healthcare training, Gibbs’ reflective model is often used.

It has similar principles to the model described above, but has more steps and enables reflecting as part of an ongoing process without too much being covered at any one stage.

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Tools to support the process – aid our thinking around what it is

Shape the process of CS – the structure and flow of sessionsDefine some of functions, outcomes and skills/competencies used in CSModels of supervision

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Examples using Gibb’s Cycle

https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/cpr-conversationhttps://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/recording-of-mental-capacity-audit These can be studied later – also please see handout.

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Demonstrating reflection

Discussing or writing down reflections as part of education, training and development.Focus equally on positive encounters and achievements, not only incidents or complaintsEmphasis on quality rather than quantity

Structure a note and capture learning outcomes and future plansAnonymise reflective notes as far as possible

Need time and space for individual and group reflection

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Focus on reflective writing

Reflective writing is written evidence of reflective thinking:

Look back at an idea, event or object

Analyse the event or object in depth and from different perspectives

Consider implications for future practice/self development – what have you learnt?

(Hampton, M. 2010, pp. 1)

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Useful phrases for writing

I thought – I felt – I realised – I noticed

I was uncomfortable about – I did not question – I was aware/I was unaware

At the time – looking back – I now see

Having realised – learned – observed – discussed – applied

I now… feel – consider – question – know – wonder – will need to

Rather than describe, you need

to

evaluate

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3 levels of reflective writing

Before (spot the issues) -

http://

www.eel.nhs.uk/sites/default/files/04.21role_play_writing_example_hc.pdf

During (showing some working

) -

http://

www.eel.nhs.uk/sites/default/files/04.21role_play_writing_example_2_with_some_reflection_jb_002.pdf

After (an academic piece)

-

http://

www.eel.nhs.uk/sites/default/files/04.21role_play_writing_example_academic_writing.pdf

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What is the difference?

Less superficial – more depth

Analysis of situation – awareness of change in perspective of self

Not just description

Multiple perspectives of others taken into account

Consideration of how learning from incident will impact in future

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Academic reflective writing

Things to consider:

Demonstrate the ability to apply theory

Show your familiarity with relevant literature

Connect the literature with your experience

Reflect on your practice and how aspects are relevant to the literature

Show your learning and make recommendations

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Things to avoid in writing reflection

Too much or too little detail

If it is not your own personal diary try to avoid writing too informally

Moralising or being judgemental

Sarcasm or irony or “know it all”

Revealing confidential information about patients, colleagues or yourself

Using obscure jargon or abbreviations

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The library can help…

Books on reflective writing

Information queries: e.g. what sort of models are there?

Sourcing documents – articles/books/etc.

Training on searching the literature

Literature/evidence searches to support your practice

Help with referencing

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ESNEFT Library and Evidence Service:

Villa 8, PGMC Education CentreColchester Hospital Ipswich HospitalLibrary.services@esneft.nhs.uk Hospital.library@esneft.nhs.uk

Tel: 01206 742146 Tel: 01473 702544 (Ext. 1544)

Website:

www.eel.nhs.uk/esneft

Intranet: https://intranet.esneft.nhs.uk/pages/library-ESNEFT Secure email: chu-ftr.libraryservices@nhs.net

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Any questions?