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Revalidation in Wales

Reflective practice

You will not meet your requirements by simply collecting the required information. Ongoing reflection on your practice is central to revalidation and should form part of the preparation for your annual appraisal. Your appraiser can facilitate further reflection, as needed, but it is your responsibility to demonstrate examples of your reflective practice.

GMC

The GMC and joint Academy of Medical Royal Colleges have provided detailed advice on what is required in the document The Reflective Practitioner.

The GMC also provide some examples which are not intended as templates but which may help you develop your ideas.

What is reflective practice?

In their reflective practitioner guide the AoRMC define it as:

“This is the process whereby an individual (a trainee or a trainer in this context) thinks analytically about a clinical situation or activity, monitoring its progress and evaluating its outcome. As this implies, it can (and should) take place before, during and after the situation. It results in a better understanding of the situation and enables the individual concerned to recognise the impact of their actions. “

Why does reflection matter?

Reflection is one of the principles that underlie adult learning. It has been shown to improve deeper understanding and improved performance not only of the individual but also of the team. It is based on research and some of the adult theories of learning such as the Kolb learning cycle and the work of Donald Schon on being a reflective practitioner.

How do you demonstrate it in your evidence?

How to demonstrate reflection in the portfolio is not defined by the GMC as they recognise that there are many ways of achieving this, however you must demonstrate reflection in the information you present for appraisal. The Academy of Medical Royal Colleges and Conference of Postgraduate Medical Directors provide a useful toolkit that outlines different reflective models and provides templates that you could use to help you record the process in your log. You do not have to be bound by the proformas on the MARS website; you could simply use one of the suggested templates and upload it as evidence.

In broad terms your appraiser is looking to see that there is more than a record of what you did i.e. “I went on an update course and learnt lots”. The appraiser is looking to see how the “learning event”, be it course, reading, e-module etc has changed or updated your practice or patient care. Providing your entry shows how things have changed it is likely that the appraiser will be happy with your information.

What this means in practise is that when you provide material for your appraisal folder the evidence needs to contain an exploration of the learning that has occurred as a result of the activity.

There are many different reflective models and some of the templates and headings available on MARS are designed to help you think about the reflective process.

By answering the questions that are suggested in the templates you are prompted to think about how you can demonstrate that reflection.

The templates are not designed to be restrictive and if you find it easier you can use one of the more free-flowing "other templates" for your appraisal.

Your appraiser is going to be looking to see how the activity, be it reflecting on a significant event, attending the meeting, reading on the subject, responding to a complaint, responding to a compliment, undertaking online modules or learning etc., has changed your understanding of the area you have learned about. In particular they are interested in how it will improve and change the way you approach your work of treating and managing patients, or improving how you undertake some other role.

Putting it another way:

  • What is it that you are going to do following your learning activity that you are not doing before?
  • What are you going to continue doing which you were doing, and which is in line with current best practice?
  • What are you going to stop doing as it is no longer best practice?

These three questions can be applied to clinical and non-clinical situations and learning.

Your appraiser is also looking to see whether any individual learning activity has made you, while reflecting on the subject, identify further learning needs.

An example of this might be: you attend a meeting on atrial fibrillation. The meeting makes you aware of the need to put all patients with a diagnosis of atrial fibrillation on anticoagulants. The two choices are warfarin or direct oral anticoagulants. The research evidence for direct oral anticoagulants only applies to those patients who have valvular heart disease. When you think about this you are not sure what valvular heart disease is. In writing up the topic you would then include this reflection and then suggest that you would perhaps wish to learn more about the definition of valvular heart disease. By stating what you want to learn about next you are demonstrating that you have thought carefully about the subject and have identified further learning needs and are highlighting how addressing those needs will develop your skills to be able to manage patients with atrial fibrillation.

Your appraiser should then help you develop the idea during the appraisal process.

As well as thinking about these activities from a personal point of view, all doctors now work within a wider team. Thinking about how the activity you have undertaken might have an effect on the team, the way in which the team works, or the “patient journey”, can also help you generate ideas about how your practice might change.

Taking the atrial fibrillation question as an example, you might then think more generally about how you would apply the knowledge you gained to manage patients within the context of the broader team, be that in primary or secondary care. You might wonder what resources are already being used; what resources need to be used; how resources might be moved from other areas of care; or how new resources might be applied for.

Writing and reflecting more on the outcomes of the learning helps you focus on how your practice in the broader sense would change.

In this section

Mock GP appraisal entry

Here is an example of the same educational activity treated in three different ways. The aim is to try and show how from the same activity different levels of learning outcome and reflection can be gauged from the entry.

Mock secondary care entry - significant event

These are examples of an SEA and QIA activities treated in three ways, as the previous examples.