Insights
Reflecting on reflection James Read Collaboration for the Advancement of Medical Education Research & Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
T
he value of reflection as an educational tool within both undergraduate and postgraduate medical education has been well studied, and reflective practice is now a required element of professional development by many regulators, including the UK’s General Medical Council, and is now a compulsory part of the revalidation of UK doctors.1–3 Teaching others how to reflect and helping students and doctors to understand the importance of reflection can, however, be challenging, as multiple different methods are employed.1 One way in which high-quality reflective practice amongst medical students and doctors could be achieved and developed is to revisit our own previous reflections, and to encourage others to do the same, to help us understand how we have changed our practice. This
process can help to emphasise the impact of reflection and remind us of learning points that we have forgotten, as I have discovered and shared with both junior and senior medical colleagues and students in recent months. During my time as an undergraduate medical student I became a participant in a study that encouraged us to keep audio diaries about our new experiences.4,5 There were no rules about what we could record, as long as patient confidentiality was maintained, but the guidance was to think about things that had happened to us and how we felt. Last month, whilst in the process of moving house, I found the dictation device I had been provided with for the study. The recordings had remained intact
and therefore I was able to listen to my previous thoughts about my transition into the medical world. What struck me was the excitement and anxiety with which I approached clinical encounters in my first year. Descriptions of events were focused not on the medicine but on the patient, the surroundings and how they felt. One reflection vividly described the anxiety I witnessed in a lady diagnosed with cancer. I noticed that I wasn’t ‘medicalising’ things in the way that I am used to doing now; instead, I was focused on her distress, and not on the type of cancer she had, survival rates and treatment.
Reflective practice is now a required element of professional development by many regulators
I was also interested in the different way I empathised with the patients I encountered. My understanding of medical terminology was much closer to
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2 1
Reflection has become a way of life in medical practice but is still viewed with anxiety and suspicion by some
that of my patients at this very early stage in my career, and therefore I understood to a much greater degree how bewildering medical jargon could be and the fear of the unknown. I feel that it was experiences like this that shaped the way I communicate with patients now. Subsequently, this experience of listening to the audio diary made me reflect on whether there were further changes I could make to my current practice. This experience reminded me of the fear that a consultation with a doctor can cause, the anxiety that medical terminology can evoke, and the preconceptions of society and patients that we forget about when we use certain medical terms, which have changed and evolved over time. I was reminded of this particularly last week when discussing the diagnosis of pneumonia with an elderly patient and her relatives. As a registrar in elderly care medicine this is, for me, a common diagnosis and discussion. With the recent events of listening to my own reflections still fresh in my mind I thought about the label that older patients place on pneumonia, and the experiences from their childhoods when
pneumonia killed far more frequently than it does now. As a result, I changed my practice. I felt I was clearer in my explanation as to what pneumonia actually means, and the information I gave about what to expect was in more detail than normal. I was also more careful about the language that I used, and I spent more time checking their understanding. This was, therefore, one of the most refreshing and satisfying interactions with a patient and their family that I have had in a long time, something that should be significantly credited to the insight I gained from my previous reflections. Doctors and medical students are encouraged to reflect, and this can feel unnatural, especially when being performed as part of assessment or appraisal work. The lesson from my experience is that recording our reflections and revisiting them in years to come, such as through the use of an audio diary with saved recordings, can allow us to gain much more from reflective practice, and can demonstrate the relevance of reflection to ourselves, students and peers. Reflection has become a way of life in medical practice
but is still viewed with anxiety and suspicion by some, which is unfortunate given the potential it has in helping to produce excellent doctors. Sharing experiences where reflection has changed our practice with our students and colleagues can help to remind us of the value of reflection, and will benefit medical education and the care of our patients. REFERENCES 1.
Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ 2009;14:595–621.
2.
General Medical Council. Medical Students: Professional values and fitness to practice. London: GMC; 2009.
3.
General Medical Council. The Good Medical Practice framework for appraisal and revalidation. London: GMC; 2011.
4.
Monrouxe LV, Sweeney K. Between two worlds: Medical students narrating tensions. In Figley CR, Huggard P, Rees C, eds. First Do No Self-Harm: Understanding and Promoting Physician Stress Resilience. Oxford: Oxford University Press; 2013.
5.
Monrouxe LV. Solicited audio diaries in longitudinal narrative research: a view from inside. Qual Res 2009;9:81–103.
Corresponding author’s contact details: James Read, Collaboration for the Advancement of Medical Education Research & Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, PL4 8AA, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: Thanks to Dr Lynn Monrouxe and Dr Julian Archer for their advice regarding this article. Ethical approval: This piece of work is a personal reflection and therefore ethical approval was not required. doi: 10.1111/tct.12388
2 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2
Reflecting on reflection James Read Collaboration for the Advancement of Medical Education Research & Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
T
he value of reflection as an educational tool within both undergraduate and postgraduate medical education has been well studied, and reflective practice is now a required element of professional development by many regulators, including the UK’s General Medical Council, and is now a compulsory part of the revalidation of UK doctors.1–3 Teaching others how to reflect and helping students and doctors to understand the importance of reflection can, however, be challenging, as multiple different methods are employed.1 One way in which high-quality reflective practice amongst medical students and doctors could be achieved and developed is to revisit our own previous reflections, and to encourage others to do the same, to help us understand how we have changed our practice. This
process can help to emphasise the impact of reflection and remind us of learning points that we have forgotten, as I have discovered and shared with both junior and senior medical colleagues and students in recent months. During my time as an undergraduate medical student I became a participant in a study that encouraged us to keep audio diaries about our new experiences.4,5 There were no rules about what we could record, as long as patient confidentiality was maintained, but the guidance was to think about things that had happened to us and how we felt. Last month, whilst in the process of moving house, I found the dictation device I had been provided with for the study. The recordings had remained intact
and therefore I was able to listen to my previous thoughts about my transition into the medical world. What struck me was the excitement and anxiety with which I approached clinical encounters in my first year. Descriptions of events were focused not on the medicine but on the patient, the surroundings and how they felt. One reflection vividly described the anxiety I witnessed in a lady diagnosed with cancer. I noticed that I wasn’t ‘medicalising’ things in the way that I am used to doing now; instead, I was focused on her distress, and not on the type of cancer she had, survival rates and treatment.
Reflective practice is now a required element of professional development by many regulators
I was also interested in the different way I empathised with the patients I encountered. My understanding of medical terminology was much closer to
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2 1
Reflection has become a way of life in medical practice but is still viewed with anxiety and suspicion by some
that of my patients at this very early stage in my career, and therefore I understood to a much greater degree how bewildering medical jargon could be and the fear of the unknown. I feel that it was experiences like this that shaped the way I communicate with patients now. Subsequently, this experience of listening to the audio diary made me reflect on whether there were further changes I could make to my current practice. This experience reminded me of the fear that a consultation with a doctor can cause, the anxiety that medical terminology can evoke, and the preconceptions of society and patients that we forget about when we use certain medical terms, which have changed and evolved over time. I was reminded of this particularly last week when discussing the diagnosis of pneumonia with an elderly patient and her relatives. As a registrar in elderly care medicine this is, for me, a common diagnosis and discussion. With the recent events of listening to my own reflections still fresh in my mind I thought about the label that older patients place on pneumonia, and the experiences from their childhoods when
pneumonia killed far more frequently than it does now. As a result, I changed my practice. I felt I was clearer in my explanation as to what pneumonia actually means, and the information I gave about what to expect was in more detail than normal. I was also more careful about the language that I used, and I spent more time checking their understanding. This was, therefore, one of the most refreshing and satisfying interactions with a patient and their family that I have had in a long time, something that should be significantly credited to the insight I gained from my previous reflections. Doctors and medical students are encouraged to reflect, and this can feel unnatural, especially when being performed as part of assessment or appraisal work. The lesson from my experience is that recording our reflections and revisiting them in years to come, such as through the use of an audio diary with saved recordings, can allow us to gain much more from reflective practice, and can demonstrate the relevance of reflection to ourselves, students and peers. Reflection has become a way of life in medical practice
but is still viewed with anxiety and suspicion by some, which is unfortunate given the potential it has in helping to produce excellent doctors. Sharing experiences where reflection has changed our practice with our students and colleagues can help to remind us of the value of reflection, and will benefit medical education and the care of our patients. REFERENCES 1.
Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ 2009;14:595–621.
2.
General Medical Council. Medical Students: Professional values and fitness to practice. London: GMC; 2009.
3.
General Medical Council. The Good Medical Practice framework for appraisal and revalidation. London: GMC; 2011.
4.
Monrouxe LV, Sweeney K. Between two worlds: Medical students narrating tensions. In Figley CR, Huggard P, Rees C, eds. First Do No Self-Harm: Understanding and Promoting Physician Stress Resilience. Oxford: Oxford University Press; 2013.
5.
Monrouxe LV. Solicited audio diaries in longitudinal narrative research: a view from inside. Qual Res 2009;9:81–103.
Corresponding author’s contact details: James Read, Collaboration for the Advancement of Medical Education Research & Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, PL4 8AA, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: Thanks to Dr Lynn Monrouxe and Dr Julian Archer for their advice regarding this article. Ethical approval: This piece of work is a personal reflection and therefore ethical approval was not required. doi: 10.1111/tct.12388
2 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 1–2
