#GPFUQ 139 How do you learn most from your
experience? Some form of reflective practice usually improves learning. In
modern times Donald Schön in The
Reflective Practitioner (1983) promoted learning through reflection. Different
writers suggest different models that can structure your reflection. The
simplest is to ask yourself three questions: What? So What? What now?
#GPFUQ 140 How did reflective practice become less
like a mirror and more like a hammer? If the only tool you have is a hammer
then everything starts to look like a nail. Reflection has been seized as an
essential tool for appraisers and written reflection the hammer to nail all learning when
no theory, evidence or rule supports this use.
The GMC’s ‘Ready for revalidation - Supporting information for
appraisal and revalidation’ says that good medical practice requires you to reflect on your practice and
whether you are working to the relevant standards. When using supporting information in appraisal you should, through
reflection and discussion at appraisal, have demonstrated your practice against
all the attributes outlined in the GMC guidance ‘Good
medical practice Framework for appraisal and revalidation’. This will make it easier for your
appraiser to complete your appraisal and for your Responsible Officer to make a
recommendation to the GMC about your revalidation. It is not necessary to
structure the appraisal formally around the GMP Framework, or to map supporting
information directly against each attribute. However, some doctors may prefer
to do this and some appraisers may find it useful to structure the appraisal
interview in this way. In discussing your supporting information, your
appraiser will be interested in what you did with the information and your
reflections on that information, not simply that you collected it and maintained
it in a portfolio. Your appraiser will want to know what you think the
supporting information says about your practice and how you intend to develop
or modify your practice as a result of that reflection. For example, how you
responded to a significant event and any changes to your work as a result,
rather than the number of significant events that occurred.
The RCGP Guide to Revalidation v 8 Sept 2013 says you need to ensure that each of your annual
appraisals covers the requirements for revalidation, and that you are sharing
the required supporting information with your appraiser.
Your appraiser is key to your
revalidation. Your appraiser reviews your supporting information with you and
offers your responsible officer reassurance that your supporting information
and your reflection on it are appropriate.
Personal Development Plan - It is very important that you reflect on the objective, the
development achieved and any reasons for not achieving the objective. This reflection
is an important attribute of your fitness to practise.
In
summary you do need to be able to reflect on your practice with your appraiser
but you don’t need to write reflective statements about everything that you
record.
#GPFUQ 141
What sort of reflection aids learning? The
theory is that you compare your current performance with desired competencies -
by self assessment, peer assessment, or objective testing (see #GPFUQ 142)– then plan your education
accordingly. Reflection on action is an aspect of experiential learning and
involves thinking back to some performance and identifying what was done well
and what could have been done better. The latter category indicates learning
needs. Reflection in action involves thinking about actual performance at the
time that it occurs and requires some means of recording identified strengths
and weaknesses at the time. Self assessment by diaries, journals, log books,
weekly reviews are an extension of reflection that involves keeping a diary or
other account of experiences. However most people only write nearer the time of
their review than the time of the activity being recorded.
#GPFUQ
142 What sorts of activity are best used for reflection? Feedback fuels
reflection.
Peer review: involves
doctors assessing each other's practice and giving feedback and perhaps advice
about possible education, training, or organisational strategies to improve performance.
There are five main types of peer review internal, external, informal,
multidisciplinary, and physician assessment. The last is the most formal, involving
rating forms completed by nominated colleagues, and has validity, reliability,
and acceptability.
Observation: In
more formal settings doctors can be observed performing specific tasks that can
be rated by an observer, either according to known criteria or more informally.
The results are discussed, and learning needs are identified. The observer can
be a peer, a senior, or a disinterested person if the ratings are sufficiently
objective or overlap with the observer's area of expertise (such as communication
skills or management).
Critical incident
review and significant event auditing; Although this technique is usually used
to identify the competencies of a profession or for quality assurance, it can
also be used on an individual basis to identify learning needs. The method
involves individuals identifying and recording, say, one incident each week in
which they feel they should have performed better, analysing the incident by
its setting, exactly what occurred, and the outcome and why it was ineffective.
Practice review A
routine review of notes, charts, prescribing, letters, requests, etc, can
identify learning needs, especially if the format of looking at what is
satisfactory and what leaves room for improvement is followed.
