Writing a meaningful Reflection For Appraisal

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The term reflection reaches back to the Late Latin reflexio, the act of bending back, from the Latin reflectere. Today, to reflect often means to have a fresh look at what we have seen, done, and learned. So take a moment now to physically bend or look backwards. What happens?

This simple exercise enables you to reflect on what happened from that movement. Your response to the question may include gaining a new (or different) perspective, stretching or turning, and seeing something previously unnoticed, you may even have thought about it being “good to move.” The exercise may even have woken you up a bit more—all through a moment of ‘reflection’. [Extract taken from Meaningful Reflection: A Practical Approach - By Cathryn Berger Kaye of CBK Associates]

Since 2012, there has been a clear requirement from the GMC for doctors and other healthcare professionals to reflect ‘meaningfully’ and regularly on their performance and standards of practice through an appraisal portfolio, but many find this additional requirement difficult in practice, because finding time to reflect amidst the increasing pressures and conflicting demands of modern clinical life can be extremely challenging. Yet, the act of reflection is a great way to develop insight and become a more proactive and qualified professional. By seeking to explore your experiences and the outcomes of everyday events, you will be learning continuously, forming an increased understanding and improving the way you work, which is not only beneficial to you, but also to your colleagues and your patients.

"Sognefjord, Norway" by en:User:Worldtraveller, - en:Image:Sognefjord, Norway.jpg. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Sognefjord,_Norway.jpg#/media/File:Sognefjord,_Norway.jpg

Creating a ‘meaningful’ reflection

Your Appraiser is looking for evidence of a meaningful reflection. This comprises three elements:

It should be metacognitive:

Focusing on self-improvement: Could I do this better? How? What steps should I take?

It should be applicable:

Reflection on events should be carried out as soon as possible after an event as a contemporaneous statement, enabling you to review and benefit from your understanding and to make improvements. The exercise may be of less benefit to you if you only review the event a long time after it occurred. Longer term non-contemporaneous reflection can also be added and this comparison of different chronological perspectives is a powerful way to generate insight.

It should be shared:

By sharing your reflections, you can both advise and seek help from your peers. Sharing your achievements helps others and by sharing your issues, you are enabling yourself and your peers to help you troubleshoot and work through a problem. What did you learn? What are you doing differently now? What improvements have been made?  

So, what makes a good reflection?

When you start writing your reflections, a structured framework is helpful as a prompt to ensure you include key points; the description, your feelings, evaluation and analysis, your conclusions and your actions.

Description: describe what happened both in factual terms and in terms of your experience of the event or material being reviewed

Evaluation: think about what you learnt from the experience, what was good or bad? Analyse what happened. What did you learn?

Action: what would you do differently next time? How has your practice improved?

The purpose of each reflective cycle is to learn and draw conclusions that will ultimately lead to actions that will impact on your clinical practice and professional development plans.

What does a good reflective statement look like?

There are many different ways to write your reflective statement but the key elements featured above should all be included to evidence your understanding of Good Medical Practice, regardless of the individual circumstance. Good reflection goes beyond descriptive observation. Instead, it is demonstrated through evidence of analytical thinking, learning and action planning. Here is the outline template prepared by the Academy of Medical Royal Colleges which helps to facilitate the documentation of reflection:



Description of activity or event

o   Which category of activity does this match? (Keeping up to date, review of your practice or feedback from others – including complaints or compliments).

What have you learned?

o   Describe how this activity contributed to the development of your knowledge, skills or professional behaviours.

o   You may wish to link this learning to one or more of the domains (knowledge, skills and performance, safety and quality, communication, partnership and teamwork; and maintaining trust) of Good Medical Practice to demonstrate compliance with the principles and values in this GMC Guidance Document.

How has this influenced your practice?

o   How have your knowledge, skills and professional behaviours changed?

o   Have you identified any skills and knowledge gaps relating to your professional practice?

o   What changes to your professional behaviour were identified as desirable?

o   How will this activity or event lead to improvements in patient care or safety?

o   How will your current practice change as a result?

o   What aspects of your current practice were reinforced?

o   What changes in your team/department/organisation’s working were identified as necessary?

Looking forward, what are your next steps?

o   Outline any further learning or development needs identified (both individual and team/organisation).

o   How do you intend to address these needs? (set SMART – specific, measurable, achievable, relevant and time-bound – objectives).

o   If changes in professional practice (individual or team/department) have been identified as necessary, how do you intend to address these?

The MEDSU MAP, a cloud-based e-portfolio system based on the GMC GMP approach to Appraisal, provides prompts and a checklist throughout the collation of your documentation and evidence to ensure that you reflect on all events and activities. Contact the MEDSU team to discuss your portfolio requirements: contact@medsu.org or telephone 0800 689 9434.

Keywords: Reflection, Appraisal, Revalidation, Appraiser, Reflective Cycle, Evaluation, Metacognitive, healthcare professionals, good medical practice, general medical council, reflective statement, evidence, contemporaneous



Article Extract: *Meaningful Reflection: A Practical Approach - By Cathryn Berger Kaye of CBK Associates

Resource: Academy of Royal Colleges Reflective Template

Resource: GMC Reflecting on your Practice

Image Attribution CC-BY-SA 3.0 ("Sognefjord, Norway" by en:User:Worldtraveller, - en:Image:Sognefjord, Norway.jpg. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Sognefjord,_Norway.jpg#/media/File:Sognefjord,_Norway.jpg)