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Senior Medical Educator and Supervisor Support Lead, Dr Erin Waters shares her insights on reflection as a practice while teaching registrars.

Teaching registrars to appraise their skills and learning needs, to reflect on and identify personal factors that impact on therapeutic relationships and the quality of care provided for patients and on professional performance will provide them with lifelong skills for continual professional and personal development.

Reflection seems to be a trendy word in academic medicine at the moment. Personally I can’t recall it ever being mentioned let alone taught during my training. So how should we be teaching our registrars to reflect?

In the book ‘The reflective practitioner’ Schon writes:

“In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solutions through the use of research based theory and technique.

In the swampy lowlands, problems are messy and confusing and incapable of technical solution.

The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be.

While in the swamp lie the problems of greatest human concern. The practitioner is confronted with a choice. Shall he remain on the high ground where he can solve relatively unimportant problems according to his standards of rigor? 

Or shall he descend to the swamp of important problems where he cannot be rigorous in any way he knows how to describe?” (Schon, 1983)

For me this describes the very essence of what is required in general practice. Being prepared to descend into the swamp of complexity of whole-person care, to listen to all of the patients concerns and take into account their co-morbidities and individual circumstances, wherever this may lead you.

Schon also described the ability of professionals to engage in ‘reflection in-action’, to think on our feet and to consider ‘what’s happening here?’ versus ‘reflection on-action’ which is also important to examine how and why we acted post-event. This enables double-loop learning (Argyris) which is a process that involves examination of one’s own beliefs and assumptions and deepens the appreciation of experiential learning.


How can we teach our registrars to reflect?

One idea is to engage in an activity of shared reflections. Ask your registrar to choose one consultation from the week ahead on which to reflect, write a one-page reflection on the consultation and do the same yourself. Provide them with a reflective model to guide their reflection such as Gibbs reflective cycle below.

Then share your reflections with each other during your next teaching session!

I’m sure you’ll enjoy this experience and find that it provides a valuable means for teaching the complexity of general practice which will help your registrar to learn and grow to become a better and more reflective practitioner.

Happy teaching!