In light of the Bawa-Garba Case, should our reflective practice change? by Dr Helen Munro

Posted 25 Sep 2018

Date: 25 Sep 2018

Author: Dr Helen Munro

Dr Helen Munro, Chair of the FSRH Clinical Standards Committee on reflective practice.

Following the Bawa-Garba case, Sir Norman Williams’ review and the update of the GMC, AoMRC, COPMed and Medical School Council Standards on Reflective Practice, Dr Helen Munro (Chair of the Clinical Standards Committee) gives her view of how this affects the current FSRH Standard on Appraisal and Revalidation.

There are few doctors who have not been moved in some way by the Bawa-Garba Case. As eager medical students we entered a profession where we were passionate to “make a difference”, to “care for people”, to “do no harm”. But we are human, and we make mistakes. We hope, beyond anything else, those mistakes will not cost a life and that we will have the opportunity to reflect and learn what to do differently the next time.

The process of ‘ reflective practice’ is an integral and established element of the annual appraisal for health care professionals. It is an opportunity to show how the quality of your medical practice is maintained and improved by thinking through what you do, what you have learned and what you would change.

But following the Bawa-Garba case, in which excerpts from the reflective documents from her e-portfolio were referred to in the hearing at the medical tribunal, many of us now question what we should, and should not, put into our reflections.

Reflective notes can currently be required by a court if they are considered relevant but Professor Colin Melville, Director of Education and Standards at the General Medical Council (GMC), has stated: ‘Reflecting on experiences, both good and bad, is hugely important. The GMC doesn’t ask doctors for reflective notes to investigate concerns; in fact, we have called for those notes to be given legal protection’.

Daniel Sokol in his article “Knocking out written reflections” discusses what meaningful reflection looks like and suggests, instead of a written piece, trainees should be given a ‘coaching session’ in the same way a sports person may have.

The FSRH recognises the importance of having a coach or mentor, and have teamed up with BASHH and BHIVA to offer a mentoring programme which you can get involved with if you feel you would benefit from being ‘buddied-up’ with a more experienced colleague.

But written reflection remains a professional requirement and a key element of the documentation included within appraisal. The six types of supporting information for appraisal remain the same:

  • Continuing Professional Development (CPD)
  • Quality Improvement Activity (QIA)
  • Significant Events (SE)
  • Feedback from patients
  • Feedback from colleagues
  • Review of compliments and complaints

The quality, not quantity, of your reflections around each of the above is important when you consider what to submit. It can be useful to build your reflection around a template, and the Academy and COPMed provide some examples in this updated guidance (see Academy and COPMed reflective practice toolkit) as do the FSRH.

An idea you may not have considered but which is suggested in the updated guidance is that of team or group reflections. Getting together with others in your service may enable you to look at things differently and improve patient care and service delivery across your organisation.

Ultimately reflection is personal, as mentioned in the guidance, and there is no one way to do it. But you do (have to do it), so find a way that makes it work for you and is more than just a tick-box exercise!


Other useful links:
The Reflective Practitioner: Guidance for Doctors and Medical Students

Supporting information for appraisal and revalidation. Academy framework document