Academy and COPMeD Reflective

Practice Toolkit
Guidance Note
Background
The Academy of Medical Royal Colleges (AoMRC), the Conference of Post-Graduate Medical
Deans (COPMeD), the General Medical Council and the Medical Schools Council have jointly
produced guidance on reflection which should be read in conjunction with this toolkit. These
supersede the interim Academy guidance produced in April 2018.

Purpose
This toolkit, which contains templates and examples of reflective styles, aims to facilitate best
practice in the documentation of reflection on a variety of activities and events. It aligns with
our joint guidance and previous AoMRC guidance. The templates are suitable for adaptation by
Colleges/Faculties. who typically have their own formats.

The toolkit provides different template options that can be used, depending on the aspect of
learning to be captured and individual personal preference. Some tools lend themselves to
immediate personal reflection whereas others are more useful when some additional
perspective has been gained, either through the passage of time or discussion with others.

Individuals will have different preferences based on how they learn best. Doctors may wish to
provide documentation of their reflection on a single event or a summary of their reflective
approach based on several different types of experience. Doctors in training are likely to need
support to develop the skills to complete reflections, with action points and documented
evidence of how learning has been translated into practice. The process is not a solitary event
but one that accumulates the learning, support, advice and teaching into good practice.

Reflective practice
Reflection should be part of a doctor’s everyday practice.

Reflective practice is ‘the process whereby an individual thinks analytically about anything
relating to their professional practice with the intention of gaining insight and using the lessons
learned to maintain good practice or make improvements where possible’.

This may be a situation the doctor observed, or was directly involved with, or may be part of
formal learning which has been particularly poignant or effective. Reflection happens with both
positive and negative events – learning from activities, either to reinforce behaviour or to
change it. As this implies, it can take place during and after the situation.

As professionals, doctors should engage in a continuous process of self-assessment as part of

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For this to be a meaningful process, individuals need to examine their previous beliefs about
their practice. These beliefs are often firmly held, and individuals needs to learn to accept that
things can be done differently or better. By continuously evaluating previously held beliefs and
assumptions learning occurs and practice develops.

Doctors can benefit from challenge in reflective practice. Reflections may accurately document
thinking that is based on inaccurate beliefs or assumptions which need some challenge. This is
the role of an educational supervisor and appraiser.

System Learning
Reflective practice should also inform organisational learning to help create system change and
development. NHS organisations need to learn and improve by listening to the
recommendations that result from individual and team reflective processes, and by facilitating
and promoting system wide reflective learning.

Reflective Practice: an overview

Requirements
Doctors must feel able to have honest and open discussions about clinical events and should be
confident that engaging in reflection provides them with a) improved opportunities to learn, b)
evidence of a professional approach to self-development, and c) changes leading to
improvement of patient care where appropriate.

Reflection should not be a detailed description nor an attribution of blame, but should focus on
feedback and descriptions of the increased understanding gained which has led to an
affirmation of, or change of, practice. Notes on reflection should thus demonstrate analytical
thinking, learning accrued from various sources, including discussion with peers and
supervisors, and action planning. The documentation of reflection should, therefore, focus on
the learning extracted from an event and should not be a full discussion of the case or situation.

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This is particularly important in reflections after a significant event as these have a different
purpose from the documentation of factual events necessary in the reporting or investigation of
serious incidents (SI).

There are different ways to reflect and to document those reflections. The GMC does not require
any specific documentation, only evidence that it is being carried out effectively.
Documentation of reflection can involve writing personal notes in CPD / appraisal portfolios or in
training portfolios, or, if reflection is undertaken as part of a dialogue with trainers, this can be
recorded as a workplace-based assessment/supervised learning encounter.

A written record of reflection may be made at any time. All details of those involved in a
reflective event – patients, colleagues, relatives etc – must be fully anonymised to comply with
confidentiality and information governance requirements. Similarly, precise locations, dates and
times should not be specified, and separating the timing of the reflective documentation of an
event and its actual occurrence may help to achieve this.

Summary
Documented evidence of reflection demonstrates a professional attitude to maintaining Good
Medical Practice by showing the ability to learn from and develop one’s own and system wide
practice; take up learning opportunities; and demonstrate the ability to be a responsible self-
directed learner. It can be as useful to learn from positive and successful situations as from
incidents where care could have been better.

August 2018

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Resources
Templates and examples are available through these links:

Templates

Reflection based on Schon

What, Why, How

Reflection based on Rolfe et al

Reflection based on Gibbs cycle

Academy reflective template

What happened, what did you do, what have you learnt, what next

Reflective diaries / Logs

Team reflection

Examples of four incidents that use the differing templates above

Incident 1 – A near miss

Incident 2 – Prescribing error

Incident 3 – WHO checklist incident

Incident 4 – A communication error

These examples demonstrate differences in personal style, in purpose and complexity of the
reflection.

Different formats work better for different individuals and in different settings, and our examples
are useful options for training logs, appraisal portfolios and reflective notes.