Hospital Dr News

New guidance on doctors’ reflection aims to address blame culture fears

New guidance to help doctors and medical students with reflection has been released.

The guidance sets out key points and principles on being a reflective practitioner, and has been developed in response to requests from doctors for clearer information on what is meant by reflection.

It has been published jointly by the GMC and the Academy of Medical Royal Colleges, the Conference of Postgraduate Medical Deans, the General Medical Council and the Medical Schools Council.

It follows widespread concern in the medical profession following the Bawa Garba case, when the GMC pursued a junior doctor for gross negligent manslaughter in the High Court.

Many felt the case challenged whether doctors should be open and honest about clinical mistakes for fear of regulatory reprisals.

The new guidance outlines the importance of reflection for personal development, as a way of demonstrating insight, to help learning and to identify opportunities to improve patient safety.

Among key points in the guidance are:

  • Reflective notes do not need to capture full details of an experience, but should focus on learning.
  • Reflection is personal and there is no one way to reflect.
  • Having time to reflect on both positive and negative experiences is important.
  • Group reflection often leads to ideas that can improve patient care.
  • Tutors, supervisors, appraisers and employers should support individual and group reflection.

Professor Carrie MacEwen, Chair of the Academy of Medical Royal Colleges (AoMRC), said: “Being able to reflect on all aspects of clinical care is important to improve the way we look after patients.

“This guidance should reassure all doctors that it is possible to record events in a way that optimises learning and promotes active change in practice based on this learning.”

However, reaction from the profession was mixed. One doctor said the new guidance is “vague” and questioned the value of “watered down” reflection.

Another suggested that the current attitude of the regulator, coupled with intense work pressures in hospital, will lead to doctors suppressing rather than sharing clinical mistakes.

Dr Caroline Fryar, head of advisory services at the MDU, said: “Careful and conscientious reflection on professional practice, particularly if things go wrong, can be helpful both in terms of learning lessons and in demonstrating insight.

“As the new guidance points out, a reflective note does not need to capture full details of an experience. It should capture learning outcomes and future plans. We hope the guidance will help reassure doctors and medical students about some of the misconceptions about reflection and the contents of reflective notes, particularly in connection with legal and regulatory proceedings.

Dr Jeeves Wijesuriya, BMA junior doctors committee chair, said: “The guidance also reiterates assurances given to us that the GMC does not ask for reflective notes in its fitness-to-practise investigations, and while we continue to ask for their full legal protection, we are pleased there is clarification of the level of information required.

“The focus must be on learning, rather than blame, and so clarity that specific factual details are not needed to improve care in the future is welcome.”

Read the guidance.

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