Reflection and professionalism

The GMC says

Reflection: Appraisal is a supportive and developmental forum, giving you the opportunity to reflect on your professional practice over the past year. Reflecting on your supporting information and what it says about your practice will help you improve the quality of care you give your patients and the services you provide as a doctor. You will not meet our requirements by simply collecting the required information. Ongoing reflection on your practice is central to revalidation and should form part of the preparation for your annual appraisal. Your appraiser can facilitate further reflection, as needed, but it is your responsibility to demonstrate examples of your reflective practice.

The GMC requirements, AoMRC guidance and RCGP recommendations, all highlight the importance of reflection on supporting information, not just the capture of raw data in a portfolio. Reflective practice is central to the annual appraisal process because the quality of your medical practice is maintained and improved by thinking through what you have learned and what you will do differently as a result. There are two stages to reflection in appraisal: firstly, your thoughts about your supporting information, captured in your reflective notes in your portfolio and, secondly, the facilitated reflection with the appraiser during the appraisal discussion, when your individual reflection may be put into context and developed into your plans for the future.

The RCGP recognises that the word 'reflection' itself means different things to different people, and there are many different models of reflection, so that there has been anxiety about how to document reflection appropriately without the recording of it becoming disproportionate. For doctors, professionalism means engaging in a continuous process of self-assessment and personal and professional development. We are trained to think about what we do all the time, and to have the insight to acknowledge gaps in our knowledge or skills, recognise when something could have gone better, and take steps to address our learning needs. This process may be so ingrained in the reflective practitioner, that it is hard to bring thoughts and reflections to the level of conscious awareness to write them down. This may be one reason why the documentation recommended for appraisal has been perceived, in some cases, as burdensome, especially if it is applied in a disproportionate way. The focus should be on practising as a reflective professional, not on documenting reflection obsessively, especially if the documentation detracts from time spent with patients, colleagues, friends or family.

The RCGP recommends that you should provide a relatively small number of representative, high quality documented examples of your reflective practice in your supporting information for appraisal and revalidation. You should not to try to document your reflection every time something new is learned, looked up or discussed, but you do need to ensure you have demonstrated your continued competence across your whole scope of practice. Before including an additional piece of supporting information in the portfolio, you should ask yourself what it adds to what is already there.

Learning and development

The GMC says

Focus on learning: At your appraisal you must discuss with your appraiser the changes you have made or plan to make, and any areas of good practice you intend to maintain or build on as a result of your reflections on your supporting information and appraisal discussion. We do not require you to document the detail of every event. You should focus on what you have learned and what changes you need or want to make.
Link to improvement and development planning: Reflection supports your development and continuous learning and will help you to identify improvements you can make to your practice. You must consider the learning needs and opportunities identified through the appraisal process in discussion with your appraiser and agree how this feeds into your personal development plan and continuing professional development activities for the following year.

The annual appraisal process is structured around continuous professional development through reviewing the progress made with your previous year's personal development plan (PDP) and agreeing new PDP goals arising from the appraisal and discussion.

The RCGP recommends that you focus on agreeing supportive and well-structured PDP goals that will contribute to your personal and professional development and help you maintain and improve the quality of your practice and your patient care.

Next: Information required for your appraisal >

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