A GUIDE TO REFLECTIVE PRACTICE

Transcription

1 A GUIDE TO REFLECTIVE PRACTICE Intrductin One imprtant cmpnent f yur Phase 2 prtfli will be evidence f reflective practice. Prfessinals need t develp and practice their reflective skills thrughut their careers. Yu began t practice and recrd these skills in yur Phase 1 prtfli and yu are encuraged t cntinue t d this in Phase2, particularly nw that yu are in regular cntact with patients and health care prfessinals. We want reflective practice t be a genuinely useful exercise that helps yu t develp real insights; nt just a paper exercise that has t be dne. With this in mind, we have intrduced an element f chice: yu can either cmmit t verbal reflective practice in a supprted grup setting r written reflective practice with persnalised feedback. Different peple prefer different methds f reflectin and this chice f activity allws yu t develp yur reflective practice in a way that helps yu t learn frm it. Yu will find that whichever methd yu chse t undertake, mst insights/reflectins when cmmitted t paper r discussed in a grup begin t develp mre persnal meaning and allw us t learn frm ur experiences in a way that is helpful t patients as well as t urselves. What is Reflective Practice? Yu will be reflecting everyday n yur actins and inactins and thse f the peple arund yu; this is hw adults learn. We wuld als like yu t develp these skills further by undertaking activities f mre critical reflectin; by stepping back frm events and actins and explring yur persnal rle r interpretatins. This increases the learning ptential f these experiences and allws yu t recgnise events and actins frm multiple perspectives (Hattn & Smith1995). The Elements f Reflective Practice in Phase 2 t be Recrded in Yur Prtfli 1. The standard patient clerking frmat (see belw) alerts yu t the need t incrprate aspects f insightful r reflective practice in every clerking. Yu shuld keep all yur patient clerkings in a supprting dcuments bx file. 2. During the year yu will be expected t undertake ne f the fllwing reflective practice activities: a. 2 extended pieces f reflective writing that will be submitted t a reflective practice tutr wh will give yu feedback n yur develping reflective writing skills. OR b. Take part regularly in a Balint grup, either as yur Year 3 Student Selected Cmpnent (SSC) activity r in additin t it. OR c. Take part in the Student Psychtherapy Scheme including supervisin Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

2 1. Clerking Frmat 1. The patient s prblems (PC) 2. Clinical histry (HPC) 3. Physical Examinatin (OE) 4. Summary 5. Differential diagnsis ( ) 6. Prblem list 7. Investigatins (I x ) 8. Management (R x ) 9. Reflectin/insight n an aspect f the clerking. Select ne f the scenaris suggested in appendix 1r chse yur wn example. Write a few lines r shrt paragraph as an integral part f the clerking and/r presentatin. 10. Fllw up ntes and discharge planning Belw are sme suggestins f areas yu might like t explre fr the reflectins/insight cmpnent f patient clerkings. Yu need nly select ne f the bullet pints here r ne area f yur wn: What is really happening with regard this patient? What was interesting r wrrying? What can yu cnclude generally abut the situatin this patient is in? What did the patient say and think abut their illness? (if apprpriate) What were the patient s ideas, cncerns and expectatins? What did the staff say and think? (if apprpriate) What has been dne well with regard this patient s care? What shuld be dne differently next time? What did yu learn abut yurself? Can yu identify future learning needs? 2. Extended Reflective Practice During mdule 1 and mdule 3 yu will submit electrnically tw pieces f reflective writing. We wuld expect the stimulus fr the reflectin t be an actin (r inactin) by yu r by thers, a patient related encunter r a grwing realisatin that yu are develping during the curse, but it can be anything relevant t yu as a develping health prfessinal. The expected wrd cunt will be between 500 and 1,000 wrds. This will be submitted t yur reflective practice tutr wh will give yu individual feedback n yur develping reflective writing skills. The tutr will als indicate whether the item is suitable fr submissin int yur prtfli r needs further wrk. OR Yu will jin ne f the Balint grups. These are supprted student discussin grups that allw the time and space t discuss the dctr, the patient, and his illness and the experiences and emtins that arise as part f medical practice. Yu will need t attend regularly thrughut the year and prvide evidence in yur prtfli in the frm f either a certificate f regular attendance r a satisfactry cmpletin f SSC frm (if yu have chsen t d this as yur SSC fr Year 3). Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

3 Hw t Get Started with Reflective Practice Yu will need t decide during yur first mdule which methd yu will use t develp yur reflective practice skills. Yu will be cntacted electrnically by the year 3 administratin team early in yur first mdule. Yu must reply t this alert s that yu can either be allcated t a grup r a writing tutr. Satisfactry engagement with reflective practice is yur respnsibility: dn t leave the attendance at a Balint Grup r the cmpletin f written wrk t late satisfactry cmpletin f a prtfli is required cursewrk and needed fr satisfactry cmpletin f year 3 and thus prgressin int year 4. Imprtant infrmatin If yu chse t jin a Balint Grup yu may register fr this as yur SSC chice fr the year r yu may be invlved in yur wn time and chse anther SSC. Please nte many Balint grups happen after hurs and regular attendance is necessary. Please d nt cmmit t this as yur chsen methd f reflective practice is yu cannt manage a regular after hurs cmmitment. If yu chse t submit written wrk please nte that we treat plagiarism very seriusly indeed. UCL has nw signed up t use a sphisticated detectin system (Turn-It-In) t scan wrk fr evidence f plagiarism. This system gives access t billins f surces wrldwide, including websites and jurnals, as well as wrk previusly submitted t by ther students in the medical schl, UCL and ther universities. Overleaf are sme useful resurces t develp yur reflective practice. Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

4 A MODEL FACILITATING STRUCTERED REFLECTION The fllwing apprach can be used t enhance discussins arund significant event analysis DESCRIPTION: EMOTIONS: OUTCOMES: EVALUATIONS: ANALYSIS: CONCLUSIONS: Describe this in mre detail What exactly happened? What did yu d? What were yu thinking/feeling at that pint? What were the cnsequences fr a) the patient b) thers c) yurself What were yu trying t achieve? What was gd/bad abut it? What internal factrs were influencing yu? What knwledge/values did r shuld have infrmed yu? Hw did yur actins match yur beliefs/knwledge? What factrs made yu act in incngruent ways? Hw des this cnnect with previus experiences? Culd yu have handled this better in a similar situatin? Hw d yu nw feel abut this experience? Can yu supprt yurself r thers better as a cnsequence? Faced with that experience again, what wuld yu d? Adapted by Anita Berlin July 2004 Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

5 Pssible Scenaris fr Reflective Practice Abut the patient A patient happy r unhappy with their treatment Hw in cntrl f a situatin was the patient? A questin f cnfidentiality r cnsent Was the patient at risk? Catheters, cannulae, nil by muth, plypharmacy Abut yu An aspect f the clerking that reveals gaps in yurs r anther health care prfessinal s knwledge skills r attitudes An area that caused yu anxiety r enjyment An aspect f care that leaves yu surprised, puzzled r cnfused Cmmunicating with lder r frail peple Cnsultatins invlving mre than ne persn (e.g. relative) Length f cnsultatin Difficulty btaining the histry r examinatin Abut the team Challenging an aspect f the diagnsis r management A disagreement within the team abut management Difference f pinin r dispute between yurself and a member f the team An bservatin that the team was under pressure Gd Medical Practice times when yu have seen Gd Medical Practice times when yu have seen practice that may be at dds with Gd Medical Practice Other examples (but yu may, f curse, chse yur wn examples) An incident that made yu prud f yurself r thers Challenging a self-evident clinical truth Ding smething fr the first time Cnsultatins invlving mre than ne persn (e.g. relative) Length f cnsultatin The mst memrable event frm that firm r mdule A specific cmplaint Cnsent Sudden death r deteriratin Team wrking r lack f it An example f perceived gd r bad teaching Valuing thers in the MDT, the rle f the dctr in the MDT and duty f care. Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

6 Gd Medical Practice The duties f a dctr registered with the General Medical Cuncil Patients must be able t trust dctrs with their lives and health. T justify that trust yu must shw respect fr human life and yu must: Make the care f yur patient yur first cncern Prtect and prmte the health f patients and the public Prvide a gd standard f practice and care Keep yur prfessinal knwledge and skills up t date Recgnise and wrk within the limits f yur cmpetence Wrk with clleagues in the ways that best serve patients' interests Treat patients as individuals and respect their dignity Treat patients plitely and cnsiderately Respect patients' right t cnfidentiality Wrk in partnership with patients Listen t patients and respnd t their cncerns and preferences Give patients the infrmatin they want r need in a way they can understand Respect patients' right t reach decisins with yu abut their treatment and care Supprt patients in caring fr themselves t imprve and maintain their health Be hnest and pen and act with integrity Act withut delay if yu have gd reasn t believe that yu r a clleague may be putting patients at risk Never discriminate unfairly against patients r clleagues Never abuse yur patients' trust in yu r the public's trust in the prfessin. Yu are persnally accuntable fr yur prfessinal practice and must always be prepared t justify yur decisins and actins. Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

7 1. Structured Debriefing frm Learning by Ding, Gibbs (1988), based n Klb s Experiential Learning Cycle Descriptin: Feelings: Evaluatin: Analysis: Cnclusins (general): Cnclusins (specific): Persnal Actin plans: What is the stimulant fr reflectin? (incident, event, theretical idea) What are yu ging t reflect n? What were yur reactins and feelings? What was gd and bad abut the experience? Make value judgements. What sense can yu make f the situatin? Bring in ideas frm utside the experience t help yu. What was really ging n? What can be cncluded, in a general sense, frm these experiences and the analyses yu have undertaken? What can be cncluded abut yur wn specific, unique, persnal situatin r ways f wrking? What are yu ging t d differently in this type f situatin next time? What steps are yu ging t take n the basis f what yu have learnt? 2. A framewrk that describes levels f reflectin frm Hattn and Smith (1995) Descriptive writing: descriptin f events r literature reprts. N discussin beynd descriptin. The writing is cnsidered nt t shw evidence f reflectin Descriptive reflective: basically descriptin, but sme evidence f deeper cnsideratin. N real evidence f the ntin f alternative viewpints in use. Dialgic reflectin: writing suggests stepping back frm events and actins - leads t different level f discurse. Sense f mulling abut, explratin f persnal rle in events and actins. Cnsideratin f the qualities f judgements and pssible alternative explanatins. Reflectin is analytical r integrative, linking factrs and perspectives. Critical reflectin: in additin, shws evidence that the learner is aware that actins and events may be lcated within and explicable by multiple perspectives, but are lcated in and influenced by multiple and sci plitical cntexts Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice

8 References Wattn P, Cllings J, and Mn J Reflective Practice: a guide fr students, Exeter University (nline) (April 2001), Available frm: (Accessed 18th August 2004) guidance/gd_medical_practice/duties_f_a_dctr.asp Balint, M. (1964) The Dctr, his Patient and the Illness. 2 nd editin. Lndn: Pitman. Students and Balint grups: Prtfli Sectin 3: Presentatins and Reflective Practice: A Guide t Reflective Practice