Dr Reena Aggarwal, European Network of Trainees in Obstetrics and Gynaecology (ENTOG) representative on the Trainees’ Committee, writes...
Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court. This has resulted in anxiety and questions about whether trainees should still provide reflection about incidents in their portfolios, particularly after the recent criminal case of female genital mutilation (FGM).
In order to progress at ARCP, each trainee has to provide at least eight reflective practice logs. Reflective practice logs should include reflection on all serious and untoward incidents and complaints in which the trainee has been named. The RCOG has given further guidance suggesting reflection can also include:
- A local incident that brought about new learning and change of practice (patient care and safety, colleagues, allied health professionals and organisational impact)
- A guideline that you’ve read, explaining how you’ve implemented it
- How you made changes to your practice as a result of significant event audits
- How you applied a newly developed protocol in practice
Local Education and Training Boards are clear that all doctors have to provide written reflections for their ARCP and appraisal, and so doctors in training must continue to write reflections, especially when there are things that do not go well. It is an essential part of training and is needed to progress through a postgraduate training programme.
This issue has been raised by the RCOG with the Academy of Medical Royal Colleges (AoMRC) where the view is that information in portfolios can always been called upon as evidence. Therefore, the advice is to document in the portfolio as one would in professional note keeping and write in the same manner as when writing in patients’ notes. It is important that doctors in training are mindful that their reflections are carefully written and focus on the learning gained from such events. In order to comply with information governance, there must be no patient identifiable information contained within written reflections.
The law will continue to challenge us (especially in our specialty), but reflection for learning is an important part of the development process. The RCOG Trainees’ Committee encourages all trainees to continue to discuss their reflections with supervisors and to seek advice from senior doctors if they have any concerns about how to reflect on a specific incident. Educational supervisors can provide support and guidance in the development of reflective writing skills.
For those who want to improve their skills in reflective writing, please see the below links: