SPOKE: Sector Partnership for Optical Knowledge and Education

Reflection and Reflective Practice by Alexandra Webster, Head of CPD, ABDO

Reflective practice is a standard expectation of healthcare professionals in modern clinical practice. It is embedded in the General Optical Council (GOC) Standards of Practice for Optometrists and Dispensing Opticians¹ the Outcomes for Registration and Approved Qualifications² and the Continuing Professional Development (CPD) scheme³. Additionally, it is an agreed ‘common expectation’ by the UK healthcare regulators⁴. Therefore, it is essential that learners develop their reflective skills as they undertake their studies and practice-based encounters, so by the time they qualify it is second nature for them to continue this life-long practice. 

According to the GOC, reflective practice is ‘the process where you think about your experiences to gain insights about your practice and to improve the way you work or the care you give to your patients’³. In its most basic form, reflection could be considered as ‘what happened, what was good/bad and why, and what should I do now?’ It is a way to look back on events, such as a particular patient encounter, and take a ‘moment of time to consider’ to learn from it. To do this there is a need for honesty, to neither allow arrogance or a lack of self-esteem or personal attitudes to taint the reality of what actually happened. There is also a need to recognise that each person encountered in practice, be they a patient or a colleague, is a unique individual and their experience of the event needs to be considered also, as much as it is possible to do so. It should be noted that it is equally useful to reflect on positive events and outcomes as much as negative ones, to understand why something went well is equally important to the embedment of good practice as finding out what went wrong.

There are many models of reflection available to support developing reflective skills and it is useful to expose learners to a variety of these so they can formally practice reflecting on situations, testing out which model may work for them. Haydn Dobby, lecturer at ABDO College, provides some simple guidance to using a reflection model in two articles written in the run up to the launch of the GOC CPD scheme^5,6. 

Reflective practice needs to be just that – practiced. Using a model of reflection, it is possible to identify events and use these real-life situations to breakdown the process of reflection. Creating a reflective journal can be one way of practicing the skill. It may be that a number of situations are suggested where the learner can choose several and write about them (or create an audio or video journal) using a formal reflective model. Both patient and colleague encounters should be reflected on, as both influence the practitioners the learners become and the care they provide.

Reflection by its very nature is highly subjective and therefore, assessment of reflective practice should be in the engagement with the process, the quality of the reflection and development of critical reflective skills, rather than on any decision-making outcome. Learning to take critical feedback is in itself a reflective-practice skill and providing staged, formative feedback on a learner’s reflective journal may support development. Using real patient cases the student is already creating as part of their portfolio can be another way to practice reflection. Asking them to use a reflective practice model when they are writing up justification of their clinical decision making, may enable them to rethink the situation and produce a more robust piece of work. Students sharing their anonymised cases in the class environment can support development of a broader practice of reflection by allowing  peer questioning and feedback. 

Learners and practitioners should be encouraged to widen their availability to feedback, to enable them to reflect fully on their role as a healthcare professional. Feedback from formal processes such as audits and appraisals can provide useful points for reflection⁷. Multi-disciplinary team learning, such as practice-based peer review can be helpful to situate the patient in the centre of practice care, rather than be considered individually by all the professionals the patient encounters. Additionally, inviting patient feedback on care and services can add an important perspective for the whole practice team to reflect on.