RCoA provides guidance on reflection

The College is aware that many of our fellows and members, but particularly anaesthetists in training, continue to be concerned by the issues arising from the Bawa-Garba case. As stated in Presidents News in Feb 2018,   we are liaising with relevant bodies to ensure a climate where clinicians can learn from errors and so deliver the safest possible patient care. Doctors should be held accountable for their actions, but it cannot be right, with current knowledge of human factors and risk management, for any individual to be held solely culpable for tragedies that have been contributed to by systemic failings.

Doctors must feel able to reflect openly and truthfully on their practice without fear of repercussions, because the ability to learn from experience is the duty of all healthcare professionals.  It is this aspect of the case that appears to have caused most concern to anaesthetists in training. We believe that clear guidance on reflective practice must apply to all specialties, and therefore advise you to study, and act upon the recent joint statement by the AoMRC and the Conference of Postgraduate Medical Deans (COPMeD) .The AoMRC and CoPMeD are working with the GMC, the Academy Trainee Doctors Group, and the BMA’s Junior Doctors Committee to produce definitive guidance that will be published in due course.

In the meantime, the College wishes to remind all its trainers and trainees that:

  • Reflection can be done on positive as well as negative events. It is equally important to learn from excellence, as it is from errors.
  • Some Schools of Anaesthesia have extra requirements for a defined number of reflections to be included in trainee portfolios. Neither the College nor the GMC specify a fixed number of reflections, in order to progress in training. We ask these Schools to consider the necessity for their extra ARCP requirements, to be sensitive to the concerns of trainees, and to guide them in achieving the necessary standard.
  • In keeping with the AoMRC/CoPMED statement on reflection, we recommend that documentation of reflective practice focuses on understanding of what has been learnt, and any resultant action, rather than on factual accounts of events. 
  • Useful and valid reflection may be undertaken verbally with a supervisor.  It is recommended that the supervisor should document that discussion with reflection on an event has taken place, and that the trainee has demonstrated insightful learning. The demonstration of capability to reflect is the key point that should be recorded.

22 March 2018