Revalidation - Top tips on effective reflection

Thinking deeply about your skills and needs is key to successful revalidation. By Dr Rodger Charlton

Dr Roger Charlton: ‘Thinking and reflecting on your patients might just be the thing to prevent burn-out’ (Photograph: NTI)
Dr Roger Charlton: ‘Thinking and reflecting on your patients might just be the thing to prevent burn-out’ (Photograph: NTI)

1 Seize the opportunity to record and reflect on learning events
Learning often takes place at the workplace. For example, problem solving is something GPs do all the time. It may involve a lab result, the opinion of another doctor or an investigation such as a scan, but each time we learn something new.

Traditional learning events such as attending lectures, reading journals or completing an e-module should also be logged and reflected on in your ePortfolio.

2 Write down your reflections on learning events
Rate the event in terms of its usefulness. What was good and bad about it educationally? What did you learn? Will it have an impact on your practice and in your contacts with patients?

List any changes you propose as a result. We all reflect, but we rarely document our thoughts.

3 Put learning needs in your personal PDP
Following an educational event, state whether you need to learn further in this area. If you do, remember to record the details of how you intend to do this and when in your personal development plan (PDP).

Make a note in your PDP of any resources or assistance from colleagues you may require, and the period in which you wish to achieve your aims.

4 Plan your learning throughout the year
A PDP is about action, and like the GP registrar ePortfolio, it should be dynamic and not an annual exercise. During your appraisal year, you will have some identified development needs that may take you a year or more to fulfill.

Learning events may also lead to short-term goals. Record them and make them part of your PDP action plan.

5 Manage your time to keep your ePortfolio up to date
Leave your ePortfolio web page open but minimised on the screen while you are consulting. When learning events occur, including patients' unmet needs and doctor's educational needs, log them while they are still on your mind.

Use any notes as memory joggers to look up a subject in more detail later. Using the tracking option at can help with this, so download it to your ePortfolio.

6 Share practice professional development plans
If you propose changes, share practice professional development plans (PDPs) at a practice team meeting or through the practice intranet. Sharing your learning with the team can optimise the quality of care for the practice's patients.

7 Think about your strengths and weaknesses
It is so easy to learn and concentrate on areas that excite you and where you want to develop expertise. But GPs are generalists so we all have weakness that we become aware of through reflection.

Concentrating on remedying these by acquiring further knowledge/skills will make you a better doctor.

8 Demonstrate the results of your learning
Revalidation is about reflection and demonstrating good practice.

So, with any areas of weakness, detail changes that are to be made in your practice so you are able to demonstrate evidence of change.

This may be via an audit or responding to feedback from patients. Record it in your ePortfolio and reflect on whether specific changes were successful or require further work.

9 Identify tendencies to avoid reflection
Perhaps you sometimes avoid reflection when a learning event makes you realise that change is needed, by pushing this to the back of your mind and doing nothing after collecting your certificate of attendance? It is not enough to say you have learnt merely because you were at a medical meeting, read a journal article and made notes or took part in a tutorial.

Proper reflection should lead to change - whether this is a matter of providing evidence of good practice where you need to strive to maintain standards or using clinical governance to improve and optimise care.

10 Get into the habit of reflecting on your work
When you work with people in the very personal way that GPs do, you can reflect in all sorts of ways as your work is interesting and always challenging.

An anecdote, a conversation with a colleague or an observation by the receptionist; if it makes you stop and think, record it.

If the idea of reflecting is uncomfortable or if nothing as a GP makes you stop and think and there is no buzz and excitement in your job, then ask yourself why. Thinking and reflecting on your patients might just be the thing to prevent burn-out.

  • Dr Rodger Charlton is a GP in Solihull, West Midlands, and associate clinical professor at Warwick Medical School

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Significant events can be critical incidents or things that have gone well. Consider your last thank you card from a patient. Congratulate yourself and recall what went well and plan how you can repeat this with another patient.
  • The definition of reflection is seeing your image in a mirror. When you see yourself, do you see a 'good doctor'? Record and consider any area in which you would like to develop. Enter one of these in your PDP.
  • Feedback from colleagues is valuable. Undertake a colleague feedback survey (also called 360 degree appraisal) with four clinical and four non-clinical staff. Include this in your PDP. Include a summary of comments and your reflections on any aspect of your own practice or working in a team that, as a result, you hope to improve and how you propose to do this.

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