Making Reflective Practice Meaningful, Not Mechanical

Reflection has become one of those words in medical education that makes some doctors groan. It shouldn’t. When done well, reflective practice is one of the most powerful tools you have for professional growth. The problem is that too many doctors have been taught to treat it as a bureaucratic exercise — something you write because you have to, not because it’s useful.

Let’s change that.

The Difference Between Describing and Reflecting

Here’s a test. Read these two statements and consider which one tells you more about the doctor who wrote it.

“I attended a two-day course on advanced life support. The course covered cardiac arrest algorithms, airway management, and team leadership. I found it very informative and it will help me in my practice.”

“During the ALS course, the simulation on cardiac arrest in a pregnant patient exposed a gap in my knowledge. I hadn’t considered the physiological differences that affect resuscitation in this group. I’ve since reviewed the Resuscitation Council guidelines and discussed protocols with our obstetric team. I now feel more confident managing this scenario, but I’ve also arranged to sit in on the next obstetric emergency drill.”

The first is description. The second is reflection. The first tells the appraiser you showed up. The second tells them you learned something specific, recognised a gap, took action, and planned further development. That’s what meaningful reflection looks like.

Using Gibbs’ Reflective Cycle in Practice

You don’t need a formal framework to write good reflections, but many doctors find it helpful to have a structure, especially when starting out. Gibbs’ reflective cycle is one of the most widely used, and it works well for medical contexts.

The cycle has six stages. Description — what happened? Feelings — what were you thinking and feeling? Evaluation — what was good and bad about the experience? Analysis — what sense can you make of it? Conclusion — what else could you have done? Action plan — what will you do next time?

You don’t need to address every stage in every reflection. For a routine CPD activity, touching on description, analysis, and action plan is usually sufficient. For significant events, complaints, or challenging cases, working through the full cycle — including the feelings stage — often produces the most valuable insights.

Examples of Strong vs Weak Reflections

Weak

“Read an article on antibiotic stewardship. Very relevant to my practice. I will try to prescribe antibiotics more carefully.”

Strong

“After reading the NICE guidance update on antibiotic stewardship, I reviewed my prescribing data from the last quarter and found I was prescribing broad-spectrum antibiotics more frequently than the local formulary recommends for uncomplicated UTIs. I’ve switched to the recommended first-line agent for my next cases and plan to review my prescribing patterns again in three months. I’ve also raised this at our practice meeting to see if it’s a wider pattern.”

The difference is specificity. Strong reflections name particular changes, identify concrete actions, and commit to follow-up. They don’t need to be long — the strong example above is only four sentences — but they need to show genuine engagement with the learning.

Why Appraisers Value Authentic Reflection

Your appraiser reads dozens of portfolios. They can spot formulaic reflection from a mile away, and it tells them very little about your practice. What they’re looking for is evidence that you think critically about your work, that you’re honest about your limitations, and that you take active steps to improve.

Counterintuitively, the reflections that appraisers find most impressive are often the ones where doctors acknowledge mistakes, uncertainty, or discomfort. Admitting that a case didn’t go as planned and explaining what you learned from it demonstrates exactly the kind of professional maturity that revalidation is designed to support.

Don’t be afraid to write about things that went wrong. Don’t be afraid to say you found something difficult. The point of reflection isn’t to present a polished image — it’s to show that you’re a doctor who learns and grows.

Making It a Habit

The best reflections are written close to the event, when details and emotions are fresh. Keep a notes app or a small journal handy, and jot down the key points within a day or two. You can polish and expand later when you transfer to your portfolio, but capturing the raw material early makes a huge difference.

Try to reflect on at least one thing each month — it doesn’t have to be dramatic. A conversation with a patient that made you think, a guideline change that affected your practice, or feedback from a colleague that surprised you. Over the year, you’ll build a portfolio that genuinely reflects who you are as a doctor.

If you’d like support in developing your reflective practice, take a look at our appraisal preparation services. We can review your reflections, offer feedback, and help you develop a style that works for you. You can also book an appraisal to discuss your development with one of our experienced appraisers.