How to use Reflection in your Portfolio Entries

Hello! If you need to use reflection in your portfolio entries and struggle with this, this blog is for you! It covers how to do it, what not to do, how to make it less tedious and how to make it less of a bore.

We all naturally ‘reflect’ all the time but sometimes it is extremely difficult to transfer this into written words. In this blog I’m going to give you three quick tips to make reflection a little bit less strenuous – may be even easy!

What is Reflection?

As mentioned, we all naturally reflect on things that happen at work. Often it is based around your gut feeling to something – your core feelings about an event. This can be based on anything – a learning event… some reading that you’ve done… or a patient that you saw that day. What did you take away from that episode and how does that add to your development as a doctor in training or a GP in training?

Personally as a trainee I used to hate the word reflection – it used to fill me with dread. When I went home and realised “I’ve got to do three or four reflections today” or “I need to catch up on my reflection entries”, it used to feel like a drag.

50-pres-traineesOne day as an ST3 however a patient encounter changed my understanding. I saw a young patient who presented with vague abdominal pain. He seemed pretty well, examination was normal and his numbers were fine. I was about to send him home as a likely simple gastroenteritis but something made me stop and think about his appendix. I don’t know why I thought about his appendix – I don’t even know why it came to my mind. It certainly wasn’t going through my mind when I was talking to him, but something made me think about appendicitis. I ended up calling the surgical on-call team and admitted him (thinking back I’m not sure how I even convinced the surgical SHO to accept the admission!) Anyway he went in, was operated on the next day and he ended up having a flaring appendicitis.

The next day I went to my trainer and discussed his case and openly admitted that I don’t really know what made me send him to hospital. My trainer replied “Oh that’s really good, you reflected really well on that – you should put it in your portfolio.” Later I thought about this – what did I really do? I suddenly the essence of reflection is not picking a patient and then simply describing what happened – it’s about letting the patient come to you and trying to understand your thoughts around it.

Key Idea Number 1

The first tip I’ll say about reflection is let the patient or the event come to you. Don’t go looking for an event or a patient to reflect about because you’re starting with the wrong idea. I’d suggest simply think about the patients you saw in a clinic – perhaps on your way home – and figure out which one sticks in your mind the most. It might not be the one that you’d think is the ideal one to ‘reflect on’. Maybe you’d think it’s the acute chest pain that you sent to hospital – maybe that would be a good reflective case to do but actually your mind turns to the young child who came in with a simple viral infection. For some reason this child sticks in your mind – try and understand why. Why is this particular child still in my mind – it could have been just one of the other hundreds of children that I see with viral infection but why has that one stuck out? If you start to think about that, you’ve likely started the reflection process.

Key Idea Number 2

Now that you’ve got your patient that, for some reason is in your mind, think about three words that come to your mind about this patient. Three emotions maybe – guilt, frustration, feeling out of depth, unsure about what you’re doing, happy, proud – whatever they may be… think of three words that really sum up that particular patient – or learning event – or bit of reading. Start with those three words – they’re the basis of your reflection. Now if you work your reflection entry around those three words, you’ll find that writing about the event becomes so much easier than when you start from the ‘normal process’ of simply describing what happened.

Start with these three emotions and you’ll find that your ‘reflections’ start to become easier to write about.

Key Idea Number 3

Once you’ve got these three key buzz emotions or words in your mind, start from the bottom upwards. What we normally do is start from the top, as normal, and type things through the portfolio boxes on screen. The result? You end up with a top-heavy, descriptive analysis because all your energy goes into the top box – what happened. You end up describing everything in detail:

“Their heart rate was X, their blood pressure was Y, abdominal examination showed Z, in their history they said they had 1, 2, 3. They took this drug. I suggested this medication, I did a referral etc etc.”

We end up simply re-writing things that supervisors could easily go and read in the notes. If you start like this the bulk of your thinking and your mental work goes in the top part of the reflection – by the time you get down to the bottom boxes, you’re already fed up of this case! You just want to end it – you save it and move onto the next one because you know you’ve still got three more ‘reflections’ to do today.

The last few questions or parts of the entry are actually the real focus – what did you get out of the event? What were your learning outcomes? What would you do differently next time? These are your real, true reflective parts.

I’d advise starting with these bottom questions and move upwards – “What did you learn out of this?”, “What are your learning needs?”, “How did it make you feel?” Put those three words in that you’ve already thought of and start there. By doing this the bulk of your entry is in the reflective end – as opposed to the descriptive end.

By the time you get to the top of the entry – the descriptive part – you’ve already written most of the bulk of the entry already – you now simply need a few short lines: “35 year old patient, came in, URTI symptoms, sent to hospital.” – that’s it – the description.

In Summary

Reflection doesn’t need to be challenging. Think about these three things when you go forward to make your reflection less of a chore:

  • Let the reflection come to you – don’t think about which patient will be good to reflect on – it never works well that way.
  • Start with three gut reactions or feelings and focus your reflection around these three words
  • Start with the bottom and go upwards – more of the reflective part and less of the descriptive part.

I hope this helps!

Happy reflecting and as always #CanPassWillPass 🙂

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Dr. Aman Arora

Dr. Aman Arora

GP and full time medical educator

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Dr. Aman Arora

About Dr. Aman Arora

GP and full time medical educator

Former GPVTS Programme Director

Former NHS GP Appraiser

Former GMC PLAB 2 Examiner

Fellow of Royal College of GPs (FRCGP)

Former HEEWM Advanced AKT Trainer

Running Exam Prep courses for 10 years

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