Posted in ARCP, eportfolio, ESR, MRCGP

Reflective learning

This entry has come about through a chat with one of our trainee’s. He felt that it was difficult to get to grips with reflection. He told me that he got to know about Gibbs (1988) reflective cycle, and that this had improved his ability to reflect. I also recalled this was the model my sister was encouraged to use during her midwifery degree.

So I went back to my theory from my Postgraduate Certificate of Medical Education, did a bit more reading, and thought I’d share the salient features. Having looked through numerous theories of learning and reflection I do agree that Gibbs’ method fits the GP e-portfolio learning log well.

It’s important to note that reflection is a very personal experience. It can give an insight to your personality, and can reveal how you are feeling at a point in time. It’s useful to be open when writing a reflection, and feeling comfortable that whoever reads your entries will treat this information as confidential, and be supportive and developmental in their feedback. Though, it is sometimes easy to fall into doing a lot of description, and sharing of feelings, but less about how this has impacted upon your learning, and any changes you might make. Hence, why having some models to frame your reflection upon can help.

One of the earliest theorists to consider reflective learning was Dewey. His thoughts were that reflection was potentially very useful when making sense of situations that we may have found difficult. To learn from it required a description of the event and questioning ourselves to analyse why it occurred in that way, and considering ways to change the outcome of the event. (Dewey, 1933)

One of the most common theorists to come up in discussion of reflection is Kolb. His learning cycle (1984):Kolb learning cycle

It’s a very simple model. But what I don’t like about it is that one of the stages is to ‘reflect’ and I find that it doesn’t help with structuring the reflection. Instead, I would use this model in association with another model, that discusses the reflection in greater depth.

So we come to Gibbs Reflective cycle (1988).

Gibbs reflective cycle

Gibbs’ model of learning is what we call iterative – learning through repetition. The aims of his model are to:

  • Challenge assumptions
  • Explore different ways of doing things
  • Promote self-improvement
  • Link practice with theory
  • Thinking about the positive as well as the negative

I’m going to give an example of a reflection using this structure

Description – I saw a man in his 30’s who presented with haematospermia. It had happened on 2 occasions. As soon as he told me what the problem was I realised I knew nothing about the topic.

Feelings – I felt myself getting stressed because I didn’t know what I was going to do. I really had no idea whether this was something to be concerned about or not. I think, looking back, I must have looked disinterested because my mind was wandering trying to think what I was going to do, whilst he was still telling me about the problem.

Evaluation – Actually, I don’t know if he noticed just how stressed I was, as I managed to keep calm on the outside which was good. I explained a need to check some guidelines so I could quickly look on GP notebook to work out what to do! He seemed satisfied with the consultation, though I was quite worried that I’d missed something else during the time I wasn’t fully listening.

Analysis – I think my worry that I knew absolutely nothing about the topic hindered my ability to listen to the patient, and thus my consultation skills were not up to scratch. If I had been able to keep calm, and think ‘I can look this up’ earlier on, it would have facilitated a better consultation.

Conclusion – I could have been completely open with the man and said I wasn’t sure and needed to have a look/ask a colleague. I could have done this during the consultation or afterwards and followed this up with a call. I also think that I need to separate my concern about a lack of knowledge from the consultation structure. It hampered the consultation, and added extra stress.

Action plan – I will read up on haematospermia more thoroughly, and this might lead on to other men’s health topics I have less knowledge about. I will also try and role play some consultations where I really don’t know the answer, and try to focus on what I can do. I can also try out different ways to signpost that I need to look up some information.

References:

  • Dewey, J. (1933)¬†How We Think. A restatement of the relation of reflective thinking to the educative process¬†(Revised edn.), Boston: D. C. Heath.
  • Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.
  • Gibbs G (1988) Learning by Doing:¬†A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.