AHPRA - Self-reflection is good healthcare practice

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What other high-performing disciplines can teach us

Safety and exceptional skills are two of the hallmarks of high-performing disciplines, take aviation and Formula 1 (F1) for example. Paradoxically, to achieve nearly error-free performance, these professions have to take into consideration that human error is not only an ever-present concern but also, an unavoidable peril of the job. The pilots and drivers have finely tuned the art of ‘learning by thinking’ and developed a reflective approach to error management.

If you have ever watched F1 live, you would have seen first-hand how the seamless and coordinated teamwork of F1 pit-stop crews allows drivers to respond to changes quickly and safely and to manage risks flawlessly, at least most of time. This world-class performance is the result of the careful attention that team members place on forecasting, minimising, and learning from mistakes1.

In healthcare, these cognitive attributes are underpinned by two core competencies, self-reflection and self-awareness, as stated under Section 2.1 of the new Medical Board Code of Conduct for Doctors – Professional values and qualities of doctors2.

Why improving self-awareness and capacity to self-reflect improve healthcare outcomes?

Pivotal to the delivery of healthcare are the concepts of self-regulation and a commitment to lifelong learning. Acknowledged as a core skill in Australian healthcare education, reflection is a deliberate metacognitive process that involves the unbiased and unattached self-observation of our own thoughts, behaviours, attitudes and prejudices in an effort to gain insight and to increase our personal effectiveness3.

A healthcare practitioner's clinical and non-clinical competencies are essential requirements for providing safe and effective care. As it is with the development of any skill, competence is not a static state, which is achieved at a particular point in time and that requires no further attention. Rather, achieving and maintaining competence requires ongoing self-reflection and is best described as a habit that is underpinned by lifelong self-evaluation and learning4. When embraced as an ongoing practice, it can transform your delivery of healthcare and ensure you are constantly evolving and refining your skills.

On the other hand, lack of insight is commonly cited by medical educators and trainee supervisors as a major concern and a common reason for lack of rectification after remediation5. In MIPS’ clinico-legal experience, having insight and self-awareness is a highly favourable attribute when dealing with notifications and claims, which has the potential to significantly impact the outcome of any clinico-legal matter.

Self-reflection makes you a better clinical leader

The literature asserts that purposeful reflection also strengthens you as a leader

, improving well-known leadership behaviours including:

  • Knowing oneself and others: Understanding our strengths, limitations, and how others perceive us – creates self-understanding and upholds self-identity. Self-aware leaders are more likely to empower others, inspire trust, communicate and lead effectively, and have more positive work relationships7.
  • Recognising and responding to the uniqueness and interconnectedness of stakeholders: Having a clearer appreciation for different viewpoints increases a leader’s ability to relate to others, leading to more beneficial interactions.
  • Problem solving and decision-making: Self-reflection provides a means to seize the multifaceted particularities and interconnectedness of clinical situations, favouring the construction of new mental models to make sense of complex, ambiguous and sometimes, even self-contradictory information.
  • Monitoring own wellness and wellbeing: Leaders with a higher tendency to self-evaluate are better able to recognise and therefore, find practical ways to regulate their emotions and implement strategies to foster their wellbeing.

How can you embrace a self-reflective practice while juggling competing demands?

While it is common to engage in self-reflection after encountering a particularly difficult patient or experiencing failure of a specific treatment, self-reflection is more fruitful if it is a planned and deliberate part of one’s professional life.

Reflective practitioners anticipate challenging situations in clinical practice and pre-emptive strategies and contingency approaches to deal with them in advance. During clinical encounters, they are attentive, while remaining aware of their own feelings and emotions. It is this constant monitoring, “expecting and preparing” for the unexpected, and assessing “how things turned out” after action has taken place, is what helps the reflective practitioner to minimise mistakes and lapses in their delivery of care8 (Figure 1).

This approach is underpinned by experiential learning theory9, whereby deeper levels of understanding occur in an iterative cycle, commencing with an experience that provides an opportunity for reflection, abstract conceptualisation of the challenges and displayed behaviours, development of new mental models and application to future situations.

Figure 1: Experiential approach to self-reflection in healthcare settings. Taken from Hutchinson (2020)8.  

MIPS CPD and assistance

Following our monthly webinars, we include a self-reflection questionnaire to help members relate their self-learnings with where they are placed in their practice. In data collected over the past six months, 86% of participants have reported a concrete action or change in practice, as a result of attending a webinar and 92% have demonstrated self-awareness and insight. MIPS is also actively researching and developing new ways to promote self-reflection into our educational offerings.

By engaging in regular self-analysis of your learning, you ensure you get the most out of your CPD experience and for us, it is a way of learning about your needs and how we can better tailor our content to support your career.

Key messages

  • Developing a self-reflective attitude is an essential component of competent healthcare practice.
  • Self-reflection is a leadership skill that needs to be nurtured and developed over time.
  • Developing a self-reflective attitude is an essential component of competent healthcare practice.
  • Different activities can help you foster a self-reflective approach, for example: 
    • Taking part in professional development activities where self-assessment and reflection are a core component. 
    • Participating in Balint-type groups to better understand your feelings, how to use them productively to establish healthy boundaries and better understand difficult patients10
    • Engaging in expressive writing to develop critical analysis and nurture your reflective capacity11
    • Adopting mindfulness skills or joining mindfulness training to foster self-awareness and attentiveness.

This information is not intended to be legal advice and as such should not be relied on as a substitute. You may need to consider seeking legal or other professional advice about your individual circumstances as appropriate. Should you wish to obtain further information contact MIPS on 1800 061 113. You may need to consider seeking legal or other professional advice about your individual circumstances as appropriate. Information is current as at the date published.

References

1 O'Logbon, J. (2020). What can surgery learn from other high-performance disciplines?

2 Good Medical Practice: A Code of Conduct for Doctors in Australia. Medical Board of Australia 2020

3 Knapp, S., Gottlieb, M., & Handelsman, M.M. (2017). Enhancing Professionalism Through Self-Reflection. Professional Psychology: Research and Practice, 48, 167–174.

4 Jordan, J., Bavolek, R. A., Dyne, P. L., Richard, C. E., Villa, S., & Wheaton, N. (2021). A Virtual Book Club for Professional Development in Emergency Medicine. Western Journal of Emergency Medicine, 22(1), 108.

5 Carr, S.E., Johnson, P.H. Does self-reflection and insight correlate with academic performance in medical students? BMC Med Educ 13, 113 (2013)

6 Knapp, S., Gottlieb, M. C., & Handelsman, M. M. (2017). Enhancing professionalism through self-reflection. Professional Psychology: Research and Practice, 48(3), 167-174.

7 Issah, M. (2018). Change Leadership: The role of emotional intelligence. SAGE Open, (3). 2158244018800910.

Hutchison, C. (2020). The role of reflection within dentistry. BDJ In Practice, 33(6), 20-22.

9 Mukhalalati, B. A., & Taylor, A. (2019). Adult learning theories in context: a quick guide for healthcare professional educators. Journal of Medical Education and Curricular Development, 6, 2382120519840332.

10 Samuel, S., & Thompson, H. (2018). Critical reflection: a general practice support group experience. Australian Journal of Primary Health, 24(3), 204-207.

11 Grierson, L., Winemaker, S., Taniguchi, A., Howard, M., Marshall, D., & Zazulak, J. (2020). The reliability characteristics of the REFLECT rubric for assessing reflective capacity through expressive writing assignments: A replication study. Perspectives on Medical Education, 9(5), 281-285.

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