Writing reflections for appraisal: what the GMC says

Reflection runs through all six types of supporting information. Doctors often worry about how much to write and what it should look like. This guide sets out what the GMC says.

The GMC’s guidance, developed with the Academy of Medical Royal Colleges, COPMeD and the Medical Schools Council, uses this definition: thinking analytically about anything relating to your professional practice, with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible.

The GMC says reflection is a core requirement for revalidation. Responsible officers normally take account of the discussions and reflections considered at annual appraisals when they make their recommendation. Reflecting helps you demonstrate insight by identifying actions for learning, development or improving your practice, and identify opportunities to improve quality and patient safety.

The GMC says reflection is personal, with no hard and fast rules. Both positive and negative experiences can produce meaningful reflections. You can reflect on clinical events or interactions, complaints or compliments, feedback, a research article, a meeting, a conversation with a colleague or patient, a team debrief, or an emotional reaction.

The GMC offers one example: What? So what? Now what?

• What? What was I thinking when I acted or made the decisions I did? What did I do?
• So what? How did I feel at the time and afterwards, and why was it important?
• Now what? What can I learn from this, or do differently next time?

It works for a single event or a period of time. The GMC also points to the Academy of Medical Royal Colleges and COPMeD Reflective Practice Toolkit for templates and examples.

The GMC says a reflective note doesn’t need to capture full details of an experience. It should record learning outcomes and future plans. The focus should be on the reflective process and how to use it productively, not on a specific number or type of notes.

At appraisal, discuss the experiences you reflected on and keep a note of the discussion, focused on the learning identified and any planned actions. Appraisals should also be used to reflect on the most important things you learned or changed over the past year.

• Factual details. The GMC says they shouldn’t be recorded in appraisal or learning portfolios, but elsewhere, in line with your organisation’s policies.
• Reflection is not a substitute for reporting. It should not replace or override other processes needed to record, escalate or discuss significant events and serious incidents.

The GMC says anonymised information will usually be enough for reflection. The Information Commissioner’s Office treats data as anonymised if it doesn’t identify an individual and is unlikely to allow identification when combined with other data. Removing a patient’s name, age, address or other identifiers is unlikely to be enough. See the GMC’s confidentiality guidance.

• The GMC does not ask doctors for their reflective notes to investigate a concern. You can choose to offer them as evidence of insight and remediation, and the GMC advises getting legal advice before sending any evidence.
• Courts. Reflections recorded in portfolios for revalidation or CPD are not legally privileged and can be requested by a court. If you receive a request, seek advice from your employer, legal adviser, medical defence organisation or professional association.

The GMC encourages group reflection, saying teams and groups improve patient care when they can explore their work together, and employers and training providers should make time for it.

Our own one-page template follows the What? So what? Now what? questions and has a reminder to anonymise. Download it as a fillable PDF or an editable Word document. Free to use for your own appraisal.

The Academy of Medical Royal Colleges and COPMeD also publish a free Reflective Practice Toolkit with other formats. The toolkit says different formats suit different people and settings, and that the GMC does not require any specific documentation, only evidence that reflection is being done effectively. Editable Word templates:

• Reflection based on Schön
• What, Why, How
• Reflection based on Rolfe (What? So what? Now what?)
• Reflection based on the Gibbs cycle
• The Academy’s reflective template
• What happened, what did you do, what have you learnt, what next
• Reflective diaries and logs
• Team reflection

The toolkit also includes four worked examples: a near miss, a prescribing error, a WHO checklist incident and a communication error.

Whichever format you choose, the GMC says reflection should be anonymised and should focus on the learning, not the facts of the case.

1. For each of the six types of supporting information, write a short reflection: what happened, what you learned and what you’ll do.
2. Keep it free of identifying details.
3. Be ready to explain why you picked the examples you did.

Your reflections feed into your personal development plan. See our guides to quality improvement activity, significant events and complaints and patient and colleague feedback, and the revalidation checklist.

GMC, The reflective practitioner: guidance for doctors and medical students; Revalidation requirements for doctors. Academy of Medical Royal Colleges and COPMeD, Reflective Practice Toolkit (August 2018).