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Professional practice

Reflective practice in medicine

Notice. Think. Learn. Change.

Turn experience into professional growth — without box-ticking, confession, or identifiers. Reflection is not only for things that went wrong.

Elaryvo will not write your reflection for you.

Elaryvo Reflection Cycle

Notice. Think. Learn. Change.

  1. 1

    Notice

  2. 2

    Describe

  3. 3

    Explore

  4. 4

    Learn

  5. 5

    Act

  6. 6

    Review

What reflective practice is

Reflective practice is the deliberate process of thinking about an experience, examining what it means, identifying what was learned, and deciding whether anything should change.

Experience → think → understand → learn → act → review.

Reflection is not only about difficult events. It is also how doctors learn from success, feedback, uncertainty, teaching, leadership, research and everyday clinical work.

Not every clinical encounter needs a written reflection.

Why it matters

Reflection can help you understand decisions, recognise strengths, identify development needs, improve communication, learn from feedback, notice assumptions, process uncertainty, improve care, strengthen teamwork, develop judgement, recognise systems issues, plan learning, and connect evidence to development.

Reflection is not confession

Good reflection is not a document full of self-blame. It is honest professional learning.

Avoid unnecessary self-incrimination, speculation, naming identifiable patients, naming colleagues unless essential, emotional over-disclosure, defensive justification, and blaming others.

Describe enough context to understand the learning, not every detail of the event.

Your reflection should remain your own account of what you learned and how it affected your practice.

Protect confidentiality

Never include patient names, dates of birth, NHS or hospital numbers, addresses, identifiable photographs, unnecessary exact dates that could identify someone, or identifiable colleague details unless essential and appropriate.

Reflect on the learning, not on identifiable patient detail. If you would not want anyone to read it, do not put it in the log.

Do not include patient-identifiable information.

What can I reflect on?

Clinical encounters, uncertainty, procedures, communication, safeguarding, patient or family feedback, colleague feedback, MSF, Mini-CEX, CBD, DOPS, supervisor meetings, teaching, leadership, teamwork, conflict, research, journal club, audit, QI, complaints, compliments, incidents, near misses, courses, conferences, new guidelines, career transitions, cultural experience, successful outcomes, and things that went particularly well.

Do not limit reflection to adverse events.

Different depths

Not every event needs the same depth.

DepthUse whenEnough to ask
QuickRoutine learningWhat happened? What did I learn? Will I do anything differently?
StructuredMeaningful developmentWhat happened? What was I thinking? What influenced me? What went well? What could improve? What did I learn? What next?
DeepUncertainty, conflict, safety, ethics, culture, significant feedback, repeated patternsAssumptions, emotion where it helps, systems, values, context, other perspectives, future action.

The Elaryvo Reflection Cycle

An Elaryvo educational framework, not an official regulator model: Notice, Describe, Explore, Learn, Act, Review.

1. Notice — why did this matter?

What made this experience worth thinking about? Something surprised you; you felt uncertain; feedback challenged your view; the outcome was better than expected; communication was difficult; a problem recurred; you learned something new; a response was unexpected.

2. Describe — what happened?

Keep this brief and factual. Only enough context to understand the learning. Avoid long chronological narratives, unnecessary patient detail, blame and speculation.

What happened, in a few sentences?

3. Explore — what was going on?

This is the heart of reflection. What was I thinking? What influenced my decision? What assumptions did I make? What information did I have, and what was missing? What emotions were present? What pressures? What did the patient, family or colleagues need? Were there cultural, hierarchy, communication or system factors? What alternative perspectives are possible?

4. Learn — what have I taken from this?

About the clinical problem, myself, communication, teamwork, the system. What should I maintain? What should I change? What do I still need to understand?

5. Act — what will I do with this learning?

Change practice, read guidance, discuss with a supervisor, request assessment, seek feedback, teach others, create a PDP goal, start audit or QI, review communication, update a local process, practise a skill, seek further supervision.

Not every reflection requires a major action. Sometimes: no change is required; this reflection reinforced a practice I should continue. That is a valid conclusion.

6. Review — did anything change?

Did I apply the learning? What happened? Did the change help? Do I need to adjust further? Has this become part of my normal practice?

Put a review date in Planner or PDP if follow-up matters.

Reflection is also about what went well

Successful communication, effective leadership, good teamwork, excellent feedback, successful teaching, effective escalation, good judgement, successful innovation.

What made this work? What should I repeat? Can this approach help elsewhere?

Reflecting on feedback and assessments

For MSF, patient feedback, teaching feedback, supervisor feedback and workplace assessments: what themes are emerging? What surprised me? Where does this agree or differ from my view? What strengths should I preserve? What development do I see? What action, if any?

After Mini-CEX, CBD, DOPS and similar: the main learning point, a strength, a development suggestion, what you will practise, when you will revisit. Do not force a long reflection after every assessment.

When the experience was difficult

What happened? What was within my control, and what was not? What system factors mattered? What support did I need? What did I learn? What should change? What should be discussed through formal governance or support routes?

Elaryvo reflection does not replace incident reporting, safeguarding, duty of candour, formal complaints, occupational support or local governance.

Emotion is allowed; disclosure is not required

You may notice anxiety, frustration, sadness, uncertainty, pride, relief or discomfort where it helps you understand the experience.

The purpose is professional understanding, not forced emotional disclosure. You may reflect on emotion where it helps. You are not required to disclose personal emotional information.

Lenses: cultural fluency, patient-centred care, leadership, teaching, scholarship

Cultural fluency: did culture, hierarchy or my usual style affect how the interaction was understood? Did I adapt? What did I preserve? See /learn/cultural-fluency (IQ, EQ, CQ and the PM Cultural Fluency Matrix™).

Patient-centred care: what mattered most to the person? Did they understand the plan? Was care experienced as respectful? See /learn/patient-centred-care.

Leadership: what did the team need? Did I invite challenge? Psychological safety? Pressure? See /learn/leadership-healthcare.

Teaching: what was the learning need? How did I know they understood? What did teaching reveal about my own learning? See /learn/teaching-supervision.

Research, audit, QI and evidence: what problem, what role, what data, what assumptions, what changed, was it sustained? See /learn/research-audit-qi and /learn/evidence-based-practice.

The Tripartite Doctor: as clinician — character, competence, compassion. As educator — who learned, including me. As scholar and improver — what question or gap. See /learn/tripartite-doctor.

Your account — Elaryvo will not write it

Elaryvo must not fabricate thoughts, emotions, learning, actions or insight.

If you use support, ask for questions, help organising your notes, clearer wording, or shortening. Do not use “generate reflection” or “write my reflection” as the primary action.

Private thinking notes versus the professional record

Private thinking notes are for you while you think. The professional record is what you intentionally keep as portfolio evidence, may map, and should treat as something another professional could read.

Sharing with a supervisor must be deliberate. Elaryvo does not automatically share private notes.

Writing a reflection may support evidence for a capability. It does not, by itself, satisfy a competency.

Useful reflection, and common pitfalls

Useful reflection is honest, focused, proportionate, confidential, curious, specific, linked to learning, action-oriented where appropriate, and able to recognise strengths as well as gaps.

PitfallBetter
Retelling the whole eventA few sentences of context, then the learning
Only what went wrongStrengths, gaps, and what to maintain
Excessive self-blame or blaming othersWhat was in my control, what was the system
Vague learning (“communicate better”)What was unclear, when, and what I will do next time
Generic statements or invented insightYour own account
Patient identifiersTheme and learning only
Writing what an assessor might wantWhat you actually learned
A large action plan for every minor eventNo change required is allowed

Career stage and place

Early career often focuses on clinical learning, feedback, communication, supervision and judgement. Mid career often includes leadership, complex decisions, teaching, QI and service. Senior career often includes systems, mentoring, stewardship and developing others. Every stage still reflects.

This is a general professional-development tool. It is not only UK appraisal. Doctors in Nigeria, West Africa, India, Pakistan, Australia, Canada, the USA, the Middle East and elsewhere can use it. Where a College or regulator has its own requirement, map separately.

Key takeaway

Notice: what deserves attention? Explore: what was really happening? Learn: what have I understood? Act: what should I maintain or change? Review: did it make a difference?

Experience does not automatically create learning. Reflection helps turn experience into growth.

Scenario

Plans that were correct but not clear

A doctor receives feedback that their clinical plans are correct but not always clear to the wider team.

A limited reflection would stop at “I need to communicate better” — vague, no exploration, no action.

A better approach asks: what was the team finding unclear? When does this happen? Is it verbal communication, documentation or handover? What might I change? How will I know it has improved?

A possible action: during handover, summarise the plan, the escalation threshold and the next review point explicitly.

This example is teaching, not a portfolio-ready reflection to copy.

  • What was actually unclear — speech, notes, or handover?
  • What one specific behaviour would you change?
  • How would you know it had improved?

Questions for reflection

  1. What made this experience worth thinking about?
  2. What happened, in a few sentences, without identifiers?
  3. What was going on — thinking, assumptions, pressures, culture, systems?
  4. What have I learned, and what should I maintain or change?
  5. Is a follow-up or PDP needed, or is no change required?

How can I evidence this?

Related capabilities: Professionalism; Communication; Clinical judgement; Teaching; Leadership; Scholarship and improvement.

Related assessments: Optional after Mini-CEX, CBD, DOPS, MSF, teaching feedback — not required after every assessment.

Put this into practice

Source and further reading