Reflection Cheat Sheet🏠

Hi! The idea for this website came from the reflections that I regularly write as part of my job — very often I find myself staring at a blinking cursor with no idea how to start at all!

On asking my colleagues, I realised the dreaded writer’s block is a universal affliction. This inspired me to create a Facebook group to source ideas from the hive mind. I’m summarising the fantastic suggestions people have come up with into this reflection cheat sheet and will be adding more content as I go along — click on capability areas to see example reflections. I will also be posting things I'm working on every so often. Happy reflecting!

Reflection Cheat Sheet

Below are ideas for what sort of things you can reflect on for different capability areas. Click on the underlined headings to see descriptors along with example reflections for each capability area.

1. Fitness to practice 🏃‍♂️

• Notifying appropriate people if health puts patients at risk, or is itself at risk. e.g driving home after night shifts if very tired.
• Reflection on feedback.
• Performance issues at work and dealing with them, e.g long COVID fatigue and going LTFT.
• Maintaining an effective work-life balance.
• Proactively promoting personal health, e.g running, meditation, stress reduction techniques etc.
• Supporting a colleague who has made a mistake.
• Seeking out problem areas with systems/practices and rectifying them, e.g feedback to IT about a new IM&T system or suggesting a new way to do handovers if the current one is inadequate.

2. Maintaining an ethical approach ⚖️

• Analysing anything disturbing or thought-provoking with Jonsen’s 4-quadrant approach.
• Applying duty of candour when someone has made a mistake.
• Analysing situations using the 4 pillars of ethics a la justice, autonomy, beneficence, non-maleficence.
• Jehovah’s witnesses and blood transfusions.
• Respecting a patient’s unwise decisions, e.g curable cancer but patient with capacity refusing it.
• Dealing with patients who speak a different language.
• Sexual histories from adolescents.
• Speaking up against racism.
• Inappropriate medication requests, e.g diazepam to help sleep.
• End of life patients refusing analgesia.
• Staying overtime to help out.
• Dealing with angry patients and patients refusing investigations.
• Capacity, consent, and confidentiality issues, e.g patient receiving letter meant for someone else.

3. Communication and consultation skills 💬

• Using ICE and PSO in consultations — also ties in with practising holistically.
• Getting a social/occupational/psychological/family history to put clinical problems in context.
• Exploring patient understanding, e.g “heart attack” can mean different things to medics vs patients.
• Tailoring consultation method to the patient in, e.g, neurodivergent patients.
• Explaining in simple language and using pictures etc in younger patients.
• Using specific consultation models, e.g Ram’s 5+5.
• Using interpreters e.g Language Line.
• Breaking bad news.
• Dealing with patient’s relatives asking for details over the phone
• Picking up on non-verbal cues and acting on them.
• Using advanced consult techniques, e.g motivational interviewing.
• DNACPR and end-of-life discussions.

4. Data gathering and interpretation 🧐

• Calling up GP for further information.
• Systematically gathering information, using e.g using a PDFBINDS history for paediatric patients.
• Using computer records and calling patients’ GPs (if in hospital) to find their past medical histories to gain context.
• Examining and investigating only as much as necessary — ties in with justice in medical ethics.
• Interpreting and acting on results adequately, e.g finding severe neutropaenia and referring urgently to hospital.
• Targeted investigations, e.g not doing certain bloods when not needed.
• Proper interpretation of investigations in light of patient’s background.

5. Clinical examination and procedural skills 💉

• Any interesting diagnosis made on clinical examination.
• Procedures like difficult cannulations.
• Using or not using chaperones as per the patient’s preferences.
• Systematic approach to examination, e.g using an ABC approach in sicker patients.
• Reflections on ethical issues encountered, e.g in relation to intimate examinations.
• Putting patients at ease, e.g examining child while playing with them.
• Applying ethical principles to exam and procedures, e.g informed consent for surgery or treating a delirious patient in their best interests.
• Taking part in QIPs focusing on examination and procedures.

6. Making a diagnosis/decisions 🤔

• Differential diagnosis focusing on common conditions but also keeping rarer things in mind, ie hoofbeats=horses but also thinking about the zebras.
• Using local guidance on intranet/internet to help reach diagnosis or make decision.
• Using clinical acumen in confusing situations where guidelines might not help.
• Treating guidelines as guidance and not as rules, e.g not observing patient with head injury if clinically confident they do not need it despite guidance suggesting otherwise.
• Using evidence to help diagnose/decide.
• Thinking about diagnoses with reference to your local patient population, e.g coal miner’s pneumoconioses in mining towns.
• Revising initial diagnosis based on investigation results, e.g revisiting meningitis diagnosis if normal CSF.

7. Clinical Management ⚕️

• Reflecting on clinical emergencies.
• Looking up unfamiliar medications on the BNF.
• Using guidelines to help prescribe non-drug therapies, e.g physiotherapy referral for back pain.
• Referring safely, e.g abdominal pain ?surgical cause that you refer to surgeons.
• Using a wait-and-see approach for, e.g, non-emergent cases with no clear cause.
• Putting the patient first, e.g using ICE to deal with the problem most concerning to the patient.
• Ensuring continuity of care, e.g handing over patients adequately or ensuring appropriate follow-up.
• Empowering patients to manage problems, e.g by directing them to patient.info or Beat Anaphylaxis.
• Medication reviews.
• Managing a patient’s unrealistic expectations.
• Audits/QIPs on streamlining referral processes and improving continuity of care.

8. Managing medical complexity 😩

• Managing patient’s acute and chronic problems both in a single consultation.
• Dealing with uncertainty, e.g with techniques such as safety netting.
• Managing risk in the consultation, e.g with detailed safety netting and ensuring follow-up.
• Patients with multiple issues needing multiple medication adjustments.
• Tie-in with promoting health competency — encouraging health promotion strategies like exercise, healthy diet, mindfulness techniques etc.

9. Working with colleagues and in teams 👥

• Helping out team members in their duties to provide patient-centred care — e.g parent team busy so you do bloods for their patient on your ward.
• Maintaining good working relationships with colleagues and how.
• Involving other teams, e.g SALT and dietitians for more holistic patient care.
• Coordinating overall care for better team working.
• Liaising with community teams to ensure continuity of care.
• Tailoring referrals to the specialists/teams you send them to.
• Getting help from other organisations, e,g social services and health visitors in safeguarding.

10. Maintaining performance, learning, and teaching 📚

• Identifying and recording weak areas and studying up on them.
• Participating in audits/QIPs.
• Signing off and teaching medical students.
• Helping to facilitate development of other healthcare professionals, e..g teaching NIPEs to midwifery students.
• Participating in departmental teaching sessions.
• Taking part in research.
• Supervising junior colleagues, e.g neonatal cannulations.
• Attending specialist clinics that will be of relevance in primary care.

11. Organisation, Management, & Leadership 👩‍💼

• Use of any IM&T system that is different from GP systems, like using electronic prescribing or looking up patient records.
• Anything to do with effective handovers or prioritisation, e.g bleeped about multiple sick patients — triaged and delegated effectively. Gave the F1 the less sick patient while you handled the more serious one for example.
• Finding areas for improvement in a clinical area and suggesting how to make them better, even if no formal audit or QIP done.
• Being redeployed for COVID as an example of responding positively when services are under pressure.
• Managing a ward on your own when everyone else is snowed in!
• Any formal QIPs or audits.
• Managing your own workload but also helping others when they need it.
• Offering to do shifts when nobody else available.

12. Practising holistically, promoting health, and safeguarding
🛡️

• ICE and PSO and how that ties in to a holistic approach.
• Helping with psychological issues affecting patient’s physical health.
• Impact of ill health on family/carers.
• Keeping patient’s needs and wants in mind when consulting.
• Tailoring management to patient background, e.g diabetic counselling during Ramadan.
• Safeguarding.
• Encouraging patients to stop smoking.
• Dietary counselling to help lose weight.
• Helping people cut down on alcohol.
• Prescribing exercise regimens.
• QRISK scores and statins.

13. Community orientation 🧭

• Orientating yourself to a new rotation in a different surgery/hospital.
• Referring to community teams like the alcohol team, physiotherapy, dieticians etc.
• Adjusting care to fit local resources.
• Encouraging patients to access local healthcare resources, e.g free gym classes.
• Balancing patient needs against those of the community.
• Working with district nursing teams, e.g on orientation to primary care.
• Learning about local referral pathways to hospital for, e.g, allergy clinics.
• Figuring out how on-calls work in your new hospital.
• Working in primary vs secondary vs tertiary care centres.
• Writing a discharge letter whilst in secondary care placement for the GP.
• Meeting local teams in your MDTs for cancer, safeguarding, palliative care etc.