In its meetings with various stakeholders since the ruling, the BMA:
- has secured a commitment from the GMC that it will never ask for reflective statements as part of its investigations. In addition, the GMC is reviewing all its documentation to make sure that it is absolutely clear that it does not seek reflective notes from third parties such as Royal Colleges.
- will be contributing, with others, to the development of GMC guidance for all doctors and medical students on how to approach reflective practice (due to be published by the GMC in the summer)
- has updated its own guidance about reflective practice.
The preparation of supporting information for appraisal and revalidation is important, but it is the reflection on the information that will lead to identification of areas for development and improvement – the key benefit of reflection is the learning that comes from it, and the positive actions that the doctor can take forward.
It is not always necessary to record reflections on each and every item of supporting information. It may be more appropriate to record reflections on a summary, or category of the information, keeping in mind the learning outcomes. The appraisal process should ensure that this reflection occurs. The GMC does not require a specific way to reflect. Doctors can discuss individual arrangements and expectations locally to establish if an acceptable alternative to written reflections can be used (although this option may be more suited to doctors working in secondary care).
The 2018 Gold Guide ‘A Reference Guide for Postgraduate Specialty Training in the UK’ sets out the arrangements agreed by the four UK health departments for specialty training programmes. This includes a number of references to reflection. It notes that trainees must reflect regularly on their standards of medical practice in accordance with GMC guidance on licensing and revalidation, participate in discussion and any investigation around serious incidents in the workplace, and record reflection of those in their educational portfolio.
The recent case involving Dr Bawa-Garba, a junior doctor who was convicted of manslaughter by gross negligence in November 2015 and removed from the medical register in January 2018 following a High Court judgement, has led many doctors to feel they are no longer able to reflect honestly, openly and safely, due to fears of recrimination – and resulted in a call for some doctors (GPs) to disengage from written reflections until adequate safeguards are in place. However, Dr Bawa-Garba's medical defence organisation have confirmed that her e-portfolio (or the duty consultant’s trainee encounter form) did not form part of the evidence before the court and jury.
The GMC has also confirmed that it will never ask a doctor to provide his or her reflective statement when investigating a concern about them, or ask for this to be provided by Royal Colleges or third parties. Although it is rare and unusual for a court to order the disclosure of this kind of material, in theory they can do so. However, doctors’ reflections have often led to the discontinuance of disciplinary and GMC action. They can form an important part of a doctor’s defence in fitness to practise hearings and can be used to demonstrate remediation and current safe practice.
All doctors should be aware of existing guidance on reflection. Guidance on entering information on e-portfolios was published by the Academy of Medical Royal Colleges (AoMRC) in November 2016, and additional interim guidance on reflective practice has also been published following the case of Dr Bawa-Garba. This guidance makes clear that any written reflections should be fully anonymised. Further guidance has been produced by the medical defence organisations, including the Medical Defence Union. If you are approached to disclose any appraisal information or training documentation you should seek guidance from your medical defence organisation.
Along with the AoMRC, the Conference of Postgraduate Medical Deans, and the Medical Schools Council, the BMA will be contributing to the development of GMC guidance for all doctors and medical students on how to approach reflective practice. This guidance is due to be published in summer 2018.
In response to the Williams review into gross negligence manslaughter (GNM) in healthcare, the BMA recommended that legal protection is provided to reflections in all education and training documents, such as e-portfolios and all annual appraisals, training forms and the Annual Review of Competence Progression – this recommendation will also form part of the BMA’s submission to the GMC’s review into GNM.
GMC commitments follow court ruling
Stages of an appraisal - Inputs into an appraisal
Back to the main index