Reflection, Audit, Licensing & Revalidation
In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.
The complexities of patient care and uncertainty within medicine, particularly with diagnosis and treatment, can mean that sometimes mistakes happen that may or may not result in patient harm.
Reflection is an incredibly useful tool when things go wrong, as well as when things go right, to be able to analyse how best we, as doctors and healthcare professionals, can deliver the best and safest care possible in a way that doesn't damage our own mental or physical health.
There are different ways to reflect on an experience to learn from it, but the most common way is to use what is known as the Gibbs Cycle. This involves taking a particular experience or event, for example you have prescribed an incorrect dose of a drug to a patient but they have not come to harm. The reflecting cycle then requires that you consider what you were thinking and feeling at the time and as a result of the event (for example guilt or worry for the patient and yourself), and evaluate what was good and bad about it (for example the event highlighted some problems with your organisation skills but the patient did not come to harm). This would then allow you to make some sense of the event in a way that highlights what else you could have done (for example proactively seek to split the clinical workload more effectively with your colleagues) and what you can do if the same situation arose again.
You are required to develop reflective skills throughout medical school as well as throughout your working life as a doctor. Reflective skills underpin the process of revalidation, which you are responsible for as a qualified doctor. Revalidation is typically a yearly process coordinated by the General Medical Council (GMC) that includes demonstrating you are sufficiently reflecting on information from your practice, learning and making improvements. This is in place not only so that doctors develop or improve their practice, but also so that patients have confidence that their doctor is up to date with their skills and practice. Revalidation needs to be completed successfully for a doctor’s license to practice to remain valid.
Another way in which we can ‘reflect’ on the quality of the care we provide is through audit. Audit is a process by which we collect information on how we provide care and compare it to the gold standard we currently have available for that topic. For example, a General Practitioner’s medicine bag should contain a supply of in-date adrenaline, this is the gold standard of care that is expected. An audit would seek to look at how often or how well this standard is upheld by looking in all GP’s medical bags to check the supply and use-by date of adrenaline within. If this standard were found to be poorly upheld, this may lead the GP practice to implementing changes. This may include frequent checks of the medical bags and requirement of a form to be completed and signed to ensure no out-of-date adrenaline is contained in the bags. This ensures more optimal patient care and prevents patient harm.