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feel feel free to just sort of interrupt. I don't mind that at all. Um, I think I want you to be to feel comfortable that you can sort of ask anything if you've got any concerns. So, um yeah. So, uh, today we'll be talking about building a reflective practice. And I put this together for F one F two s and one just last year. Um, to sort of just give uh huh a general idea of why you should be reflecting and what you can be getting out of reflection. And also hopefully clarifying the, um there's a lot of perhaps fear about reflection and a lot of sort of a lot of worry that it can either be too fuzzy or not useful. Or how do I actually reflect? I'm just going to ask at the beginning, actually, what grade people are in and what sort of So I'm I'm an f three. I'm wondering if if what sort of people are here, you all f one F two registrars, non medics. Um, if you can pop that in the chat, that would be really kind just so I can get an idea. Brilliant. Thanks, Sarah. It's okay. Don't be shy. So I'll carry on with the kind of idea of of F one F two and junior sort of doctors. Medical student. Brilliant. Fantastic is really good to be engaging with this early, I think, um, as you'll see going on brilliant. Thank you, everyone for the engagement. I love it. Um, cool. A nice spread then. And I spread, um, I hope from today and forgive me, I think that the animations aren't going to work on this. So forgive me if there are busy slides here. Um, but I will then talk about today what reflections are why they're important. The really important thing is how to use a reflective structure as well as also building a reflective practice. So sort of making this not just I'm going to do one reflection but moving forward to become just a generally more reflective person and doctor. So the reason to reflect, and there's lots of them, but I think that it's really good to you. You can open new perspective on old habits by by reflection, you can look deeper into things that you've just been doing all the time. You can also use them to cement your learning experiences. So by actually going away thinking about things, writing them up, you're spending more cognitive time on that experience. And so the lessons learned will sit a bit more deeply. You can also use them to deal with and make sense of difficult situations, and particularly in medicine. We come across a lot of emotionally taxing, um, experiences, either with patients or perhaps even with our colleagues, yes, and to actually reflect on those you can and get and get some closure. But we're all doing portfolios. Even doing F one F two can look really good. It's a very important part. Uh, that has talked about portfolios. Has that slide changed for everyone? Or has it? I think it's frozen from you as well. Okay, that's no problem. I'm gonna do you and I'm going to do my backup plan. I won't be able to chat, So if promise you can keep an eye on the chat and that would be kind, how is, Uh and this one will actually have the animations be on Is that that's the next question. Think feelings about events about your day, important situations. So it's, uh, no f one f two X's dot So I think that's spread throughout. Um, hum reflect on sort of a case study and reflect on interactions that you've had with colleagues, you can sort of reflect on, uh, missions. You can even private reflections on how you think you're doing with your sleep schedule. You know you can. The reflection practice is very broad, and you can do it. You can use it for anything. So, perhaps feelings about the events throughout the day with a year, just some examples, you could say this situation was restful and I felt out of my depth. Maybe I was feeling really proud of my actions today. I didn't feel supported. Who should I have escalated to? That person's actions were wrong, but I didn't know how to speak up. I wish I knew more about this condition. The team I worked with made the experience so much better or perhaps made the experience so much worse. Or just simply I didn't expect that to happen and I knew what to do, but I wasn't confident enough. Some of the important situations you might be able to reflect on really good as serious instances or day Texas or anything that you encounter in normal activity and mortality, successful procedures. What went right? What went wrong? Misdiagnoses. And I think one of the things that some people worry about is is reflecting on things that will make them look bad as a doctor. And you, you don't want to be sort of proudly stating bad practice. But actually, as long as something is safe and as long as you did the right thing, you can reflect on those and you can You can talk about your flaws because as well go on to see this process is about improving and so we can see what we did badly and what we can then do well next time. And so actually, these moments where we're not particularly happy with ourselves are also important. Difficult shifts and this process of repetition seeing a case going away and revising it and then seeing a repeat case. One of the questions people might have is Well, I've I've already been out there and I've gone through the experience. Why do I have to go back through that experience again? But actually during the day, a lot of us can be really focused on the job and just making sure that we get our jobs lists done. Um, there's actually a little time. It depends on where you're working. But sometimes there's. There's not much time in the middle of a busy day to actually sort of be able to go through and and process what's going on. Or, as I say, talking about those learning experiences. And there are Sometimes there's some strong emotions which quite intense in the moment, whether we're feeling angry or whether you're feeling sad about the situation. But given time that night, the next day we might be able to actually deal with them a little bit better. And often the first glance is not enough for real learning. So, um, just that first sort of dipping the toe into a situation, Um, as I said this, this space that you get in reflective practice this cognitive space for an experience helps to cement it. And also, really, I think it's good for your mental health as well. It's good to, um, be able to see things for what they really are, I think, and also in all of these these portfolio uh programs that require portfolios. They all encourage reflective practice, and for me, that means there must be something good about it. So I think I've talked to Hopefully I've persuaded you that reflection is a good idea and what you can reflect on, Um, and so the next thing is is probably what most people are wanting is actually the the physical structure on of what of how to reflect, like, what does that actually mean? So in basic terms, you look at something that that you faced use a reflective model, and then you repeat and there's a reflective. These are cycles of reflection and action that you do, so that's quite fuzzy. So let's let's talk a little bit more specifics and talk about the possible models. And so this is sort of a brief search that I did on line of the different reflective models that I used to find the one that I used. So there's one called Ampyra, which stands for experience. Reflection, action. Very simple. You write down what the experience was. You write down your reflection on it, and then you write the action of what you'll do next. The Driscoll's what model which is quite handy to remember. What So what? And now what? The colds experiential learning cycle. Now, this is quite involved, I think, Um and, uh, perhaps a little bit too big for my small brain to understand. So it starts off with concrete experience, reflective observation, abstract conceptualization, active experimentation. So that's the experiential learning cycle. Um, I think that so I'm a little bit biased because the next one is the one that I use. But I think, really, they're all getting it the same idea. And this is the kids reflective cycle. And you start at the top and you describe what what happened? Let me just see what my side's doing. Just prescription feelings if the urination analysis conclusion, action plan. And I don't want you to think that necessarily memorized every single step of this. This is something you sort of you can pick up over time just by using it. But I really do rely on these structures, and I really rely on the the um yeah, I rely on questions, and I rely on these titles and I sort of copy and paste them and use them for my reflection. I don't want you to think that just because I do this means that I've got to memorize every single one of these things. So let's go a little bit more in depth of what each of these steps mean. So description is just stating the fact. And here are some questions that you could ask. You don't need to ask every single one of them. But here are some questions that you could ask about the situation for your reflection. This is all sort of taken from, I think, the University of Edinburgh website with with specific questions. So what happened? When and where did it happen? Who was present? What did you and the other people do? What was the outcome of the situation? Why were you there and what did you want to happen? These. You can just answer these with very short questions and and really, especially with the description, you can answer these with very short answers just to give you that sort of general picture. And what's particularly good about these questions is that they start to draw out things that you wouldn't necessarily think about. For example, who was present. That's a question that you can start thinking. Oh, and you know, actually, during this during this crash call, the family member was present at the site, you know, or or or there was a There was a medical student who was who was very fresh. And this was the first crash call, you know, that sort of thing. So these questions are really good at drawing things out by no means have to memorize them at all. So we've talked about what happened with this description. Now, we talked a little bit about our feelings. Um, and they're just stating your feelings, and you can also include thoughts in here. So what were you What were you feeling like a false assessment before, during and after? Um, what do you think others were feeling again? That's giving you the opportunity to start engaging the sort of empathy and start sort of engaging starting to broaden your your thoughts on what's going on. What were you thinking during the situation, and what do you think about it now, then evaluation. Now, these words start to become a little bit more tricky to nail down. But the evaluation is simply about evaluation. Ascribing value. So what went well and what didn't go as well. So this is simply you're at this point you're not even thinking about why. And actually, I will say that in this process of going through the reflective cycle, you don't jump ahead in any of it. Stick to each of the stick to each of the sections as you go because it develops and it progresses to become a bit more a bit more in depth each time. So your descriptions, your feelings and now we're just saying what went well and what didn't go as well. And now we're into the analysis stage. So we've had what went well and what didn't go so well. So now we can go. Why did things go well and why didn't things go as well? And you can spend a bit of time with this and you can just sort of start thinking what were the reasons? I mean, you can you can start breaking things down into, like, systemic reasons of Why did things go? Well, we were really well start that day. Or why didn't things go as well? I was really, really tired from the night before when I stayed up late. You know, um, and you can start thinking about things in yourself and also start thinking about things around you, and then you can come to conclusions. And so these are some of the questions that you can ask yourself. What did I learn from the situation? How could this have been better? What skills could I learn to make the situation better? And what else could I have done? So this is now starting to look forward into the next step. Um, and then the final thing is actually setting up the concrete action plan of real steps to take. So what will I do now? Um, if the situation occurred, what could I do? How do I developed the skills that I need? Maybe you had an atrocious time talking to a family member who got really, really, really angry at what you were saying. The way that you were saying it So you could talk about how could I developed the skills I need? I could talk to my medical education, a team about getting some funding for a communications course. That's a very specific action plan. And how can I make sure I do things differently next time again. So this is this is a really old story. That was I had I've had a situation in the kitchen the day before I wrote this, um and so I I thought I'd sort of use something a bit light hearted. Um, not medical to just show you how you can use reflection, um, to extract some meaning from all sorts of things. So the description was I made a blueberry sauce from some old blueberries in the fridge. When I tasted the sauce, it tasted funky. I added some sugar and salt try to improve the taste taste, and I tried cooking it for longer. But I threw the sauce away after spending 15 minutes trying to save it. And in the end, I had honey on my porridge. So my feeling is going into it. So I felt excited about trying out a new idea. I thought I was being thrifty, trying to say some fruit. I felt clever trying to get another portion of fruit into my diet, but also I felt some humor, and I laughed at my failure. But I was a bit sad that the source I made was disgusting now moving on to the evaluation. So what went well? So I think I It's good to be trying something new and try to save money and prevent food waste. Um, it's good to that. The salt and sugar did improve things a little, and also I didn't really go sort of too heavy on myself for for making a bad, bad blue resource. But what didn't go as well, really. I made a bad source, and I also wasted time and resources. So why did it go well? So, looking back at the preceding days and weeks, I've been starting to explore cooking things in the kitchen. I've been trying to do things differently, and so I was in that state ready to go to at least try cooking a blueberry source. I have been reading some books on cooking in flavor, and also I was on a break, so I was able to actually spend that time at the moment. This would have been a very different situation. Had I been really, really round on A and E. I've been having 12 hour days, and I just wanted to get home at the end to have a take away. Um, and also, I'm lucky enough that I have some nice pants that were given to me. It's important to remember sort of some of the benefits that you have the, uh, sort of blessings from other people. I also have a well stocked kitchen with, with salt and sugar and oil and all sorts of other things. But why didn't get it goes so well. So it turns out that old blueberries are never going to be be nice if they'd been in the fridge that long. Um, and I had two planets, one that was slightly nicer and one that wasn't very good. And so I added both of them together. Um, and also, I hadn't eaten the blue reason the very 1st 1st instance when they were actually in date. Um, and also I have made a meal plan for myself and not stuck to it as well. And at that morning, I have been getting up late for work and not having time for a profit breakfast. And so I hadn't been using the blueberries in my porridge that I wanted to. Uh, So what did I learn from this experience? So not all of the things that I do in the kitchen will be successful, but that's fine. I can still learn from my failings. The blueberries did make quite a beautiful blue color when they cooked. And I really need to eat things before the expiry date. But also looking at the bigger picture. The decision of just I'll have a canteen breakfast is quite wasteful and expensive. I'm paying money both for the canteen breakfast, and I'm also wasting money on the food that I'm not eating. So what will I do now? Simply. I'll eat my blueberries before the expiration date, and if they do run out, I'm going to throw them away. I'll also try adding fresh blueberries two sources to see what flavor and color it will bring. I'll try to find a book about being thrifty and recycling to see what I can actually cook after the cell by date. Um, I sort of through this in tongue in cheek for the portfolio. I'll do some learning on health promotion, um, using my experience on how difficult it can be sometimes to do healthy eating, Um uh, and using the learning to help make a small important difference on patients, lifestyle factors and and also I'll continue to develop a reflective practice to improve my knowledge and skills. So I hope that going through and the next time I do this talk, I'm definitely going to use a specific example from medicine as well, just to sort of really sort of bring it into into reality for you. I hope that this has been really useful for, um, seeing that process. But on reflection, I think it would definitely be more useful to have the the set sort of clinical scenarios for you. So sort of with a reflective practice is just just do it even if you do it badly, Um, because what you want to be doing is doing it often and getting better at it, and you just you can spend as much time as you want. You can do a really quick reflection, or you can do a much longer reflection, and you can also, with this this cycle, as you saw in the beginning, where you had starting from description and going all the way around to an action plan, you've got the action plan that you put into place before doing it again and describing the next one and going all the way back ground. And you can do that over multiple times over multiple cases and get better and sort of do that spiral process that medicine is all about. And also you don't always have to reflect alone. I think it's really important to find people around you that you can talk about talk about cases with. There was a a really, really difficult situation at work recently. Really difficult, sort of, Um, yeah, I won't go. I won't go into the depths of it. But it was just emotionally taxing for everyone and has shaken a lot of people who felt like they had. The rugs sort of pulled out from under their feet, and we had an M D. T. On Tuesday morning to discuss it, and we had all sorts of people there who were able to say they're they're piece on it and actually those people who were going through the situation, I hope you feel much better and me just being a bystander and just sort of being there to listen, listen and learn. I was also able to get a lot from it. and and I actually set up a reflection sort of group as an F one as an f two, um, where we were able to talk about cases and I was actually able to bring cases of my own but also listen to cases from other people. And it's amazing how much learning you can do from hearing another person talking about their experience. Same conclusion. There's one way to look good on the portfolio and get good with reflections. And that's what I would recommend is just using the gives reflective cycle on every SLE. That's just kind of the If you. If you take nothing away from this except this one thing, use a model for the things that you you, you already due for your portfolio. So for for your mini taxes, for your dots, for for everything that you you have to do for your portfolio, just get the kids reflective. Cycle up, get the questions up and ask them of yourself. You can even just copy and paste the questions into the boxes on your portfolio so that you can answer them and then you'll you'll just you'll just do it and hopefully you'll get better hopefully be able to see the different, different things that you can get from it. So, uh, that's what I Googled is gives reflective cycle. Edinburgh University. Edinburgh has got a really good sort of page where I've taken all of these questions from, and that's the That's the link there. So that's the end of my slide show. Um, I hope you can. I think you can tell that I'm quite passionate about about reflection. I think it's a really important tool to be developing. I think that it's quite it's easier than you think. I hope that Just those simple questions, uh, I hope that those questions are simple enough that anyone can do it. Um, and I think you just got to go for it. You've just got to try it. You've got to try it and be bad, and then you'll get better as like medicine. Really? Um, but I'd love to answer any questions. And if anyone sort of wants to do a, um, on the spot reflection, that would be very cool. Um, but also, I understand putting you on the spot like that is a bit mean. Um, So yeah. Thank you. very much for for letting me speak. If you have any questions, please, either a mute or or send a message in the chat. Yeah, that's a really good question. Would you recommend reflecting on errors or near miss that resulted in patient harm? Will it be used against me? I think that's a I think what I really would recommend for each of those individual situations is to actually talk to one of your seniors about it and talk to. So talk to your talk to your friends. You can kind of air those thoughts, and you can also talk to your seniors about it. Um, because I understand the fear that came with the blood gobble case, Um, hum ago. Sorry. I'm butchering the name um and I understand the fear of getting pulled up on on your reflections, but I think that you can make things. First of all, you can just reflect privately. You don't have to make every single reflection you do just for your portfolio. If you want to learn from it, then you can just reflect on it privately and no one needs to know. Um but you can also be quite one thing that I've I've learned in particular, which is something that that's important for me is is actually with the description of what? What? What happened? You don't need to write as much. You don't need to do full sort of clerking, booklet style stuff on that description of what's going on. You can just keep it very, very simple. Sort of just the headlines. Really, Um, so, yeah, I think it's a tricky one. If there's anything that you're really worried about in your own practice, or or about feeling like you're going to make yourself look bad, I think I just have a chat with with one of your seniors about it first, before sort of writing anything down on paper. Um, but ultimately, actually, that's That's the really annoying and sad thing about the fear of getting pulled up is actually when we haven't done things right is when we most need to reflect. So I would recommend reflecting on errors and or near misses that have resulted in patient harm. Um, and I hope that there has been due process around all of those things. Um, annoyingly day Texas are sometimes actually really useful because they can pick up on they can. You can start to think about the systemic things of what went wrong that led to patient harm, you know? Um, so, yeah, I'm too too short. Answer after a long answer is yes, I would, but just be careful about getting things down on paper. Um, that might put you at risk of litigation, you know? And so talk to a senior about it. I would really talk to your your educational supervisor about it first. Um, that's really just my own opinion, though It's not necessarily official guidance.