21—APR—2021 21:14 GMT
Who am I?
Hi, my name is Bilal. I’m 24 years old and currently work as a junior doctor in Manchester, England. I studied Medicine at The University of Liverpool and also completed an MBA. I am a firm believer in primary preventative medicine. Outside of work I love watching football, playing squash and eating snacks.
Bilal's graduation photo from his MBA degree.
Image from Bilal's iPhone
Why do i want to talk about reflections?
The whole way through medical school, there was one assignment which I dreaded the most and therefore would always leave it on the bottom of my to do list. However now, it is probably one of the things I do the most, consider it extremely valuable and recommend everyone do so. That assignment is reflecting. As this is something which really helps me, I wanted to share it in hope that it may help you too.
What is a reflection?
"A process of looking back on what has been done and pondering on it and learning lessons from what did or did not work…. The act of deliberation, when the practitioner consciously stops and thinks what shall I do now?" (Conway 1994)
There are many different definitions of reflection and many different methods of doing so. I like to think about it as taking some time out of my day to think about what went well and what measures I can put in place to keep things going well, and vice versa.
I want to use a model to help illustrate this process, however, keep in mind there are many different options, depending on what suits you. This model is called The Gibbs’ Reflective cycle.
The Gibbs’ Reflective cycle.
This is a 6-step process that starts with a description of any events and ends with an action plan. This is something you can do at any place and in any way you feel comfortable. It can be as easy as just having a little ‘you-time’ to think for a few minutes.
The Gibbs' Reflective Cycle.
Image from psychsoma's website
I will explain some more about each of the steps and will share with you an example of one of my experiences. If there is something on your mind or any experience you wish to revisit (positive or negative) and wish to join me on this reflection, I encourage you to do so. You may not know the answer to all the questions, and that’s fine! They’re just prompts to help you think :)
Have a go at reflecting!
Step 1: Description
- 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?
- What did you want to happen?
My experience was during work. I had a cardiac arrest call towards the end of my night shift. I found myself in an acute situation which I have only ever practiced in simulation. It felt like everything was happening so quickly and then all of a sudden it stopped. Sadly, the patient had passed away.
There was a lot to take in for this situation. Describing what happened step by step can help you remember what was going on and how you felt at that time. If you have any experience whether it be big or small, it is always helpful to reflect. I actually find reflecting on smaller day-to-day things more impactful, as it is easier to make a change!
Step 2: Feelings
- What were you feeling during the situation?
- What were you feeling before and after the situation?
- What do you think other people were feeling about the situation?
- What do you think other people feel about the situation now?
- What were you thinking during the situation?
- What do you think about the situation now?
At the time I felt extremely stressed and scared. I was doing chest compressions for the first time. I couldn’t help but worry if I was doing something wrong. I was worried in case someone asked me to do something that I didn’t know how to do. However, once all the chaos ended, I felt an overwhelming feeling of helplessness. Now when I look back, although it felt chaotic at the time, everything was done correctly and with sound leadership. It was not chaotic; it was just unfamiliar.
Step 3: Evaluation
- What was good and bad about the experience?
- What went well?
- What didn’t go so well?
- What did you and other people contribute to the situation (positively or negatively)?
Looking back, what went well was that I had amazing colleagues by my side. After the event we all went and had some food together which allowed us to talk about what had just happened. However, sometimes you may be so busy you don’t have time to reflect till a little later. I find talking with someone who was present or understands your experience, can often help.
Step 4: Analysis
- Why did things go well?
- Why didn’t it go well?
- What sense can I make of the situation?
- What knowledge – my own or others (for example academic literature) can help me understand the situation?
I can look back and say things went well because we had a good leader come and take control of the situation. Everyone had assigned roles and knew their task. Another example of reflecting on a bad day could be that, as part of my bad day I noticed I didn’t do 10-minute meditation in the morning. So, I could then ask myself, what is the reason for that? If the reason is, I overslept because I was watching Netflix till 1am (oops), then I know to try and watch it earlier next time.
Step 5: Conclusion
- What did I learn from this situation?
- How could this have been a more positive situation for everyone involved?
- What skills do I need to develop for me to handle a situation like this better?
- What else could I have done?
I gained valuable experience and exposure in a high pressure acute clinical setting. I also learnt that it was completely normal and healthy, to feel a little upset afterwards. I had the weight of the whole traumatic situation on my shoulders. However, after opening up, I felt the weight ease away and I can now look back and see all it taught me. Your conclusion may be that there was nothing more you could have done, that’s fine too.
Step 6: Action Plan
- If I had to do the same thing again, what would I do differently?
- How will I develop the required skills I need?
- How can I make sure that I can act differently next time?
It’s good to recognise what we can change, but the hard part can often be, how do we change? I was able to implement some factors which made me feel more comfortable at future arrest calls, such as clarifying roles beforehand. I also learnt that reflection really helped me deal with situations which are extremely difficult to process emotionally. I now try and implement this on all things that may be playing on my mind, whether big or small.
Image from Ethan Elisara
So that is the story of how the one thing I used to hate doing, is now the thing I am imploring you all to try (this is remarkably similar to my relationship with eating olives). I hope that you gained an insight on what a reflection is, how it has impacted me, and the potential it has for you. Feel free to read this through again as a reflection guide, to any experience you wish to explore.