Reflective Notes Made Easy Faculty of Public Health

Reflective Notes Made Easy Faculty of Public Health CPD Committee (Naveed Syed & Andrew Terrell)

Dumbledore to Harry…. Harry stared at the stone basin. The contents had returned to their original silvery white state, swirling and rippling beneath his gaze. “What is it? ” Harry asked shakily. “This? It is called a pensieve”, said Dumbledore. “I sometimes find, and I am sure that you know the feeling, that I simply have too many thoughts and memories crammed into my mind. ” “Er”, said Harry, who couldn’t truthfully say that he had ever felt anything of the sort. “At these times”, said Dumbledore, indicating the stone basin, “I use the pensieve. One simply sipons the excess thoughts from one’s mind, pours them into the basin, and examines them at one’s leisure. It becomes easier to spot patterns and links, you understand, when they are in this form”. 2 Source: J. K Rowling The Goblet of Fire, Bloomsbury (2000: pp 518 – 519)

Example 1

Who gets audited? • All members and fellows except for those claiming exemption from CPD are eligible for audit • One in five eligible members (non-random sample) • Additional 2 per cent random sample • Anyone with unsatisfactory audit (including not submitting) previous year • Anyone not returning CPD submission for that year

Audit thresholds • • Submission must be personally identifiable There must be a PDP(s) covering the relevant CPD year Must be at least 50 credits (up to 100 assessed) All credits supported by a reflective note No more than 5 credits per reflective note A minimum of 25 credits directly related to PDP Balance type of activities – One type of activity not more than half of claimed credits

Audit thresholds • To be submitted online (unless given prior approval) • If not submitted online, any disparity between credits claimed in the annual return and those recorded on the CPD Log must be less than 10% • At least 40 credits supported by a reflective note assessed as ‘satisfactory’ This was the second year of qualitative assessment of reflective notes.

Outcomes of audit • If submission deemed satisfactory • Participant sent letter advising satisfactory audit • If submission deemed unsatisfactory • Documentation sent to a second Regional CPD Co-ordinator for repeat audit • If deemed satisfactory by second auditor • Participant sent letter advising satisfactory audit • If deemed unsatisfactory by second auditor • Reviewed by Director of CPD who will make ultimate decision whether to send letter advising unsatisfactory audit

Review of CPD audit results Selected for audit Submitted audit papers Failed by at least one auditor Failed audit • • 2016 2017 364 319 59 22 (6. 9%) 436 356 81 35 (9. 8%) Less than 40 points supported by a satisfactory reflective note No Personal Development Plan Less than 25 points explicitly cross-referenced to the PDP Errors resulted in <50 CPD points

A selection of comments • Your reflective notes were of a satisfactory quality • But, the PDP provided is not for the year being audited • After requesting correct PDP - the same one was submitted • <50 points claimed • 12 points claimed for a single day • The reflective notes are not well developed • all virtually the same wording, no evidence of reflective practice • Reflections are very brief and notes are mainly descriptive • Comments such as ‘self-evident’, or ‘as day 1’ are not reflection • Lists of subjects covered are not reflection • There was no linkage of any activities to the relevant PDP

Not talking about CPD audit ……but how to write a better Reflective Note

Learning Objectives ‘In school, we think about math, and we think about spelling, and we think about grammar. But who ever heard of thinking about thinking? … If we think about electricity, we can understand it better, but when we think about thinking, we seem to understand ourselves better. ’ Source: Lipman, M. , Sharp, A. M. , Oscanyan, F. S. , Lipman, M. , & Montclair State College. (1982). Harry Stottlemeier's discovery. Montclair, N. J: Institute for the Advancement of Philosophy for Children, Montclair State College.

The importance of reflection Increasing professional emphasis on good quality reflective notes to augment professional learning and strive to be a better and more effective practitioner both in appraisals and revalidation: You should use the framework for appraisal &revalidation to§ • reflect on your practice and your approach to medicine, • reflect on the supporting information you have gathered and what that information demonstrates about your practice, • identify areas of practice where you could make improvements or undertake further development, • demonstrate that you are up to date and fit to practise. § Source: General Medical Council. The Good medical practice framework for appraisal and revalidation.

What is reflection? • ‘consciously thinking about and analysing what you are doing and what you have done; thinking about what and how you have learnt’§ • Reflection is a developmental thinking process that is contextualised into past experiences, thus it is unique to each individual and not merely a description of the events themselves § Source: Brodie, L. (2008). Reflective Writing Guide for Students

What is reflective thinking? • Reflective thinking process starts with you • Before you can begin to assess the words and ideas of others, you need to pause and identify and examine your own ‘baseline’ position • This involves revisiting your prior experience and knowledge of the topic you are exploring & involves considering how and why you think the way you do • The examination of your beliefs, values, attitudes and assumptions forms the foundation of your interpretation of a new events and ultimately building a richer understanding and new learning • You recognise and define the valuable knowledge you bring to every new experience • The learning process fundamentally relies on the important connections between what you already know and how you place that in the context of new events. In this way, you become an active, aware and critical learner

What is reflective writing? • Reflective writing provides evidence of reflective thinking • valuable tool for helping you to formulate and clarify your evolving thinking as it develops. • Usually involves: • Looking back at something (often an event, i. e. something that happened, but it could also be an idea or object). • Documenting your personal analysis of the event or idea (thinking in depth and from different perspectives, ). • Writing carefully about what the event or idea means for you and your ongoing progress as a learner and/or practising professional. • Reflective writing is thus more personal than other kinds of academic writing. • Genuinely reflective writing often involves ‘revealing’ anxieties, errors and weaknesses, as well as strengths and successes. This is fine as long as you show some understanding of possible causes, and explain how you plan to improve or manage a change in behaviour.

Reflective writing is not: • just conveying information, instruction or argument • pure description, though there may be descriptive elements • a straightforward decision or judgement (e. g. about whether something is right or wrong, good or bad) • simple problem-solving • a summary of course/conference notes • a standard essay

Reflective writing is: • your response to experiences, opinions, events or new information • your response to thoughts and feelings • a way of thinking to explore your learning • a way of making meaning out of what you study • a way to achieve clarity and better understanding of what you are learning • an opportunity to gain self-knowledge • a chance to develop and reinforce writing skills

What are benefits to the practitioner? • Learning is both an active and a reflective process. • The learning cycle - reflection or thinking about what you have done and how and why you did it, form an integral part of learning. • Because learning is often subconscious, we don’t realise that we have gained new knowledge or understanding until we stop to contemplate a particular activity. • Reflection, is a way for critical analysis, problem solving, synthesis of opposing ideas, evaluation, identifying patterns and creating meaning. • Reflection will help you reach the higher levels of learning as well as identifying your own learning needs and improving your practice.

Theory behind Reflection Learning cycle and examples of each phase Concrete Experience Eg. , Reading; Examples and Problems; Field Work; Observations Testing the Implications of Concepts in New Situations (Active Experimentation) Eg. , Projects; Field Work; Simulations & Exercises Kolb’s learning cycles; Schön’s ideas about reflection; with Gibbs outlining stages in reflection and reflective writing Reflective Observations and Reflection Eg. , personal logs; discussions; brainstorming; questions and rhetorical questioning Formation of Abstract Concepts & Generalisations (Abstract Conceptualisation) Eg. , Lectures; Peer-review Papers; Conferences

Levels of Learning Increasing Difficulty Evaluation Synthesis Analysis Application Comprehension Knowledge Process Involves acts of decision making, or judging based on criteria or rationale makes judgements about Combines elements to form new entity from the original one - draws on experience and other evidence to suggest new insights Separates wholes into parts until relationships are clear – breaks down experiences Uses information in a situation different from original learning context Interprets, translates or summarises given information - demonstrating understanding of events Recognition and recall of information and facts - describing events Explanation

CPD and reflection • CPD is formative and it is about what it achieves for you and your practice rather than the summary of a learning event • These do not have to be lengthy but should reflect on how the learning was relevant and how it will impact on your practice • ‘Reflection’ is to improve practice and this needs to be effectively communicated

“Yellow Sticky Note” to Self Vs Journal s h t n o m 6 later… Makes sense? s h t n o m 6 later Makes sense?

Mental Processing • When writing a Reflective Note there must be evidence of mental processing covering four elements: 1. Purpose – of attending the event or undertaking the activity (this may be related to PDP or may be identified out of general interest or to widen public health experience or knowledge) 2. Message – identifying the message or learning from the event or activity. 3. Application – of how the learning applies to me and my work 4. Result – the next steps I am going to take, as a consequence of my application. 24

Personal Reflective Notes Purpose Result Message Application

What makes a good quality reflective note? Style Use full sentences and complete paragraphs You can usually use personal pronouns like 'I', 'my' or 'we' Keep colloquial language to a minimum (eg, kid, bloke, stuff) Keep the length appropriate or concise (quality not quantity) • Presentation and coherence • A reflective task may allow you to use different modes of writing and language: • • • descriptive (outlining what something is or how something was done) • explanatory (explaining why or how it is like that) • expressive (I think, I feel, I believe)

What makes a good quality reflective note? Content Authentic, personal & relevant for learner Clarity & good observation in presentation of learning event or issues Depth and detail of reflective accounts Honesty and self-assessment (exploring emotions in learning) Thoroughness of reflection and self-awareness Evidence of a willingness to revise ideas / live with uncertainty Evidence of creative thinking Evidence of critical thinking / questioning Evidence of a deep approach to the subject matter of the journal article, or online learning • Representation of different cognitive skills (synthesis, analysis, evaluation etc) • Identifies gaps in learning & willingness to act • • •

FPH CPD Questions 1. Why did I choose this activity for my CPD? 2. What did I learn from this activity or event? 3. How am I going to apply this learning in my work? 4. What am I going to do in future to further develop this learning and/or meet any gaps in my knowledge, skills or understanding?

Audit thresholds • To be submitted online (unless given prior approval) • If not submitted online, any disparity between credits claimed in the annual return and those recorded on the CPD Log must be less than 10% • At least 40 credits supported by a reflective note assessed as ‘satisfactory’ This was the second year of qualitative assessment of reflective notes.

Useful Vocab: Interpretation & Analysis Dr Naveed Syed: Consultant in Health Protection

Useful Vocab: Outcome & Synthesis Dr Naveed Syed: Consultant in Health Protection

Example 2 - Unsatisfactory

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http: //www. fph. org. uk/continuing_professional_development_%28 cpd%29

Finally… Faculty CPD is not about catching people but to support and help colleagues so that we as a profession are assured that standards are maintained and we all continuously learn and develop

CPD and reflection • CPD is formative and it is about what it achieves for you and your practice rather than the summary of a learning event. • These do not have to be lengthy but should reflect on how the learning was relevant and how it will impact on your practice • ‘Reflection’ is to improve practice and this needs to be effectively communicated

…any questions…