Reflection in the Practice of Medicine

Reflection in the Practice of Medicine

In my previous post, I mentioned that there are a distinct pattern and process to how physicians go about deciding on their development.

That all sounds good and well—but fortunately and unfortunately, medicine, like any other professional area, can be chaotic. This means that physicians don’t always have the luxury to go through the four stages that I outlined previously. Sometimes there is a need for more immediacy in resolution to their training needs, or sometimes their pondering over areas of development happens much quicker and is directed by external factors.

A big piece of input for physician learning comes from the very people who spend 16.3 minutes (on average) with each visit. In this post, I will explore other areas of input for change.

Patient-specific problems often emerge unexpectedly for the physician during a visit. Therefore, the health professional may wish to consider there and then if there is an efficient and convenient method for a proposed learning activity to bridge this gap in knowledge, and if the information is immediately available (Davis & Fox, 1994).

Gorman & Helfand (1995) found that experiencing urgent patient problems and the expectation of finding a definitive answer were both significant contributors to a physician’s pursuit of learning; additionally, improving general medical knowledge and skills was a negative predictor of their information seeking, as it seems that physicians want to improve their knowledge in a way that will have the greatest effect on their immediate practice. Does any of this remind you of andragogy and our old friends Lindeman and Knowles?

Building on the role of andragogy and the different stages of learning, physicians also have the tool of self-reflection as a means of learning.

Schön wrote extensively on reflection and its role in learning, and came up with the notions of reflection-in-action and reflection-on-action. Reflection-in-action can be seen during a clinical encounter when there is the need—even if only be for a moment—to stop to think and problem solve in the midst of activity.

If the physician’s body of knowledge and skills is inadequate when an unexpected situation arises, it can be suggested that the physician be prompted by these “surprises” to search for a way to understand and take steps to address the issue (Schön, 1987).

“I have never seen this combination of symptoms before in a patient so young.”

This reflection-in-action during a clinical encounter helps physicians to formulate decisions on how to proceed when a situation with a patient or group of patients does not marry with current understanding.

“I read that this is a common presentation in Decrum’s disease, but I have never seen this before—I need to find out how to confirm this.”

Reflection-on-action occurs after the office visit encounter, when the physician revisits what has occurred and considers whether there may be a better way to approach the issue. Both forms of reflection can be factors in deciding to learn new knowledge because they help physicians prepare for future actions (Schön, 1983) that could include the reviewed need of learning to solve the practice issue that initially invoked the reflection.

“I wonder why this patient is getting angry when I told [him or her] to lose weight, stop drinking and smoking, exercise more, or expect a heart attack before… 40. Was it something I said?”

Rather than going down the somewhat formalized route of the four stages of physician learning, here we are seeing a need for learning that is almost instantaneous. There is a strong link to what is happening immediately in the here and now, which will be a benefit for the patient and doctor alike.

It can be argued that physicians that consciously reflect may be better able to monitor their ability to address and solve emerging problems related to patient care. In this sense, reflection is a type of self-assessment that is conducted repeatedly during situations that a physician encounters during everyday practice.

Some physicians, as with members of any profession, are more reflective than others. Having this propensity toward being reflective may lead to greater depth in thinking about a problem and exploring ways to improve their practice (Mamede, Schmidt & Penaforte, 2008). Factors influencing the decision to learn may be related to the degree to which any physician engages in reflective practice and subsequently considers investigating these potential problems.

Reflection is a vital aspect of any learning, and having the ability to attend to this both in the moment and afterwards is a vital skill that can ultimately improve a physician’s development. I hope I’ve given you something to reflect on. Grab a cup of tea – I find that helps me reflect.

Feature Image by: Jacob Ehnmark