Abstract
It is a few weeks into my new rotation and I am starting to feel settled. I know my roles and responsibilities, the names of the nurses and the code to the mess. It is therefore time I wrote some more material for my ePortfolio. I do not mean the personal development plan or self-assessments; those are mere form filling. I refer to that section of my portfolio entitled learning log, intended for my self-reflection.
Despite my best intentions to get on with this and forgo my usual procrastination, I feel that last sentence deserves a reflection all to itself. Why is it my portfolio? I never asked to keep one and if I did, it would bear little resemblance to this one. Why self-reflection? Surely, by its very nature, reflection takes place in the privacy of one's mind and is introverted enough without adding the word ‘self’ to it.
Nevertheless, I swallow my distaste, reach for my patient list and ponder … ‘Whom shall I honour with my failures and successes today? Which situation should I choose to embellish? What will best show my empathy, my knowledge or my areas for improvement? How shall I demonstrate the General Medical Council (GMC) duties of a doctor without being too clichéd? Am I being tongue-in-cheek or is this really the kind of doctor I am expected to be?’
It is not the reflection itself that concerns me so much as the stiff and formal way we are instructed to go about it. To reflect is to reassess one's own past actions and their consequences, in order to improve future practice. I have no objection to doing this, but resent writing my thoughts down at someone else's behest. I do things badly sometimes and I acknowledge my mistakes with a muttered ‘Don't do that again, you prize idiot’. Then, when I have a quiet moment, I go over what went wrong. I do not need to fill out a form on the Internet to do this.
Self-criticism can be constructive and promote learning without being paper-based. To be a doctor is to be in a position of huge trust and I endeavour daily to be worthy of it. Surely therefore, I can be expected to reflect and learn from my own actions, without writing my thoughts down for others to read. British school children are reportedly the most examined in Europe (Cassidy, 2008). What is it about our culture that says that learning is not acknowledged until it is somehow recorded on an official looking document?
While I am a doctor and therefore a professional, I am a human being too. The work that I do stimulates many conflicting thoughts and emotions. I am saddened by a stillbirth, grin at a twin birth, frustrated with heartsinks, depressed by the suicidal and disappointed by my failures. The way in which I contemplate and deal with such incidents should be up to me.
If at the end of my shift I need some time to think, I go for a walk. If I need to step off the world for a while, I read a book or watch a film. If I want to talk about my day, over a pint with a friend, I do that too. Alternatively, I could choose to keep a diary or write a blog. I actually quite enjoy writing; I have an ‘A’ in English A Level, to ‘prove’ it. A diary is a very personal and private thing. My portfolio, however, varies only marginally from those of other trainees, allows perusal by others and is intended for verification of my learning and to further my career. While I do not have to share all my entries, a decent number must be shown to my supervisors in order to qualify. I therefore find myself writing for my audience. This somewhat taints the self-reflections it purports to contain.
Several well-known authors and poets were also doctors; John Keats, Che Guevara, Anton Chekov and Arthur Conan Doyle to name a few. Somerset-Maugham wrote of his time as a medical student that it allowed him to see ‘life in the raw’. He said ‘I saw how men died. I saw how they bore pain. I saw what hope looked like, fear and relief’. The late Michael Crichton used his hospital experiences to create the award winning television drama ‘ER’. Are these not reflections of sorts?
In 1915, a Canadian army doctor, named John McCrae, sat outside a dressing station near Ypres and wrote ‘In Flanders Fields’. His reflections on the losses he had seen in the First World War struck a chord, not only with his generation but also those that have followed. His scribbles allowed him to express what he felt. He was dissatisfied with the poem and did not intend it to be published; it was only due to the actions of a fellow officer that it was finally submitted for publication. The aforementioned writers found a personal method of expression that suited them. They wrote for their own benefit and enjoyment. My supervisors tell me that a good portfolio reflects a good trainee, but the format seems to discourage individuality not promote it. Does my reluctance to engage enthusiastically with my portfolio suggest that I am a poorer doctor than my peers? Or does it just reflect my particular style of learning?
I began these musings as a sardonic reflection on self-reflection. I wanted to feel that I was writing my own opinions not paraphrasing those expected of ‘Tomorrow's Doctors’. I acknowledge that reflection on one's actions and their consequences is essential to learning and to being a better doctor. However, the manner in which I reflect ought to be my decision. That is how to put the true ‘self’ into self-reflection. Whether it is through drawing cartoons, undertaking research, writing satire, auditing best practice or typing reams in my ePortfolio, my reflections should address situations that have affected me and changed my practice, instead of just writing what I believe my assessors will want to read.
If I find myself sat in front of the Annual Review of Competence Progression (ARCP) panel in future and they ask me about the portfolio lying on the table between us, I want to be able to say, like Frank Sinatra, ‘I did it my way’. If not, it is just another exercise in creative writing.