Reflective Practice and why it’s so important

Rachel Smith
Feb 21, 2024
7 min read

Well, we’ve made it to February! How are your goals for the year going so far? As you’ll know, we do love a bit of goal setting at Red Square Medical HQ. But, we also understand the importance of Reflective Practice too. Especially in relation to setting goals.

Want to know more? Please read on…

In the medical world, the term ‘reflective practice’ is used frequently. But what does it really mean, and how can it be used effectively by medics and non medics alike?

Reflective practice first developed in medicine, teaching and social work as a way to learn from real life experiences. It’s your way of thinking about everything that has happened in an incident, event or time frame and what went right and wrong. It’s the opportunity to ask yourself whether you would or could do anything differently if faced with the same situation again.

Reflective practice can be formal or informal and while there are a number of models that can be followed (see links at the end if you’d like to know more), there’s no right or wrong way to reflect. It’s a very personal process and how you do it will depend on you and your circumstances. It can be done alone or with others involved in the situation or event. However reflective practice is carried out, the intended outcome is to think about our experiences, learn from them and develop a strategy of what to do next.

It’s possible to reflect on pretty much anything, and the benefit can be personal as well as professional. The main benefits include:

Stepping back and allowing yourself to look at the bigger picture. It’s easy to become very task focused in any role (think about your Human Factors!) and reflection can help you to think about goals and future plans.
Combating ‘self-talk’, self doubt and imposter syndrome. When the little voice inside is insisting that you’re not good enough, don’t know what you’re doing and someone else would be better at it than you, reflection can remind us of the good things we’ve done and help us to learn and move forward.
It helps to identify areas to improve or develop, on a personal and business level.
It can use previous experience to guide future development.
Reflection can help creativity and encourage you to try new things by thinking about what you do and WHY you are doing it.
We’re all guilty of unconscious bias and reflection can help to challenge assumptions about people and situations and see things from a different perspective.
Reflection is a core part of emotional intelligence - which is the ability to understand and remain in control of our emotions. A really important attribute in a highly stressful situation and useful for our own wellbeing and working with others.
If something is bothering you about a situation or event, reflection helps you to focus on the positives of the experience, learn from things that didn’t go so well and move on rather than dwelling on an issue.
By providing a process for thinking things through, reflection can help maintain a healthier work/life balance.

As you’d expect, the Red Square Medical team LOVE a bit of reflection! We always ask for feedback from our courses and in relation to other work we do, and this often starts the process for us. From there, we can talk about what went well and what could be done better next time, which elements need updating or refreshing, whether there are gaps in our knowledge that we need to fill and should anything change in the short or long term.

Our Paramedic, Rachel recalls a recent experience when reflection was essential. With her partner and a paramedic student, she was called to a gentleman who’d had 3 falls in 24 hours and his family were quite rightly concerned. He seemed alert and chatty, aware of what was going on and able to answer questions. On examination he had low blood sugar (corrected quickly with food/drinks) and his temperature was reading LO (low meant under 34 degrees) but with no obvious reason other than the low blood sugar; the house wasn’t cold and he was suitably dressed. Although his blood sugar increased to a normal range, his temperature still read LO. This affected the crew's ability to get an accurate oxygen level reading as his fingers were too cold. The patient was cannulated at the scene.

On the way to hospital, with the patient wrapped up like a burrito in foil and blankets and sleeping peacefully, Rachel became concerned about a couple of really tiny changes to the observations and stood up to check a few things. The patient suddenly roared loudly, threw his head back, went rigid, turned purple and stopped breathing.

Driver alerted, the ambulance pulled over and the other crew member jumped in the back. Rachel had laid the patient flat, put an OP airway in, got oxygen on, and was using the BVM to breathe for the patient. The student was monitoring the pulse and BP. A 12 lead ECG was carried out quickly. The patient was breathing at around 6 breaths per minute so still needed respiratory support. But, there were no clues as to what had caused this ‘seizure’ and respiratory arrest. The hospital was alerted and the patient taken straight to resus. Much later on, the crew found out that the seizure had been caused by an undiagnosed brain condition that couldn’t have been discovered prehospital.

Afterwards, the two crew and the student took a few minutes to reflect and talk through the job step by step. It was a very dramatic and dynamic development in a short space of time. Everything had happened so quickly and they needed to make sure everything that could have been done was done. It was also the first time the student had experienced a patient deteriorating so rapidly to this extent when she had carried out the examination, taken his history, and been chatting and laughing with the patient and his family, creating a great rapport in the house.

Not knowing the cause, our conclusion was that whatever had happened, it couldn’t have been anticipated (this was confirmed by the final diagnosis), though the attention to monitoring and seeing those minute changes en route had indicated that things were starting to happen a minute or so before the seizure, which was good.

The crew acted quickly and worked well together to secure the ABCs and rule out anything acutely cardiac which could have meant a different pre-alert and different destination at the hospital. So from a clinical perspective, it was felt that everything that could have been done was done.

From a more emotional perspective, it was a huge shock. Feelings are important. The student talked about how she’d never experienced anything like this before and found it upsetting that she’d had such a good relationship with the patient and then experienced such a sudden and dramatic deterioration. It worried her because she hadn’t seen the warning signs and didn’t know what to do. She remembered freezing for a few seconds and felt she had been slow to check his breathing when instructed to.

So a discussion around expectations and her stage of training followed, as it’s important to learn rather than lose confidence. It was also one of those jobs that you will never forget, so if someone presents in a similar way, you’re likely to be on high alert and have suspicions.

Rachel and her partner had also been surprised by the speed and severity of the situation, and the need for an instant reaction without knowing the cause. All agreed that it reiterated the importance of ABCs as that’s what got the patient to hospital. For the student, it also reinforced the need for cannulation if there’s even a tiny suspicion that you might need it later - in this case Rachel cannulated basically because she didn’t know why the patient was so hypothermic with no real reason, and it didn’t improve even when his blood sugars did. Her ‘Spidey Sense’ was tingling! Trying to get a line in when your ABC isn’t secure is a problem you could well do without and that was a valuable lesson.

The reflection in this case meant that all three crew who attended could analyse the job at every stage and consider whether their response individually and as a team was appropriate and fast enough. It allowed a decompression time to talk about how it had made them feel, and how that was different for each person due to personality, job role, relationship with the patient and role in the emergency. The learning points for all 3 were different too as they are all at different stages of their careers, with different levels of experience and viewing it from a different perspective.

We hope you’ve found this useful and if you do already use reflective practice, it’s given you some ideas. If you don’t yet use reflection as a tool, please give it a go and we’d love to hear your stories about when it has, or maybe hasn’t, worked.

If you’d like to explore reflective models in a bit more detail, please use the links below for some of the better known options. But remember, while the structure can be helpful, real life doesn’t always work this way, you can be more informal, and reflective practice is a continuous process.

	Gibbs’ Reflective Cycle (1998) This is described as a structured debrief and takes you through what happened, your feelings and reactions, an evaluation and analysis, the conclusion and an action plan of what you’re going to do about it. We find it quite useful, though sometimes it’s difficult to separate the evaluation and analysis sufficiently. https://my.cumbria.ac.uk/media/MyCumbria/Documents/ReflectiveCycleGibbs.pdf
	Kolb’s Cycle of Reflective Practice (1984) This model has a simpler structure which suits some people more. Based on 4 stages, it looks at what the experience actually was, thinking about the experience (feelings, skills, etc), analysis and learning from the experience, and then putting it all into action with SMART goals. https://libguides.hull.ac.uk/reflectivewriting/kolb
	Rolf, Freshwater and Jasper (2001) Three simple questions of What?, So What?, Now What?, make up this model, but they do require comprehensive answers in order to consider the description of what happened, what that means and what actions are needed. https://www.ucd.ie/teaching/t4media/reflective_practice_models.pdf
	Schon (1991) Schon’s model appears to be the simplest on the surface as there are only 2 parts to it - Reflection in Action and Reflection on Action. Otherwise described as thinking while doing and thinking after doing, it’s largely aimed at teaching environments. https://www.ucd.ie/teaching/t4media/reflective_practice_models.pdf