Reflective Practice and Examples:

Reflective Practice and Examples:

A lot of IMGs struggle to write reflections and sometimes go to the extent of saying they hate reflection or they can’t reflect at all.

Refection is a basic human behaviour and we survive on constantly reflecting and appraising the situations around us. So everyone is reflecting all the time but we just don’t call it refection.

I have been thinking about how to help IMGs improve their quality of refection and have experimented with different methods locally. But on reflection of teaching reflection, I feel if I try to make it too simple the quality of refection goes down and if I try and create a standard method people start taking it literally and the thought process goes out of the window.

While I am trying to figure out the best way to teach reflection, here are some examples (CPD reflection) from the portfolio of my wife who works as a GP. She writes good quality reflections. Read them and see if you get the concept, follow the flow of the thought process and learning out of teaching event.

Please feel free to suggest to me how you think Reflection can be best taught?

Example # 1:

Attended a full day course on (Topic - Date - venue)

Reason:
As a GP it is important to continue to renew our knowledge even in areas that we become experts in such as hypertension, asthma and diabetes. Common things are common but medical research is always evolving hence the importance to continue to update our current knowledge base. It was a useful course and new useful guidance is always gained when attending this course.

Reflection:
Amongst many nuggets of knowledge I learned the following:

NSAIDS & Antidepressants- co-prescribing these increases the risk of intracranial haemorrhage (ICH) particularly in the first thirty days. ( BMJ2015;351:h3517) I have always advised patients on short courses of NSAIDS and AD to beware of GI bleeding but had not considered ICH.

The study also suggests that this risk is across the range of antidepressants such as TCAs, SNRIs as well as SSRIs. I will continue to use these with caution. Of course, nothing is straightforward in General Practice. We do not know of the risk beyond 30 days. This risk is also higher in men but surprisingly no increased risk is seen in older people or those with co-morbidities.

Outcome:

Given that we prescribe approximately forty million prescriptions for antidepressants across the UK, we are unaware of patients using NSAIDS over the counter, we have to use caution and advise our patients against such risks.

This has a direct impact on multimorbidity and polypharmacy in primary care.
I have made it clear to patients taking antidepressants about the risks of using NSAIDs. More so, there are a number of patients with depression with chronic pain, these groups are clearly vulnerable to the risks mentioned.
There is a suggestion with NICE guidelines that if an SSRI & NSAID is co-prescribed, gastro protection should be advised.

I have discussed this with our practice pharmacist, as she does the majority of our medication reviews, and made her aware of the risks.
On a personal note, I will be adding gastro protection where possible and advising patients to avoid OTC NSAIDS.
We also discussed the use of NSAIDS which in actual fact cause more deaths than RTA. This has certainly put things into context for me!

Example # 2:

Title:
Menopause Masterclass

Activity:
A refresher about menopause and risks/benefit in the current climate.

Reason:
Women are far more self-aware of the menopause and approach the doctor to discuss treatment for the menopause than perhaps decades ago.
As women are also living longer, as is the general population, so comes with it increasing the risk of cardiovascular diseases and other co-morbidities.

Reflection:
It was useful to look at the quality standards that are now in place for HRT. There were several useful websites for information for both health professionals and patients:
British Menopause Society- BMS
Menopause matters.org
M anagemymenopause.co. uk
Also, for younger women with premature ovarian failure the daisynetwork.org.uk< br />

There was useful information on the use of testosterone. I had a peri-menopausal lady who requested testosterone gel to improve her libido. I had no experience in this area so wrote to the HRT clinic, she is now a very happy patient on testosterone gel. As long as the testosterone levels are measured every 3months to ensure that low maintenance doses are continued it is acceptable.

Given that I see a lot of women who often come with an agenda and an expected outcome this seminar was very useful in addressing these issues. HRT can have a lot of expectation for women. Some women are very reluctant to stop taking HRT, it is challenging such as stopping HRT after 5years or more when the risk becomes more concerning that I find challenging. The risk increases in term of CVD, obesity and breast cancer.

I have used the BNF statistics to place this risk into context for women who have been on HRT for many years. On one occasion in a 72year old lady, I stopped HRT much to her consternation. I did refer her to the HRT community clinic where it was restarted. Unfortunately, the risk and responsibility fall on the prescriber and I decline to continue to prescribe in this scenario. This seminar reinforces my practice in such unique case scenarios.

Outcome:
This was a good seminar, given the subject, it validated my current practice and helped me develop a more patient-centred paradigm within our current approach.

Example # 3:

Title:
Dermatology update day

Activity:
(Venue)
Evening lectures covering typical skin scenarios commonly seen and dealt with in the primary care setting.

Reason:
The topics discussed on the day were eczema and skin conditions in young children, vulval rashes and psoriasis in the community.
I see a lot of vulval rashes and being contraception lead at my surgery. Also, I have a lot of consultation with women so find that this area needs to be kept up to date.

Reflection:
It was reassuring to know that my management of childhood eczema was in keeping with dermatologist consultant approaches.
The key points to take home were that GPs tend to undertreat eczema rather than over treat. It is reasonable to continue a moderate potent steroid cream as long as it is for a short period and stepped down at the earliest possible.

Outcome:
I will continue to practice as I have been but will take on board certain practices such as treating superimposed infection in eczema for 2weeks and also despite what the instructions are on steroid creams we can apply to broken and infected skin!