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

2. 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”.
Source: J.K Rowling The Goblet of Fire, Bloomsbury (2000: pp518 – 519)

3. Example 1

4. 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

5. 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

6. 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.

7. 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
If deemed unsatisfactory by second auditor
Reviewed by Director of CPD who will make ultimate decision whether to send letter advising unsatisfactory audit

8. Review of CPD audit results
2016
2017
Selected for audit
364
436
Submitted audit papers
319
356
Failed by at least one auditor 59 81
Failed audit
22 (6.9%)
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

9. 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

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

11. 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.

12. 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.

13. 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

14. 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

15. 15

16. 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.

17. 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

18. 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

19. 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.

20. Theory behind Reflection
Concrete Experience
Eg., Reading; Examples and Problems; Field Work; Observations
Reflective Observations and Reflection
Eg., personal logs; discussions; brainstorming; questions and rhetorical questioning
Testing the Implications of Concepts in New Situations (Active Experimentation)
Eg., Projects; Field Work; Simulations & Exercises
Formation of Abstract Concepts & Generalisations (Abstract Conceptualisation)
Eg., Lectures; Peer-review Papers; Conferences
Learning cycle and examples of each phase
Kolb’s learning cycles; Schön’s ideas about reflection; with Gibbs outlining stages in reflection and reflective writing 20

21. Increasing Difficulty
Levels of Learning
Increasing Difficulty
Evaluation
Involves acts of decision making, or judging based on criteria or rationale - makes judgements about
Synthesis
Combines elements to form new entity from the original one - draws on experience and other evidence to suggest new insights
Analysis
Separates wholes into parts until relationships are clear – breaks down experiences
Application
Uses information in a situation different from original learning context -
Comprehension
Interprets, translates or summarises given information - demonstrating understanding of events
Knowledge
Recognition and recall of information and facts - describing events
Process
Explanation 21

22. 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

23. “Yellow Sticky Note” to Self Vs Journal
6 months later
Makes sense?
6 months later… Makes sense?

24. Mental Processing
When writing a Reflective Note there must be evidence of mental processing covering four elements:
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)
Message – identifying the message or learning from the event or activity.
Application – of how the learning applies to me and my work
Result – the next steps I am going to take, as a consequence of my application.

25. Personal Reflective Notes
Purpose
Message
Application
Result 25

26. 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)

27. 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

28. 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?

29. 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.

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34. Useful Vocab: Interpretation & Analysis
Dr Naveed Syed: Consultant in Health Protection 34

35. Useful Vocab: Outcome & Synthesis
Dr Naveed Syed: Consultant in Health Protection 35

36. Example 2 - Unsatisfactory

37. Example 3 - ???

38. Example 4 - ???

39. Example 5 - ???

40. Example 6 - ???

42. 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

43. 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

44. …any questions… ?