1. Written Reflective Practice - Clearly Dangerous
Jo Walker MBE VS
Simon Struthers COM

2. Personal experience
Dr Bawa-Garba and others
All of us

3. Personal experience
Written reflection and revalidation

4. Why dangerous for me ?

5. Dr Bawa-Garba and others

6. Hands up if you were involved in a serious event or incident in last 12 months
Hands down if went exactly to guidelines/APLS/NLS etc
Hands down if you didn’t write a reflection on this event (GMC)
Hands down if you are sure that all of your written reflection was completely anonymous
Should the written reflection become public, do you think the general public/Daily Mail would understand the clinical implications of deviation from guidelines ?

7. Dr B-G’s case
B-G’s reflections were written down and appended to the report of the on call consultant Dr O’Riordan
B-G’s reflections were read by the prosecution
The consultant also acted for the prosecution
They were used in a court of law
They were very dangerous for B-G

11. Academy Medical Royal Colleges, GMC, Postgraduate Medical Deans, Medical Schools Council, sept 12th 2018
“Recorded reflections, such as learning e-portfolios or for revalidation or CPD are not subject to legal privilege”
“Disclosure of these documents might be requested by a court if they are considered relevant”
“We have called for these notes (reflective) to be given legal protection”

12. RCPCH, aug 15th 2018
“There is no absolute legal protection for a doctor’s reflections so it is, at least in theory, possible that they could be demanded by the court.  In addition, if used as part of a doctor’s defence (to demonstrate learning, etc.) these reflections are then in the public domain and can potentially be used by other bodies, eg tribunal processes”  
“The GMC have stated that they would not use reflections in a fitness to practise hearing, however there is still some uncertainty around this.  It is prudent to write reflections as if they could be shared in a court of law”

13. Written reflections – and life
GP ST3 trainees have to do 3 written reflections a week
45mins each
total 2 ¼ hours/week
44 weeks a year = 99 hours= 4.1 DAYS/year
More than 1% of the year !!!
Why is this dangerous?

14. An Introduction to Service Improvement
Assuring Safer Care: Embracing Human Factors for Improvement 
Conflict Resolution and Challenging Conversations
Effective Negotiation Skills
Influencing with Integrity
Leadership for Culturally Diverse Teams
Maximising Assertive Behaviour
Maximising Resilience/Stress Management
NHS Structure and reform - what it means to you!  
Patient Safety First
Personal Impact
Presenting with Power and Authenticity
Primer in Genomics
Psychological First Aid Training
Run up to the Consultant Interview
The Essentials of Effective Leadership
Time Management

15. What else cant they do? Exercise Seeing family or friends
Making cakes, Zumba etc
SLEEP
Things that maintain either physical and/or mental wellbeing
Not doing these things is dangerous

16. Summary Written reflections have been dangerous
For me
For Dr B-G and others
Written reflections are dangerous
For all of us

17. Thank you