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Independents' Day

Reflecting on revalidation

The new emphasis on ‘reflection’ is irrelevant, onerous and unlikely to improve patient care, argues Dr Jim Sherifi

Our society seems to lay increasing store by words such as ‘clarity’, ‘transparency’, ‘openness’ as if they were virtues whereas - and I appreciate that I might be exhibiting staggering naivety in saying this - they have been in common use by mankind ever since thoughts were first articulated. I truly believe that these qualities are instinctive; that the default lies in such activity rather than their antonyms and that their use is implicit. So much so that when someone, usually a salesman, actually prefixes a statement with, ‘I’m going to be honest with you (guv)..’, we immediately infer that the opposite is so. Is not the same true of ‘reflection’? Surely reflection is hard wired into our learning instincts from birth. We touch a candle flame; it is hot; it burns; it hurts; we think about it; we don’t do it again. The process is not only a nervous reflex arc but also an intellectual one.

Reflection is an intellectual reflex loop that we utilise throughout our lives of intellectual advancement.  Similarly we intuitively have an audit cycle where learning sometimes is either acquired and utilised, discarded or needs reinforcing. None of this is exclusive to doctors and none has been invented by the GMC or RCGP. However until now, with revalidation, we have never had to document what is a natural occurrence. And I am still not sure why.

Is it not the height of intellectual arrogance to presume that doctors have not been engaged in such activity up until now? Of course the GMC accepts this and will reply that all they ask is for us to prove that this is so. But why should we? All doctors complain of increased clinical and administrative workloads so why does our regulatory body choose to make our lives even more onerous? I am not even sure that this activity will improve patient care. 

If I repeatedly see something then it sticks. I see a lot of diabetes and I know a lot about it. The same cannot be said for Gaucher’s disease. If I see someone with Gaucher’s, I look it up on the internet but I retain that knowledge for no longer than a goldfish. We are all good at common general practice presentations; less so with the esoteric. Does that really matter?

In our forthcoming appraisals, with increased emphasis on reflection, we are going to have to demonstrate an incremental growth in knowledge for which we get double points if that new knowledge is being applied in practice. Am I going to have to learn and retain the information on Gaucher’s just to please my appraiser? And can I do so without shunting something more vital out of the limited capacity of my brain?

I am not sure that doctors can or will wholeheartedly engage in this new venture or whether they will do what they always have; the bare minimum. As for myself, when I have my appraisal I shall produce this article which will show that I, at least, have gone that extra mile: I have reflected on reflection itself!

 Dr Jim Sherifi is a GP in East Bergholt, Suffolk

Readers' comments (6)

  • Ah yes, but can you demonstrate that your reflection upon your reflection has had tangible benefits. Then you need to reflect again upon those benefits, and why you perceive them to actually be of benefit. And so on, ad infinitum, until you disappear up your own reflective a**hole.

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    Well said Dr Sherifi
    The whole process is just an experiment
    to see if it will work by making us all do pseudowork

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  • You have expressed what many of us think but have not dared to openly admit so: that is the revalidation emphasis on reflection is an exercise in futility

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  • It is worse than that.
    I am now retired [thank God] but I distinctly remember started to read the Nice guidlelines on Paediatrics and realising very quickly that they were at best an irrelevance and in places frankly dangerous. I made a concious decision to read no further as having done a paeds job and spent years looking after children as a GP and mother I knew that I had a robust model in my head which had served me and my patients very well indeed and that to read the guidelines may upset my framework and actually do harm. I have no doubt that there are other guidelines that do the same and as far as I am aware this is not being examined.
    To be forced to show that I had read them and reflected upon them would, I believe, have been damaging to my practice.

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  • In additon to the above I must add that I continued to read about Child health and disease and to learn from Paediatricians and other people looking after children but I did this in my own guided way.

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  • So, so true. As I am close to retirement I was bold enough to tell my appraiser that although I never stop reflecting, it is a non-conscious act and not something that I need to navel gaze to achieve. It is great that someone like Dr Sherifi has articulated my very thoughts and given me more ammunition when I have my next appraisal tomorrow!

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