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The qualities of reflection and resilience are developed throughout a person’s life, This is of particular significance to those pursuing a career in medicine as these attributes are encouraged from the very beginning of medical school, continuing after graduation as a part of professional development. In this essay, I will outline the importance of these to a successful medical career; beginning in medical school and spanning into clinical practice.
Reflection can be performed using many different models, all of which can be broken down and shown to share the same three core processes: awareness, critical analysis, and changing perspective (Atkins and Murphy, 1993). Awareness has been described as either experiencing inner discomfort (Boyd and Fales, 1983) or the feeling of surprise (Schn, 1991) which arises as a result of a situation that has been emotionally, mentally, or physically challenging to the individual. Following the awareness of the need for reflection is a critical analysis of the situation. This is where the quality of self-awareness comes into play, the coming to understand your actions, decisions, thought processes, limitations, and such. Critically analyzing situations in this way is what allows for the development of a new perspective; a new way to think and approach situations that can present themselves in order to ameliorate the outcome.
One model of reflection commonly used within healthcare is Schn’s reflective model, which suggests that reflection can be classified as either reflection-in-action or reflection-on-action, both of which have been hypothesized to be beneficial methods. As the names suggest, reflection-in-action occurs during an incident, whilst reflection-on-action occurs following the incident. Practicing reflection at the time of an event allows the individual to develop skills such as flexible thought. Within medicine, this is a vital skill in many specialties such as emergency medicine or surgery when quick thinking and the ability to adapt to fast-paced situations can mean the difference between life and death. A common barrier to reflection is the idea that the individual lacks time to be able to reflect, a widely shared belief among medical students and clinicians alike, due to the less time-consuming nature of reflection-in-action it makes reflection more accessible and appealing as less time is taken away from tasks that may be viewed as more ‘important’. One possible criticism of Schn’s reflection-in-action model is that he fails to provide sufficient clarity on how to actually undertake the reflective practice (Eraut, 1995). However, it could be argued that by negating to include a rigid structure on how to reflect using his model, Schn is allowing the individual to develop their own method of reflection that is most suited to them. Reflection-on-action is a more time-consuming process but allows for deeper reflections by considering a greater variety of viewpoints. This type of reflection can be done in different formats; written, verbal, or thought, Recently written evidence of reflection has been asked of clinicians as part of revalidation processes, as outlined in ‘The reflective practitioner – guidance for doctors and medical students’ (GMC, 2019). These two methods need not always be used in conjunction as valuable insights can still be gained from using just one, These insights can be used to guide practice – developing skills and attributes as a medical student and as a qualified doctor, whilst also maintaining those already obtained.
I’ve used Schn’s reflective model previously in many different scenarios, one that stands out however is from my experience in dealing with a demanding patient in the role of a ward host. In the initial encounter, the patient became very rude when I explained I was not able to provide him with what he was asking for. In the moment I could feel my anger rising as he started directing racial abuse towards another member of the healthcare team. Once I recognized my inner turmoil, I was able to use reflection-in-action to calm myself in order to handle the situation as effectively as I was equipped to do, At that time I was not able to deal with it on my own – instead a senior nurse on the ward intervened. Following this incident, I used reflection-on-action to identify my own skills and shortcomings, the skills the senior nurse demonstrated, but also to look at the situation from the patient’s eyes – coming to understand the frustration, isolation, and pain he must be experiencing with no way to express these emotions other than verbally. These reflective practices meant the next time I encountered a similar situation I had the confidence to handle it with an empathetic but firm approach which proved to be effective.
Crane et al. (2019) discussed the correlation between reflection and resilience, suggesting when exposed to stressful or possibly even traumatic events – although there may be an initial cost to productivity and mental well-being – through reflecting on the situation an individual becomes more self-aware, identifying shortcomings in their resilience and being able to build on this. Additionally, it equips them with the skills, knowledge, and planning to deal with a similar situation again if one were to arise, thus giving them the confidence to keep going in the knowledge they are well-equipped to manage the situation. It could be argued reflection on scenarios that have been difficult to handle may lead to demotivation through harsh self-criticisms however, if done properly, reflection is a vital tool in being able to process and cope with the stressors you will inevitably face as a student and doctor, enabling you to keep moving forward.
There are many definitions of resilience, all with the same key themes of being able to adapt to challenging situations and responding productively whilst maintaining physical and mental well-being (Epstein and Krasner, 2013). Generally, the area in which these definitions differ is whether resilience is innate or acquired (Herrman et al. 2011). From my own experiences, I am more inclined to agree with the idea that resilience can be developed over time. When I started work at the hospital it exposed me to a whole range of new experiences, Initially, I felt overwhelmed (the initial dip in productivity as described by Crane et al. (2019)). Over time, through reflections and continued exposure, I became more adapted to the environment. Part of the reason I came to love my job was the challenge it often presented, as I began seeing an opportunity to learn and test new skills, rather than a daunting prospect as I once had – demonstrating my personal growth in gaining resilience.
Medicine is undoubtedly a demanding vocation, therefore resilience is vital for coping with the everyday responsibilities and experiences in this profession. High levels of resilience have shown a correlation with greater compassion satisfaction, whilst reduced levels of burnout (Cooke, Doust, and Steele, 2013). Possessing compassion satisfaction refers to the pleasure that can be found in helping others – as a doctor helping others is at the very core of everything you do. Therefore a high level of compassion satisfaction is hugely important in job satisfaction as well as providing quality patient care with empathy. It has been observed the levels of burnout among students and doctors are at an ‘epidemic level’ (West et al., 2016), suggesting the highly stressful and demanding environment pursuing a career in medicine entails puts those in such positions at a greater risk of burnout compared to the general population – although research on this is limited, and has been found to vary widely between location, specialty, stage in career and many other factors (Lemaire and Wallace, 2017). The presence of burnout however poses a detriment to patient care, as well as the care of the doctor themself, highlighting the importance of resilience to avoid the consequences of burnout within healthcare. However, this idea has been contradicted in a study by McCain et al. (2017) where it was highlighted that despite the higher resilience observed among doctors as compared to the general population, burnout was still prevalent, In trying to improve resilience within this population further would have a negligible effect. From this, it may be possible to conclude that resilience can reduce the risk of burnout, but without easing stressors faced by those affected the widespread burnout in the profession will not be remedied.
As I’ve discussed within this essay, both reflection and resilience are vital no matter what stage of a person’s medical career. Not only is evidence of reflective practice a requirement for revalidation by the GMC, but it is also necessary to be able to cope with the mental, physical, and emotional tolls faced without succumbing to burnout and related issues, in turn providing high-quality care from healthy, empathetic and skilled doctors.
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