Reflection and probity are essential skills medical students need to develop throughout their lifelong education, in order to grow as good healthcare professionals. These skills lead to constant learning on one’s own self and thus will always be relevant in the academic and clinical context. In this essay, I will discuss and analyse their personal relevance to me as a medical student and as a future doctor.
Reflection is one of the skills through which future and current doctors grow and develop. It is a “metacognitive process” (Sandars, 2009) that helps in deepening one’s internal and external understanding. Reflection is required in the continuum of learning and improvement of the self (Ménard et al., 2013), thinking about actions done, what went well and how to do it better in the future (GMC, 2016). It helps to construct a therapeutic relationship between the patient and the doctor, and develops competence (Ménard et al., 2013). Reflection can be done by taking actions on feedback received by teachers, trainers and colleagues (GMC, 2016). It can occur solitarily or in group, in an informal or structured way. Reflection can be applied through different models, such as the Gibb’s Reflective Cycle (1988). The first step is description, where a particular situation is explained. It is followed by a recognition of feelings and thoughts experienced during the event. Then, the individual evaluates the good and bad about the experience and analyse them to make sense of the situation. Finally, through a conclusion and action plan, the individual identifies other possible courses of actions if the situation arises again in the future (Lawrence, 2008).
As a medical student, I would say that I have experienced group reflection through presentation feedback given by my GP in my CBM placements or facilitators during Small Group Teaching. We discuss in group the strong and weak aspects of the presentation, analyse how we proceeded to make the presentation and how the role of each group member contributed to the final project. We then always seek different ways of preparing for the next time in order to improve our performance. Personally, I find this useful as it enables me to improve my oral skills and fluency, which will serve me when giving formal presentations during my time at medical school, such as the end of year project in Year 1, and future career. I have also experienced solitary reflection concerning my note taking skills. The extensive amount of information in a lecture was overwhelming during the first three weeks at Medical school, as I had difficulties writing down and assimilating the relevant information efficiently. Evaluating and analysing what was going wrong, I realised that my concentration was disturbed every time a new scientific term was introduced, as I had to search for its role, while the lecturer was explaining another point. Concluding that I was often missing important part of the lecture, I decided to take action by reading older years’ notes and researching unknown terminology before the lecture. I am now able to concentrate through the whole lecture, understanding concepts and actively learning rather than writing few dry facts in my notes. I have thus improved my learning efficiency and will continue with this method in future lectures.
Reflection is as important for a medical student as it is for a doctor. As a future doctor I will be responsible for patients (GMC, 2016) and I believe that the therapeutic care I will deliver can be improved through reflection, although there is currently little evidence that reflection impacts clinical behaviour and patient care (Mann et al., 2009). It will also be my responsibility to reflect and think deeply on the knowledge and skills required to stay up to date. In addition to this, reflection also develops professional ethical behaviour and “critical” thought making process (Plack et al., 2005) in a healthcare professional, which both influence clinical decision-making skills. This is part of reflective practice, which is an on-going learning achieved through the capacity to reflect on an event (Schon et al., 1986). In order to assess professionals, the GMC has recently put in place the ARCP (Annual Review of Competence Progression), using e-portfolios and other items for evidence of progress (Goodyear et al., 2013). E-portfolios are sources of reflection on one’s own practice and enable one to keep track of their own development. During my work experience, the cardiologist I was shadowing always kept a small notebook on him in which he would write down some thoughts after each consultation, in order for him to remember what he changed about his practice, and how, with time, it would affect the patients’ progress.
Probity means “being honest and trustworthy, and acting with integrity” (GMC, 2016) as doctors’ attitude should always uphold the trust society places in medical practitioners. Honesty involves acting with a respectable manner and professional integrity (Medical Protection Society, 2016). Trustworthiness conveys the act of being reliable, honest and faithful (Anon, 2014). From those concepts we can derive that probity implies that healthcare professionals must own up to their mistakes and act on it. Probity is a vital quality that needs to be developed in medical students and maintained in qualified doctors. The GMC encourages medical schools to teach probity through lectures on Ethics, however it can only be really learned with time and experience (Medical Protection Society, 2016).
As medical students, we need to prove that we are fit to practice in order to qualify and receive our Primary Medical Qualification (Hilton et al., 2005). To do so, several outcomes are expected, such as reporting incidents occurring during clinical placements. Last summer during my work experience in Bangalore, India, I was assisting nurses in an NGO, helping elderly patients sitting down and preparing injections. There was an increasing number of patients waiting for their injections, but the team was running short of staff and the ward was gradually cluttering. The medical team needed more hands and as a volunteer, I was asked by the nurses to give the injection to patients. Even though I wanted to help as much as possible, I knew I was not clinically trained and refused the offer. Later, I discussed the issue with the GP in charge of the NGO, and we both agreed that I had made the correct decision. In this situation, there is a moral and ethical conflict, but I had to make a fast decision by acting with probity, knowing the limits of my competence. I am aware that such cases are likely to happen even more during my clinical years as a medical student, but I will always make sure that I do not lie to patients or myself about my competences. Another example of outcome is to sincerely and openly communicates information about your own health (GMC, 2016). Indeed, we were required to have several vaccinations before attending Medical school because of the exposure to patients in CBM and hospital day placements. We must be honest about our vaccination records as otherwise patients could be put at risk.
As a doctor, probity becomes practically relevant. It is a fundamental tool used to create trust in the doctor-patient relationship, enabling the patient to give all the information needed for the practitioner to make a correct diagnosis and reach the most efficient treatment possible. Without trusting the doctor, the patient might keep some valuable information away, possibly damaging their own care. Probity is important when the patient has to make a decision about a particular procedure, or when the patient has to give consent (Drane, no date), especially because patients are in vulnerable physical and psychological states and put all hope remaining in the doctors treating them (Goold, 2002). Lying to them might significantly damage their health state; if they discover they have been lied to, they might not even want to be treated anymore as their trust in the doctor and the profession will have been undermined. In disastrous cases like the Mid Staffordshire crisis in 2001 (Newdick et al., 2013), the majority of doctors at the hospital were aware of the issues but no one reported any concerns through external whistleblowing, worsening care of patients (House of Common, 2011). Following this, the GMC aimed to create a culture of openness, and now requires doctors to react instantly if one of their patients experiences pain or discomfort, apologise and then explain the reasons of the issues to the patient (GMC, 2013).
Reflection and probity are skills that medical students need to develop during their time at medical school and continue to nurture once they are qualified doctors. In my opinion, this development is essential as healthcare professionals hold a responsibility in society. Both qualities push an individual to strive for excellence, to learn in a continuum and to critically think about their actions and their effects on patients. I intend to apply those skills throughout my education, in order to become a mature medical professional.