Reflection

FD Handbook

Reflection

The Benefits of Reflection

From the start to the end of your foundation training year, you will be exposed a variety of learning and professional development experiences. With each experience, comes an opportunity for you to take a step forward on your year long journey to become a competent dentist.
It is when you take a moment to think seriously, during or often after your experience or an event that starts the process for you in reflecting. As you reflect, it will be your thoughts and feelings about your new experience that will come to you, and by linking these with the old experiences, you will have a revelation or a new meaning about what you reflected upon.
The benefits for you when you regularly and continually reflect is that you become a better dentist because you will

come up with theories, improve your critical thinking, and enhance your learning
become self-aware understanding your abilities and your limitations
know about future learning needs
develop safe and sound practice with improved outcomes for patients

Reflective writing in DFT

The E-Portfolio requires you as a FD to write about your experiences, with a view to demonstrating your learning and development. Some elements of the E-Portfolio logs take the form of reflective writing.
Reflective writing follows on from your reflective thinking. So how do you go about this? It can be viewed simply as a three stage process.

1	First, identify and look back at something (such as an event i.e. something that has happened. However, it could be an idea or object)
2	Then, analyse the event or idea (you should think deeply and from different perspectives or viewpoint. Then try to explain, often with reference to the subject matter concerned)
3	Finally, think carefully about what the event or idea means for you now and for your ongoing progress as a professional dentist.

Reflective writing therefore has a purpose but importantly has to be personal to you. Your piece of writing will be: relevant to you and so it will have originality and be written in your own style. It needs to be coherent and easy to follow. It is your own story!

You should complete the reflective elements of the E-Portfolio such that the person reviewing it is clearly informed about every stage of your reflection. The reflective writing if written well enough, will provide justification of new learning. Only then will the reviewer of your training records clearly understand and accept that you are progressing at the required pace in this foundation training year.

It is always a good idea to reference particularly if referring to sources of material. It is helpful for the reader to see a reference to the competency concerned. The DFT curriculum serves as a useful document for this purpose.

Description v Reflection

There are different types of e-portfolio logs where you are required to reflect, these being: reflection on the learning from tutorials; the learning from study days; and there are also general reflection logs on learning derived from anything that falls outside tutorials and study days. Logs

As you explore the layout of the e-portfolio logs, you will quickly notice a pattern. That is, the initial part of each log requires you to write a description to introduce what it is that you will then reflect upon. It is important to separate out this description from the reflection that will later flows from it.
So what do you write in the description section of logs? Anything relevant is acceptable, for instance you may write about the description of topics, events, incidents, achievements, concerns, challenges, difficulties, problems, or any other experience that is relevant to the log or pertinent to the stage of your learning. Description must also state and refer to the curriculum competencies or domains covered in that log.
Once you have completed the description part of the log, your next task will be to write reflectively as instructed above. For this section, unleash your thinking power to gain the maximum benefit. If you get stuck at any point, then consider questioning yourself as a prompt to kick start your thinking once more.
Here are some useful list of questions as prompts for writing:

Why did you choose to reflect on this? Is there a significance in any way?
What went well for my patients? For me? How have I applied this for all my patients in practice?
What did not go well for my patient? For me? And how do I feel about this?
What could the patient be thinking? Did the patient respond in anyway? What does that tell me? Were there any body language signals that helped me? Was there any patient reaction? What did they say?
What do I think happened? Why do I think this happened? How do I feel about this?
Was there anything that came in the way or did not help my patient? Or me?
What issues have I identified as being personal to me? How does this affect my values and beliefs?
What were the difficulties and why? What can I do next time to avoid these?
Were there unexpected outcomes? If there is something I can change for the future what will that be?
Was there any feedback from my nurse that I should consider? From my Educational Supervisor? Are my thoughts similar or different in any way to my Educational Supervisor? How did the revelation make me feel? How can I use this feedback from improvements?
What exactly were the learning points? What impact has this had on your learning? Why has this reflection been useful for my own learning and development as a dentist?
What do I still need to do? What are my new learning and development needs? What do I need to do to progress? How can my patients benefit?
Do I see any patterns in my day to day experience? Do I see a pattern across time?
What can I now do differently as a direct result from this experience? How has this experience helped/hindered me to meet the standards/competencies?
Who can help me further my knowledge or skills? What resources do I need and how can I find these?
Following the event, my action plan is…. And the timescale is….
Some of the things that have happened since the event are…

Examples of reflective writing

Below are three examples of how a poor piece of writing could be transformed into a good reflective piece of writing

Instead of:

This week I had to cancel one patient at the time of his appointment because her laboratory work had not arrived on time. There were unexpected delays. The technician should have told me that the work will not arrive. Systems need to be changed so that next time I can ensure this does not happen to anyone else to avoid patient complaints.

this is much better:

There were several lessons I learned from the incident where I had to cancel my patient who had just arrived for their denture fitting appointment because of laboratory work that had not returned from the laboratory. It was embarrassing for me to have to explain the situation to the patient, being honest with her about the reason why I could not fit the denture at this time. I found myself in a little difficulty here, lost for words except I remembered to provide my sincere apologies for lack of organisation on my part and will investigate the reason why we did not have her work. I saw the disappointment on her face. I understood her time was precious, her trip to see me had been wasted, and also my surgery time was unused. I later found out that the laboratory work that should have arrived the day before was delayed because the technician had a family emergency. It would be a reasonable expectation for my patient to have known this in advance of their appointment, about the reasons behind delays. That way alternative arrangements that are mutually agreeable could have been made. I believe that to prevent such incidents that could lead to patient dissatisfaction, it would be good practice to check laboratory work is logged as in practice being available the day before the patient’s appointments. Whilst I was sensitive towards the technician who found himself called to the emergency, I also think that there can be improvements in communication between the technician and practice. My nurse also said to me that this was not an isolated incident as she recalled that two weeks ago there was another laboratory item needed for an associate colleague that was also delayed I want to bring these points to the attention of my team, so I have included an item on next week’s practice meeting agenda to discuss with my team a revision of system avoiding a similar situation for anyone else.

Instead of:

I have treated a dental phobic nurse in the practice providing her with fillings and general prevention advice. I am building my experience and have received good feedback on my ability to treat the anxious.

this is much better:

I have been approached by a dental nurse in the practice to examine and see to her dental treatment needs. She said that she had heard that I am patient and good with anxious patients. I have successfully managed to treat a few anxious patients, but I felt particularly chuffed because clearly she has heard that I enjoy treating anxious patients, having a calm manner, and taking the required time to understand their individual perspectives. And that despite my lack of clinical experience, she had confidence in my abilities, trusting me to become her dentist after several years of avoiding dentistry being disabled by her general anxiety and dental phobia. I accept that clinical time is precious, however I was sorry to have heard about her pain and suffering, and by knowing this, I tailored my approach to best suit her needs. I know how important it is to get to know my patients, understand their preferences, and just being kind and respectful. I do enjoy treating anxious patients. It can be immensely satisfying for me to have helped this group of patients but at the same time I am conscious that in the future there can be risk of stress particularly if there are time pressures in the surgery associated with either a heavy workload or UDA targets. I am at a stage fostering my interest in treating paediatric and anxious patients. I am thinking about how I can link my interest to a future career and will be exploring this further with my Education Supervisor.

Instead of:

Dentist’s opinions can be variable. When I took second opinion from two other dentists, I had opinions from them that were quite different from each other. I gave these varied options and thought best to leave it for my patient to decide about what she preferred as it is crucial to gain patient consent.

this is much better:

It is with the passage of time in my foundation training year that I have come to the realisation that there are often many treatment options for patents and sometimes patients have not made up their mind in the surgery Furthermore, when I have discussed cases with my peers on study days and also associate dentists in the practice, I soon realised that there is not an outright agreement on the favoured treatment option. This difference in opinions I accept does not matter greatly so long as there is justification behind each option then it is a valid option. I have now been providing my patients with all options, risks, benefits, costs etc. I do not believe it helps the patient if there is confusion from too much information. So for complex treatment options I try and present accordingly and I do not rush my patients to tell me their choice. For example I had a patient earlier this week who had a significant amount of pain and the diagnosis of irreversible pulpitis established. The patient was visibly suffering and could not see beyond the elimination of pain through tooth extraction. With severe pain like this I observed that he was not thinking straight and not in a position to arrive at a sound or sensible decision. I reassured and we agreed that treatment of some form will be done but we could discuss the pros and cons following administration of a local anaesthetic which I did. As soon as his pain diminished, he could concentrate and was partially amenable to the idea of root canal treatment although not completely certain on that day if that was the right way forward for him. So immediately I came up with the idea of dressing the tooth to manage his pain and symptoms whilst he thought more about what he actually wanted over the coming week. He was very pleased about this option and gave him the opportunity to discuss this with his partner before committing to either irreversible extraction or a complex restorative options, both with very different outcomes for my patient. I gained experience in the process of consent, however I do need to find out about how dentists determine the point at which they feel there is sufficient information for the patient to make their choice of treatment.

Further important advice

At all stages of your reflections, please be aware that your E-Portfolio is a document that may in some circumstances be seen by others, some outside the profession, almost certainly in serious cases where a significant event involving a patient had occurred. For this reason it is essential that in all your reflections you do not refer to patients by name and that you do not describe events as mistakes or accidents. A useful course of action to remember is:Keep reflections anonymous and target the learning from the event rather than the details and the angst of the actual event.