Reflective Practice After an Error

SJT Textbook: Reflective Practice After an Error

Reflective Practice MSRA

This guide covers the professional skill of Reflective Practice MSRA scenarios. In the Professional Dilemmas paper, candidates must demonstrate that they can learn from mistakes without breaching confidentiality or indulging in self-pity.

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🎯 THE CORE PRINCIPLE

Reflective practice after an error is a structured way to understand what happened, why it happened, what you have learned, and what you will do differently. It is not a confessional; it is a professional tool for learning and improvement. Good reflection reduces repeat harm, strengthens systems, and supports your own development and resilience.

GMC and Academy guidance emphasise anonymised, balanced, evidence-based reflection that avoids blame and speculation. You should record brief factual “What” details, then move quickly to “So what” (insights and contributing factors) and “Now what” (specific actions and timelines). The content should be suitable to share in summary form with supervisors and governance processes.

In MSRA SJT questions, higher-scoring options show you using a simple structure (such as What–So what–Now what or CLEAR), removing identifiers, focusing on contributory factors and human factors, setting SMART actions, and sharing learning with the team or PSIRF-style forums. Low-scoring options either avoid reflection altogether, include patient identifiers, or dwell on self-blame without change.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Use a recognised structure such as What–So what–Now what or CLEAR to organise your reflection.
2. Record a brief, factual “What” with only essential clinical details and no patient identifiers.
3. Identify contributory factors and human factors (workload, communication, systems) rather than blaming individuals.
4. Translate insights into SMART actions (specific, measurable, achievable, relevant, time-bound) for yourself and the team.
5. Link actions to relevant guidance or training (e.g. guidelines, e-learning, simulation, supervised practice).
6. Share key anonymised learning points in governance forums (e.g. safety huddle, PSIRF meeting, M&M).
7. Agree how and when actions will be reviewed, and record the planned follow-up date.
8. Acknowledge your emotional response and seek appropriate debrief or wellbeing support if needed.
9. Distinguish between reflective notes and clinical or incident records, and keep each in its proper place.
10. Document that notes are anonymised and learning-focused, suitable to be shared in summary form if requested.

Good SJT options avoid secrecy, blame, and over-sharing identifiers. They show you writing a brief, anonymised, balanced reflection that leads to practical changes and can be shared for learning.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I have excluded all patient identifiers and focused on what I learned and what will change in my practice.”
* “We agreed team actions, including a new checklist and teaching session, which I will help present at the safety huddle.”
* “I will review relevant guidance, complete the training module by Friday, and arrange supervised practice to consolidate learning.”
* “I have discussed the incident and my reflection with my supervisor and know how to access wellbeing support if needed.”

Capture brief facts • Learn insights • Establish actions and timelines • Anonymise record • Reshare learning with the team

📋 QUICK FAQ

Do I have to write a reflection after every error?
Not every minor slip needs a long write-up, but significant incidents or recurring patterns warrant structured reflection. The focus is on meaningful learning, not volume.

Can my reflective notes be seen in legal or regulatory processes?
They may be requested, which is why guidance advises factual, anonymised, learning-focused notes. You can often provide a summary. Follow local policy and GMC/Academy reflective guidance.

How much clinical detail should I include?
Only what is needed to support learning: a brief outline of the situation and key factors. Do not duplicate the clinical record or include identifiable details.

What counts as a good “Now what” section?
Specific actions linked to learning (for example, “complete insulin prescribing module by Friday”, “introduce double-check checklist”, “present learning at safety huddle”) with named people and dates where appropriate.

How do I balance personal responsibility and systems issues?
Acknowledge your part and what you will do differently, but also consider workload, communication, environment, and processes. Phrase this in a constructive, non-blaming way.

What if I feel overwhelmed or guilty after an error?
It is appropriate to acknowledge this in reflection and to seek support. Arrange a debrief with a supervisor or senior colleague and use occupational health or wellbeing services if needed.

📚 GMC ANCHOR POINTS

• Duty to reflect and take steps to improve your practice (GMC Good medical practice 2024, improvement and learning duties).
• Maintain clear, accurate and timely records in the appropriate place (GMC Good medical practice 2024, records and documentation).
• Contribute to a just and learning culture by raising and acting on concerns (GMC guidance on raising concerns and patient safety).
• Work collaboratively with colleagues to improve systems and quality of care (GMC Good medical practice 2024, teamwork and leadership).
• Maintain patient confidentiality and avoid unnecessary disclosure of identifiable information (GMC Confidentiality guidance).

💡 MINI PRACTICE SCENARIO

A prescribing error with insulin is discovered on the ward. The patient was monitored closely and came to no lasting harm, but you feel shaken. You complete an incident form and now plan to write a reflection.

Best action: Use a structured model such as What–So what–Now what, write a brief anonymised account, identify contributory factors and personal learning, set SMART actions with timelines, and share anonymised learning through a safety huddle or governance meeting.
Why: This meets GMC and Academy guidance by protecting confidentiality, focusing on learning and improvement, and helping prevent similar events in future.

🎯 KEY TAKEAWAYS

✓ Reflection is for learning and improvement, not punishment or confession.
✓ Use a simple structure such as What–So what–Now what or CLEAR.
✓ Keep reflections anonymised, factual, balanced, and separate from clinical records.
✓ Turn insights into SMART personal and system actions with review dates.
✓ Share anonymised learning with supervisors and governance processes.
✓ Look after your wellbeing and seek support after significant events.

🔗 RELATED TOPICS

* → Duty of Candour and Disclosing Mistakes
* → Learning from Adverse Events and PSIRF
* → Supporting Colleagues After Incidents
* → Patient Safety Incident Reporting and Governance

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You are an FY2 doctor on a medical ward. Yesterday an insulin prescribing error was detected: you charted the wrong dose, but the nurse queried it and the patient came to no lasting harm. An incident form has been completed. You feel embarrassed and worried about your portfolio. You are writing a reflective note for your e-portfolio and considering what else to do.

Options:
A. Write a detailed narrative including the patient’s full name, NHS number, admission date and bed number so you remember the case.
B. Decide not to write any reflection at all, as it “might be used against you” in the future.
C. Write a brief, anonymised reflection using What–So what–Now what, focusing on contributory factors, learning and specific actions with timelines.
D. Use the reflection mainly to document how the nurse “should have spotted it sooner” and shift blame away from yourself.
E. Arrange to complete an insulin prescribing module and supervised prescribing sessions, and record this as part of your action plan.
F. Present anonymised learning from the case at a safety huddle or teaching session, including the new double-check process you have introduced.
G. Describe in detail how “useless” you feel and how guilty you are, without identifying any learning points or changes.
H. Post about the error on a public social media forum (with no names) to “get it off your chest”.

Example SJT — Rank 5 (best → worst)

You are a GP trainee. A test result was filed without action, leading to a delayed diagnosis of anaemia. The patient is now stable but understandably upset. An incident report has been completed. Your supervisor suggests you write a reflection and think about how to prevent recurrence.

Options:
A. Use What–So what–Now what to write an anonymised reflection, identify contributory factors, agree changes to the results-handling protocol with the team, and review them at a practice meeting.
B. Write a long narrative naming the patient, the receptionist and the supervising GP, and upload it unchanged to your portfolio.
C. Decide not to write anything, saying you “do not trust how reflections are used”.
D. Write a short reflection focusing mainly on how angry you are with yourself, without identifying system issues or actions.
E. Use your reflection to argue that the receptionist was mainly to blame and that you did nothing wrong.