reflective practice

What? So what? Now what?

What happened? So what? Now what?

What?:

what happened

what went well,

what was challenging.

Be objective about sequence of events

So what?:

why the events mattered.

consider the decision-making, communication, teamwork, situational awareness, and human factors involved.

And the impact on the patient, the team, and myself,

identify both strengths and areas for development. Where appropriate,

I seek feedback from colleagues and compare my practice with relevant guidance or evidence.

Finally, I focus on what I will do differently or continue doing. I identify a specific, realistic action—for example, discussing the case with a supervisor, undertaking targeted learning, changing how I prepare for a particular scenario, or sharing learning with the wider team. I then review whether that action has made a difference to my practice.

I think reflection is most valuable when it leads to a demonstrable change in behaviour or reinforces good practice, rather than simply documenting that an event occurred.”

A shorter interview version would be:

“I use a What? So what? Now what? structure. I establish the facts, analyse the clinical and human-factor aspects—including communication, teamwork and decision-making—and then identify a specific action or learning point. I seek feedback where appropriate and revisit the issue to check whether the reflection has resulted in a meaningful change to my practice.”

For anaesthetics, adding “I reflect on both routine cases and challenging events, because learning is not limited to complications” is a useful point.

E.g

Latest QI project

Well

-delegated to mange work load

-used MDT approach (surgeons involved)

-data useful to be objective and get buy in

Challenge

-engaged stakeholders in clinical areas

-missed an important manager

-led to temporary conflict

Future

MDT

Ask those on shop floor who their key managers are/who might want to/need to be involved

Ds

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