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Reflective Practice and Lifelong Learning - MRTY3122 Notes

Resources for Reflective Practice

  • Life in the Fast Lane (LITFL) – Clinical Debriefs: A compendium of critical care knowledge; useful beyond lectures.

  • Clinical Excellence Commission Reflective Practice Workbook: Structured guide to implementing reflective practice in clinical work.

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Reflective Practice: At a Glance

  • Reflective practice is:

    • A process of thinking clearly, deeply, and critically about any aspect of professional practice.

    • A way for practitioners to explore emotional challenges of clinical practice and cope with escalating pressures.

  • Sources: Clinical Excellence Commission (2022); The University of Sydney

Why We Reflect

  • Rationale for reflective practice:

    • Things often go wrong in healthcare settings; practitioners are human and make mistakes.

    • Reflection helps understand causes of errors and identify solutions.

  • Potential benefits for clinicians:

    • Improved insight

    • Enhanced wellbeing and higher motivation

    • Reduced job turnover

    • Enriched on-the-job learning

Things Going Wrong: Incident Data ( NSW Public Hospitals, NSWCEC )

  • Patient-related incidents by severity (January–July 2024):

    • Total incidents: 89{,}331

    • Harm Score 1: 276 incidents ( 0.3 ext{ ext{%}} )

    • Harm Score 2: 1{,}695 incidents ( 1.9 ext{%}} )

    • Harm Score 3: 20{,}117 incidents ( 22.5 ext{%}} )

    • Harm Score 4: 65{,}210 incidents ( 73 ext{%}} )

    • No Harm: 2{,}033 incidents ( 1.3 ext{%}} )

  • Harm Score 1 definition: An incident that is preventable and results in serious harm or death to a patient; also called sentinel events or SAC 1 events.

Reflective Practice: Definitions and Distinctions

  • Reflective practice is not:

    • Critical incident debriefing

    • A performance review or disciplinary procedure

    • Psychotherapy or counselling

    • Preceptorship or mentoring

  • Reflective practice is:

    • A continuing practice

    • A way to recognise and sustain good practices

    • A process to change and improve systems or practices that are not working well

Barriers to Reflective Practice

  • Common barriers:

    • Being busy; time/effort required

    • Junior practitioners may lack clinical knowledge to appreciate different perspectives

    • Difficulty thinking critically about actions and improvement

    • Tendency to be over-critical of one's own actions

Models of Reflective Practice

  • Atkins and Murphy model (1994)

  • Johns’ model (1994)

  • Gibbs’ Reflective Cycle (1988)

  • Key references:

    • Atkins, S. and Murphy, K. (1994)

    • Johns, C. (1994)

    • Gibbs, G. (1988)

Atkins & Murphy Model (1994)

  • Key features:

    • Five cues to prompt analysis of emotional responses to experience

    • Emphasis on feelings and knowledge

    • Potential difficulty applying to all clinical scenarios

  • Reference: Atkins and Murphy (1994)

Johns’ Reflective Model (1994)

  • Structure:

    • Six phases of a reflective cycle

    • Directed questions to encourage:

    • Description of the event

    • Reflection on an event

    • Acknowledgement of contributing factors/impact

    • How could I have dealt with it better?

    • Learning from the experience

    • Note: Directed questions may limit depth of insight

  • Reference: Johns (1994)

Gibbs’ Reflective Framework (1988)

  • Widely used in Australian settings; six phases:
    1) Description of the event
    2) Inner feelings
    3) Evaluation of those feelings
    4) Analysis of impacts
    5) Learning points
    6) Action plan

  • Advantages: structured approach to learning from experiences

  • References: Gibbs (1988); Clinical Excellence Commission (I) (2025)

Gibbs’ Framework: Step-by-Step Details

  • Step 1: Description

    • Provide a factual, objective recount of what happened

    • Be objective; adopt the role of an impartial observer

  • Step 2: Inner experience

    • What were you thinking and feeling? How did you react? How did you feel?

  • Step 3: Evaluation

    • Positive/negative impact on you and others; consider stakeholders

  • Step 4: Analysis

    • Make sense of why the situation happened; assess how feelings contributed

  • Step 5: Learning

    • What else could you have done? What can you learn from this? What changes are needed?

  • Step 6: Action plan

    • Specific, achievable, impactful goals to change future outcomes; identify required resources

  • References: Gibbs (1988); Clinical Excellence Commission (I) (2025)

Scenario 1: Gibbs Reflective Framework in Practice

  • Context:

    • DR student on placement in a busy private practice

    • During a routine hand X-ray series, the incorrect side was imaged

    • Patient discharged before the error was identified

    • Supervisor caught the error days later and asked for reflection

  • Step 1: Describe

    • Working in a private practice under supervision

    • Performing hand X-ray series

    • X-rayed the incorrect side

    • Mistake caught after patient discharge

  • Step 2: Inner experience

    • Felt stressed due to workload; competing priorities; fatigue concerns

    • Disappointed about the situation; concerned about supervisor’s view of progress/competency

  • Step 3: Evaluation

    • Felt overwhelmed by workload; high autonomy with limited supervision

    • Potential contributor: high responsibility with junior experience

    • Fear of repercussions from site/supervisor

  • Step 4: Analysis

    • Link between overwhelm, low oversight, and error

    • Simple mistake with important learning point

  • Step 5: Learning

    • Always confirm: correct patient, correct examination, correct side before X-ray

    • Recognise that overwhelm can lead to errors; seek support when workload is high

  • Step 6: Action Plan

    • Self-check before exposure: correct patient, procedure, and side

    • Strategies for high workload: seek help early; follow up with supervising radiologist for feedback

  • References: Gibbs (1988); Clinical Excellence Commission (I) (2025)

Scenario 2: Clinical Debrief and Colleague Support

  • Scenario:

    • You are a qualified diagnostic radiographer in a tertiary hospital CT suite

    • A contrast reaction (anaphylaxis) required a code blue; IM adrenaline given; patient stabilized

    • A few days later, a colleague involved in resuscitation is upset and repeatedly questions actions from that day

    • You are asked: what do you say to your colleague?

  • Prompt: Would you like to debrief?

  • Debriefing discussion guidance

    • Can be formal or informal; can be small group or one-on-one; should follow a structured framework; ideally involve all involved, including a team leader; privacy and confidentiality are essential

  • Indications for debriefing

    • Unexpected patient death

    • Traumatic incidents

    • Major incidents (e.g., mass casualty incidents)

    • Staff member request

Debriefing: Types and Timing

  • Hot (immediate) debriefing

    • Occurs immediately after incident; 5–10 minutes; often in heat of moment with limited data

    • Provides immediate support to staff

  • Cold (delayed) debriefing

    • Occurs days or weeks after event; allows extra data and hindsight; may include expert facilitators; memories may be less fresh

  • Standard debriefing

    • Usually run by the most senior clinician involved

    • Invite all staff involved (including support staff); designate a scribe

    • Listen to all viewpoints; be kind and consider the human factor

  • Structured debriefing questions (What happened? What went well? What could be improved? What can we change?)

  • Debriefs are not disciplinary hearings; not about blaming colleagues; not about past cases; participation should be voluntary and safe

  • Recipe for a debrief (Nickson, 2021):

    • What happened? What went well? What could be better? What can we change? Action plan; assign responsibilities

STOP5: A Practical Debriefing Model

  • STOP for 5 Minutes: Brief team debrief to support patient care, not blame

  • Steps:

    • State purpose of the debrief

    • Confirm team members’ well-being

    • Keep information confidential

  • Case review: Summarise case; discuss things that went well; identify opportunities to improve

  • Action items and responsibilities

  • Use: A hot debrief form for each case; collect forms centrally

  • Contact: For questions/feedback, refer to The University of Sydney and Walker et al. (2020)

End-of-Shift Debriefs and Reflection

  • End-of-shift reflection: quick daily check before going home

  • Tips:

    • Identify three things that went well and why

    • Identify one thing to do differently next time

    • Check on colleagues and self-care; senior team available for support

  • Encourage a culture of reflection and team resilience

  • Additional information: The NSW Clinical Excellence Commission resources on team-based improvement

Following Up on Colleague (Scenario 2)

  • When supporting a colleague after a difficult case:

    • Ask if they would like debrief privately or with the team

    • Provide a quiet space free of distractions

    • Follow the algorithm: What happened? What went well? What could be better next time? Action plan; connect with support (EAP)

Employee Assistance and Team Wellbeing Resources

  • Employee Assistance Programs (EAP):

    • Usually provided by employers; confidential; flexible access (24/7 phone counselling)

    • Provides psychological support services; can arrange time away from the department if required

    • Useful for ongoing support after difficult incidents

Lifelong Learning and CPD in Health Professions

  • Health Professions and Lifelong Learning as a core professional identity component.

  • Healthcare is constantly evolving; pace of biomedical research publication accelerates; clinical guidelines update regularly in response to new evidence.

  • Lifelong learning in radiography includes: AI, radiomics, new technologies (e.g., PC-CT, TB-PET), and refinement of existing technologies.

  • CPD is a requirement for registration with the Medical Radiation Practice Board of Australia (MRPBA) / AHPRA and is expected by employers; failure to complete CPD or to maintain CPD records can jeopardise registration.

CPD Requirements and Exemptions (MRPBA/AHPRA)

  • Minimum CPD requirements: 60 hours over 3 years; 10 hours per year; 35 hours must be substantive CPD activities.

  • Examples of substantive CPD activities:

    • Reading a journal article relevant to practice and reflecting on it

    • Attending conferences; educational dinners with relevant content

    • Presenting in-service sessions

    • Supervising students; training applications; higher education in practice

    • Completing research papers, posters, or presentations

    • Journal clubs; quality improvement and assurance activities; accreditation activities

    • Reflection on practice; attending skills-based workshops or courses; participating in clinical audits (e.g., hand hygiene)

  • Examples of substantive CPD activities are listed by the MRB/AHPRA (see references).

  • General CPD activities: Up to 25 hours can be general CPD; these activities should relate to learning in a healthcare environment but are not DR-specific.

  • CPD recording: Keep a record of each activity with date, activity details, and provider; complete a reflection on what was learnt relevant to practice.

  • Exemptions: Possible exemptions for specified periods (e.g., illness, caregiver leave, maternity leave, ongoing medical conditions).

  • Partial exemptions: Possible to apply to AHPRA for a partial exemption for a given period.

CPD Records and Next Steps

  • It is easier to maintain an updated CPD record than try to recall activities for audits.

  • When recording CPD, include:

    • Date of activity

    • Details of the activity

    • Details of activity provider

    • A reflection on relevance to practice