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Interview with Jenny Gavriel
15 Plays1 month ago
In this episode, Jenny Gavriel talks about reflective practice in GP training. We’ll be exploring what reflection really means, why it matters, and how it can help international medical graduates get the most out of their learning. We’ll also share some practical tips to make reflection useful in everyday practice.”
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Transcript
Introduction to GP Training Support
00:00:04
Speaker
Hello and welcome to this episode of our podcast series aimed at supporting international medical graduates in GP training across the Thames Valley region.
Meet Jenny Gavriel
00:00:16
Speaker
Today, I'm joined by Jenny Gavriel to talk about reflective practice in GP training.
00:00:22
Speaker
We'll be exploring what reflection really means, why it matters, and how it can help IMGs get the most out of their learning.
00:00:32
Speaker
Jenny Gavriel is an Associate Director for the Professional Support and Wellbeing Service, which is an NHS initiative to help doctors in training and offers confidential advice. She's also a certified Principal Business Psychologist with a background in medical education.
00:00:51
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Jenny has been a Training Program Director at EPD for GP training since 2012.
What is Reflection in GP Training?
00:00:57
Speaker
and delivers a wide range of educational courses to support trainees and educators ah across Thames Valley.
00:01:04
Speaker
Jenny, thank you so much for joining me today. I really appreciate you taking the time to be here. That's quite all right. Thank you. Thank you for having me. Right. To start us off, how would you define reflection in the context of GP training and why is it considered such a key part of adult and vocational learning here in the UK?
00:01:26
Speaker
um In terms of so defining reflection, i mean, there's there's entire books written about that, but if I were to sort of try and distill it down, shall we say, to one sentence, it would be around...
00:01:42
Speaker
It's sort of being self-aware and able to think critically about your own knowledge and skills um and or potential organisational learning. um and And I think that's probably what it comes down to. And part the reason why there's so much emphasis on it is because of...
00:02:00
Speaker
the need for that to keep happening beyond CCT. um You know, doctors have to remain up to date, they have to be able to identify knowledge gaps, reflect on their own experiences. And, and you know, it for so it is that sort of lifelong skill that's being developed, um which is sort of fundamentally, it's about keeping all those future patients safe that they see, not just not just the ones that trainees are seeing within the training programme.
00:02:27
Speaker
Um, so it really is about that kind of that skill and developing it so that it becomes part of day to day practice for, um, all GPs once they're, once they're through and out the other side of training.
Importance of Reflection for GPs
00:02:41
Speaker
Um, And so what the what the college are looking to try and do is to sort of basically have evidence of and have nice, well-rounded evidence of learning that shows that you're thinking ah holistically about your patients, you're thinking about the wider impacts of NHS resource availability, that you've got self-awareness of your decision-making processes, that you can you can think about how you function effectively with others, or all these sorts of things that are really core skills for GPs and across the three years what you're demonstrating to to your supervisor, to panel, to the college is that you've taken the time to think about all of these um as part of your practice and that you've got the skills to keep doing that and to keep learning beyond the end of your training.
00:03:28
Speaker
Absolutely. I think as a GP who's been working for nearly 15 years now, Reflection still continues to be part of my everyday work, whether it's done alone or in a group. So yes, thank you for that.
00:03:43
Speaker
um So when trainees reflect on a clinical encounter, how can they draw on their past experiences to shape what they might do differently in future?
How Does Reflection Tie Experiences to Learning?
00:03:53
Speaker
and And what sort of things are trainees expected to reflect on and how do they demonstrate the change in practice?
00:04:02
Speaker
i mean part of making reflection useful is that it builds on the what you already what you've already experienced before and what you already know um and sort of building out from and and scaffolding out from that existing um knowledge um and um in fact the app that sort of the adult learning the experiential learning cycle is is just that the idea is is that you have some sort of experience of something, um you take a little bit of time to reflect on it, um think about what went well, what didn't go so well, why that might have been, think about what theoretical knowledge might be relevant. So bringing in whether it's, you know,
00:04:43
Speaker
might be guidelines or it might be actually, you know, the biochemical pathways, maybe don't But, you know, actually bringing in that theoretical knowledge and then putting in place a plan to test that out again and to test that in real life by, you know, seeing another HRT patient or whatever it might be that, you know, you need you need to do so.
00:05:01
Speaker
that That is what the reflection process is, is that essentially you're you're always going to be as part of that cycle where you're always drawing on a previous experience of some sort and some knowledge that you've had before to to scaffold out from that. And that's really important for adult learning.
00:05:19
Speaker
Because the for for adults, our brains are becoming slightly perhaps less plastic. There's less flexibility, moldability in there for us. And actually, the hippocampus is the whatet's part of our brain that really does continue to be highly plastic in that way. And and that's where we store all our experiential episodic memories.
00:05:40
Speaker
So actually, for for us as adults to learn, the more we can tie our learning together to experiences that we have had, um the better chance we've got that it will actually stick um because we we sort of lose the ability to learn abstract lists of things as we get older um if they're not linked into those experiences, which is why it's really important to sort of think, OK, what has happened
Reflective Practices and Strategies
00:06:03
Speaker
to me?
00:06:03
Speaker
How does this link in? um You know, the hippocampus allows us to what's called mental do mental time travel. So it's what we do when we actually when we're thinking back to, OK, what similar experiences have I had in the past?
00:06:14
Speaker
right through to the how can I imagine the future um and all of that, that is all part of what goes on in the hippocampus when we're tying it to this experiential learning, which is again why there's such an emphasis on it because actually it does it is the best way for ah for adults to to learn um I mean, in terms of what they're supposed I mean, it in short, the answer in terms of what sort of things you can reflect on is is everything or anything.
00:06:40
Speaker
um i mean, really, um it it might be, um is quite often it's identifying some kind of knowledge gap. um And, you know, where you you had a patient and you debriefed and actually you really didn't know what to do. um and and it can feel a bit counterintuitive, I think, because, you know, the portfolio is an assessment tool.
00:07:01
Speaker
Yes, it's something that, you know, your your educational supervisors are looking at this and they're know you're judging how much, you know, and and so on. So it sort of feels a little bit counterintuitive to put on the put on there something like I didn't know this.
00:07:15
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But that's OK. You know, the idea of these clinical case reviews is that they are evidence of learning. They're not necessarily evidence of what you know They're evidence of you being able to undertake that cycle of learning where you have an experience, you reflect on it, you draw in the information you need, and then you plan to move forwards from it.
00:07:38
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um and And that's what you're demonstrating. So it's absolutely OK to reflect on something that you didn't know or you could have done better um as long as your focus is next time. This is this is how I'll do things better. This is why I'll know more another time.
00:07:54
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um And that's yeah, that's okay. That's expected. it's It is a ah process, a formative process of development that you're demonstrating. And as I say, it's demonstrating the skills of reflecting so that.
00:08:07
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the college represented by panel and and um advised by your ES can feel confident that, you know, you're going to keep doing it and you're going to keep learning because you're really good at it and you've had loads of practice.
00:08:21
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um And it's also, I mean, the thing I should say, it's also absolutely OK to reflect on something that went well as well. That is OK, too. and We often don't put much effort into that. But as long as you put in the effort to, to again, analyse it,
00:08:35
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and say, well, this consultation went really well. Why? What did you say? What was done? How did it work? What were you thinking? How were you communicating? Because then you can repeat that.
00:08:47
Speaker
Sometimes it's really useful to reflect and know what you can do to repeat things um because it went well, as well as reflecting on, you know, perhaps those gaps that you might need to um need to improve so you know you'll be doing all these sorts of things within your within your learning logs and um and your your clinical case reviews um and yeah you might find that you know you then plan to do some reading or some e-learning or a workshop or you find a particular patient presentation for you to then use that to to practice on that sounds terrible but you know to practice actually and what you have learned from that um
00:09:27
Speaker
Yeah, it will be taking that. I because i guess there's also the the strategic element to it as well, that sometimes certain capabilities are easier, should I say, to say to to find the evidence for. us Some of them can be a bit trickier.
00:09:43
Speaker
So sometimes actually you might want to take a case and go, do you know what? I am going to reflect on the fitness to practice or the ethical components because... I need that evidence. It was a bit of strategic thinking in terms of what they might reflect on. There might be a bit of strategy there as well.
00:09:59
Speaker
Yes. Yes. Something we often miss. um I was also wondering in terms of reflection, how it, you know, this links into the puns and dents, which were words that made no sense to me or to in the beginning. So probably it's useful to clarify that for the, the, those IMGs early on in training.
00:10:20
Speaker
and So the puns and dens, which are the patient unmet needs and and the doctor's educational needs, which I suppose is right to say could be ah easy starting points for reflection.
Starting Reflection Without Fear
00:10:32
Speaker
Yeah, yeah, absolutely. And as you say, it's that patient unmet need when you've debriefed and they've, you know, somebody's actually said, perhaps give them a call back and do this. um and And from there, you've got a clear, oh, actually, OK, that patient had a need.
00:10:47
Speaker
that I didn't fulfill so that I've got an educational need from it. So yeah, puns and dens, absolutely. That's been around for a long time, that acronym. Yes. ah Okay. and Moving on, what's the value of considering the different perspectives and what's the value of balancing objective reflection with subjective reflection, i.e.
00:11:12
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with personal emotions or cultural insights when analysing a clinical experience? e I mean, yeah, there's lots of value there's lots of value in doing these things and and not necessarily predominantly because what it does is it stretches our thinking.
00:11:27
Speaker
um As I say, reflection is about this kind of self-aware, critical thinking that goes on. And We all have some natural tendencies in the way that we think about things and the way that we reflect.
00:11:41
Speaker
um So for some people, the tendency to will be to sort of dive into the detail um and to sort of, you know, look, narrow things right down. For other people, they might have a tendency to go, oh well, we could change this entire pathway um and revamp the NHS and think much bigger picture um and and similarly when it comes to thinking about the kind of objective or subjective that will have a natural tendency so again the being aware of your natural tendency towards things then allows you to potentially stretch it in other ways um and so two of two of those sort of crucial ways are thinking about perspectives and making sure that you're thinking objectively and subjectively using the
00:12:26
Speaker
using the different perspective, the ability to think about those other viewpoints it is ah is a, it's a key, it's a key part of stretching our critical thinking around an event or a, or a subject, um,
00:12:39
Speaker
And actually the sorts of perspectives that you might be thinking about. So you can be thinking, obviously, there's your own perspective um and that would be your perspective as as a doctor, but also as a human being in that, you know, you are allowed to recognize that you are human.
00:12:57
Speaker
um That would come under your fitness to practice capability um to sort of link that in there. um So there's your own perspective. there's There's the other people's perspective, which perhaps the obvious one is the patient. But you've also got other clinicians involved. You've got patients.
00:13:13
Speaker
Carers or relatives who are involved, you know, what's their perspective on things? What are they thinking? um You know, try and be in their shoes, as it were, to recognise actually what they might be thinking and feeling in that circumstance.
00:13:27
Speaker
um And then you can you can get bigger. Then there's the organisational perspective, actually. And here we'd be looking perhaps at community orientation capability where you're thinking about the use of funds.
00:13:38
Speaker
um And actually, you know, we've got a finite pot of money. How is the and NHS justifying? And and so on what's the organisational perspective on that? um You might be thinking about processes, pathways, protocols, all of those sorts of things, which, again, you might be linking into your organisation management and leadership, perhaps, perhaps.
00:13:58
Speaker
So there's that organisational perspective on things. so um And then there's also and you can go even broader than that and sort of start to test yourself. think There is a world outside the and NHS as well. where You know, the and NHS doesn't exist in a vacuum. So, yes, there are demographic changes. There are technological advances, AI being ah an obvious one at the moment.
00:14:20
Speaker
um you know there are societal expectations there are things going on in the media there are all of these sort of things that are sort of a way out there as well but they're all feeding into it and and and impacting on that that interaction that you have with the patient in front of you. So you can really stretch your thinking a lot by just moving along those perspective perspectives and and thinking about different things.
00:14:45
Speaker
um And then at each stage, just remembering, you know, how comfortable do you feel in discussing the way you felt while you were with that patient? um You know, how...
00:14:55
Speaker
how more do you manage to to step back and to look objectively at the facts involved um you know what were the cultural factors in play you know what is the what is the the written down guidelines you know and and again just stretching if you happen to know if you know your preference and your tendency in thinking is sort of sort of trying to stretch yourself in the opposite direction, which hopefully your trainers will be helping you with as well. Because when you write these log entries, they'll be putting in little questions underneath. They don't do that for their own health.
00:15:25
Speaker
They're doing that to try and stretch your thinking, to try and help you think in different ways and to really expand your reflective critical thinking. Absolutely, really interesting.
00:15:37
Speaker
and You've just made me realise I should probably reconsider if I'm looking at all perspectives during my consultations.
00:15:47
Speaker
Right. um For IMGs who come from systems where reflection wasn't explicitly taught or expected, how do they start or what what advice would you have for them to help them begin engaging with reflection as a practice?
00:16:06
Speaker
Yeah, absolutely. um It is tricky as a lot of UK systems do kind of gear towards teaching reflective processes, don't they even through things like PBL problem based learning and things. It's all about teaching and helping um learners to understand how to structure their own learning and and reflect and so on.
00:16:25
Speaker
um I mean, my advice for people who haven't really done it before is just get started. Just do it. Just write your first clinical case review.
00:16:35
Speaker
Don't worry about getting it wrong. Your trainer will guide you. um you know, actually, the the worst thing you can do is to get yourself so twisted up in knots that it's got to be perfect that you don't release anything for eight weeks.
Maintaining Routine Reflection
00:16:48
Speaker
um At which point your trainer is chomping at the bit. So mean, they haven't written anything yet. They haven't done anything yet. um They would far rather see something that they can then help you with than than nothing at all.
00:17:01
Speaker
um So dive in um and get started with it. the The absolute worst thing that can happen is that your trainer looks at it and goes, actually, I don't think it really links to these capabilities and delinks them.
00:17:14
Speaker
And that's that's it. that there's There's nothing else that can go wrong and and that doesn't matter. So dive in, have a go, get started. um The only thing that I would... perhaps emphasise, because for people not used to this process, um it may feel different, um is to don't worry about giving too much descript descriptive information about the patients.
00:17:37
Speaker
um Generally speaking, your trainer doesn't need to know much about the patient at all to be able to understand the learning that you're taking away. um So, you know, think to yourself as you're doing that descriptive bit, does it actually matter if the patient was male or female? Is it important it was your afternoon clinic? Is their age even relevant?
00:17:57
Speaker
It is quite easy to slip into presenting a history mode. um which is not what the log ent entry is about. And your trainer doesn't want to have to spend you know their time reading through reams of patient information that doesn't relate to what you're learning and reflective actually is. So keep that descriptive bit as minimal as possible. I'll be honest, you can quite often get away with like three sentences um and that is all that is needed um so that you know you don't have to spend a good sooner or two hours putting these things together.
00:18:28
Speaker
um keep that short and then get into the reflective bit, which is the bit that matters. Absolutely. and And are there any any practical methods or tools you'd recommend to help IMG trainees build reflection into their routine?
00:18:43
Speaker
I mean, generally, I say do one clinical case review a week when you're not on leave all night. And if you do that, you'll pretty much hit your numbers accurately in terms of routine. That's the easiest way to kind of stay on top of things gradually, which is what the panel wants to see.
00:18:58
Speaker
um And your trainer doesn't appreciate suddenly having 10 learning logs to read through all at once. So, yeah. the The aim is to try and trickle them through. And that's the way you'll get the best feedback as well.
00:19:10
Speaker
You know, because if you if you just sort of write one, get a bit of feedback about, okay, that's how that's how I can do this better, I can be better at this process. And then you can you can get that incremental feedback. Whereas if you do release most of your learning logs all in one go, you've got no learning.
00:19:24
Speaker
in terms of the reflective process happening in between those. um So yeah, so I would try and build it in something like that so that it is a gradual thing. um i mean, what you can do, so most people, what they'll do is they'll either open up a blank one um and just create it with a heading and a few bullet point notes and not release it yet.
00:19:44
Speaker
um But if not doing that on 14fish itself, um putting down a few notes somewhere um electronically on paper, um You know, you can you can set up a a WhatsApp group on your own.
00:19:57
Speaker
um If you set up a WhatsApp group with one other person and then remove that other person, you are now on your own in a group, which means you can add in voice notes really easily to listen back to later on.
00:20:08
Speaker
which is a quick way to to make. Yes. yeah and Yes. Like you said, just one a week sounds a very a practical way to build it into the routine.
00:20:19
Speaker
Yeah. And I mean, if you're sometimes people struggle to get started, like it's all when you're saying, yes, I want I intend to do one, but actually sort of struggling to to make a start. And I suggest that there's it's a four minute exercise, which I get some trainees to do when they're doing this.
00:20:35
Speaker
um And what you do is you just set yourself, you know, a timer to go off every minute for four minutes. And during that time, you put pen on paper and you're just going to write.
00:20:46
Speaker
You can't lift, you can't lift your pen off paper. Pen has to stay on the paper. You have to keep writing. It will be words and sentences that may make very little sense, but you're dumping everything that you think. And what you do is you do one minute on the biological aspects and one minute on the psychological aspects, one minute on the social aspects, and one minute on what you've learned.
00:21:07
Speaker
um or could learn from it. um And if you do that four minutes of kind of brain dump activity, and then go back to it, reread it with the capabilities in front of you, you'll actually find things will start to jump out.
00:21:21
Speaker
And you'll, you know, just from that four minute activity, you've sort of broken that initial barrier, that you can then look at it and go, actually, yeah, I see this, I could look at practicing holistically here, because I've got some really good psychosocial elements to this case.
00:21:34
Speaker
um and and it'll start to jump out at you. So yeah, if you're struggling to get started on that once a week, that that four minute activity can sort of get you past the barrier.
Motivation Through Enjoyment of Learning
00:21:46
Speaker
Cool. that's That's all very useful. Thank you, Jenny. um Moving on to closing. Finally, if you could give one piece of advice to trainees about making reflection genuinely useful um as our closing note, what would that be?
00:22:05
Speaker
um I would say try and hang on to the fact that most of the trainees that I work with enjoy learning. They enjoy feeling more competent. they They like, you know, people haven't got through medical schools and into postgraduate training without some kind of internal drive to learn useful stuff.
00:22:23
Speaker
So while you are writing out these log entries and linking them to capabilities, try and hang on to the usefulness of the process. um Remember that actually you probably quite enjoy learning, even if not the writing of the log itself.
00:22:38
Speaker
And try and hang on to that to keep yourself motivated because 36 a year for three years is quite a project.
00:22:49
Speaker
Right.
Conclusion and Farewell
00:22:50
Speaker
Thank you very much, Jenny. um That brings us to the end of today's episode. A huge thank you to you, Jenny, for joining me and sharing your valuable insights into reflective practice.
00:23:02
Speaker
I hope our conversation has given our listeners some useful ideas on how reflection can support their learning and development in GP training. Thanks for listening and all the very best.