70 - Reflecting on the things
Journaling as a reflective practice
The past week has been dedicated to working on my trainee portfolio which I had abandoned for a few weeks. Prior to commencing my current medical training programme, I’d never had a portfolio. To hear my trainee friends talk about it, it sounded like an actual belly ache, being expected not just to do the everyday work of being a clinician, but to also write reflective log entries about your day-to-day encounters. These entries are then reviewed by supervisors who sometimes give helpful feedback and make an assessment of your progress towards achieving training competencies based on your reflective entries.
I found this a little strange in the beginning. I was used to being assessed by tests and examinations, I didn’t see how writing about my work could be used to measure my progress. During our induction, the importance of portfolio work was emphasized and although I still didn’t see how it would make me a better clinician, I decided that I would do my best to engage with the portfolio in order to avoid any possible setbacks to my training.
Thankfully, I have managed to stay on top of things by having my portfolio page permanently open on my computer, which helps me remember to make entries a few lines at a time, whenever I get a chance. When I first started making entries, I wasn’t sure if I was doing them the right way and I wanted to get it right and not just to tick a box.
To this end, I decided to educate myself on reflective writing, becoming a better clinician through reflection, and the theories underpining all of it. There has been a lot of work done by educationaliists over the years around reflective practice, which I shall attempt to summarize.
David Boud (1987) has defined reflection as:
"… a conscious activity in which we engage to explore our experiences and develop new understandings and conceptualisations." (Boud 1987)
John Dewey - the philosopher who popularised reflection - proposed 5 steps towards developing a reflective practice, but I found a four step one that I like better.
Step 1: Look back at a situation or experience
Step 2: Think in depth about your experience or thought
Step 3: Describe what you learned about yourself or your role
Step 4: Plan what you will do next
According to the educationalists, “By committing reflections to paper the learner can stand back from them and create another opportunity to reconstruct knowledge, awareness and practice.”
Now that I’ve had almost 2 years of practicing this at a professional level, I can attest to it’s truth. In order to write an entry, I may have to refer to my notes and sometimes I find things I missed, questions I should have asked but didn’t, information from previous documentation I could have accessed to improve my decision making. I have to access my memory for details about the consultation and the thought process that led to my list of differentials. I also notice the things I did right how I felt about my eventual decision. With all of this data I’m able to come up with a plan for the next time I am faced with a similar scenario. I am also able to identify knowledge gaps and plan to address them.
This practice of reflection has been beneficial in my personal life as well. I’ve always been the girl who had a diary where I’d write occasionally, usually on significant occasions or whenever I needed to sort through hard things on my own. Writing things down has always been part of my process, but only over the past few years has it become a more ingrained habit.
It started with this one line a day journal which I have now had for 5 years. It is a ruled journal, with 5 lines for every entry. The pages are dated and so everytime you make an entry, you get to see your entry from the same day 1,2,3,4 or 5 years ago.
Last year I heard about morning pages for the first time. It is described as a tool to help creativity and it is pretty straightforward - first thing every morning, write three long hand pages. No thinking neccesary, write for your eyes only, no topic is off limits, just write three pages.
I was quite excited by this concept and keen to incorporate it into my daily practice but not without a few tweaks. In the spirit of starting small, I started by writing only one page a day, with the option to write more on the days I felt like it. I also decided mine would be night pages because as a non-morning person, I might be setting myself up for failure
My journaling habit was already established thanks to the one line a day journal, so it was easy to stack this new habit onto it. Thanks to my modifications, I have now been able to stick to this new habit for a year. I now look forward to the end of the day when I can put everything down on the page(s). I am able to recount the events of the day, expanding on how I felt about different situations and what may have been responsible for my feelings. Having to find words helps me process things better and I find that this practice helps me end the day on a much lighter note.
The practice of reflection continues to give me so much information about myself and I would definitely recommend it as a way to get to know yourself better.
This week I am reading
Leaving Isn't the Hardest Thing by Lauren Hough. I came across this book while going through the comment section for the book - Sex Cult Nun. One reviewer mentioned this book, claming it was a better account and 40% into the book, I can definitely say that I do not agree. The book is written as a collection of essays and essays are usually my jam but something about this one feels disjointed. In my opinion, the story telling is underdeveloped and not compelling enough. It is not a bad book, but let’s just say I’ve started another book without finishing this one.
The days are getting even longer, the weather is starting to get warm and outside season is upon us. The cost of living crisis means that enjoyment has to be in moderation but I’m quite looking forward to air of excitement and activity that comes with warmer days.
I find out about my exam result this week. Eeek. Pray for me.
Here’s wishing you a week of reflecting on the things.
Chioma.