The ‘independent assessment of clinical competence’ is a critical reflection of our training experience and how it has prepared us to practice as clinical scientists. Since earlier this week I shared my thought piece on the IACC, I thought it might be more useful to share some tips I’ve gathered from various resources on critical reflection. I am going to tailor this post to applying critical reflection to the IACC, but please note: I don’t have any more information about it than what has been shared by NSHCS! So, when I offer my opinion on what the examiner might be looking for, please don’t take this as gospel; it is just my opinion.
A critical reflection goes deeper than just exploring how an experience has made you feel. Critical reflection finds grounding in critical thinking; challenging us to analyse our actions during a particular experience and speculate on how we can use them to inform future practice. It can require us to examine our knowledge, opinions and biases and change the way we think, in order to change our behaviour. While the word ‘critical’ sounds negative, critical reflection should be a positive experience, through affirmations of competence, alongside identifying opportunities for learning and growth.
There are three types of critical reflection:
The IACC requires examining past experiences and theorising how we should act in the future; this is reflecting on and for action. As we are not reflecting on something currently occurring (unless you want to reflect on the IACC while writing the IACC? Refleception…?) we are not considering reflecting-in-action.
Reflection-on-action is particularly well tackled using the ‘what, so what, now what’ framework. It’s simple and does what it says on the tin:
- What: a short (remember we’re on a tight word budget here) description of an experience. This section only really needs to be long enough to give context to the next sections.
- So what: this is a general reflection; how did you feel and what were the implications for you and the patient (remember those? They’re very important). You should consider three perspectives, although they won’t all be relevant to every experience you describe:
- Academic: Did you improve/learn a concept, theory or skill, or identify gaps in your knowledge or perception?
- Personal: Why was this an important experience to you and how has it changed your thoughts or understanding?
- Systems: Did the experience give you a better understanding of an organisation/system? Would you suggest making changes?
- Now what: This is the part where you really challenge your actions and reflection-for-action comes into its own. What did you learn from this experience and how can you apply that to future similar experiences? Would you do things the same, or differently? How? Why?
Critical reflections are intended to really self-inspect the way you think and behave, so the questions you ask yourself should be probing and sometimes challenging to answer. For example:
- Why did I take the actions I did?
- What are the consequences of my actions for:
- the patient and their family
- my colleagues
- How did I feel about this experience? How do I feel about it now?
- How did the patient feel about it and how do I know?
- What influenced my decision-making and actions? Were there resources that influenced, or should have influenced this?
- What could I have done differently, and would it have been better?
- How can I use this experience to influence my future practice?
- Have I already taken action to change my behaviour as a result of this experience?
A good critical reflection uses personal experiences, takes responsibility for the consequences of the event described and provides insights that are transferable from a unique experience. You should reflect on complex scenarios, that don’t lend themselves to simple solutions and display evidence of scientific knowledge underpinning decision making. Ultimately the point of a critical reflection is to draw out key learning points from experiences and summarise them as conclusions and recommendations for going forwards.
On the other hand, a poor critical reflection doesn’t draw on real personal experiences and bases insight on theoretical situations. You should avoid blaming others, talking about insights that are too specific to a single experience or not drawing insights at all. Describing your experiences without reflecting on them is an easy trap to fall into but is a waste of precious words in that pesky word count!
By its nature, a critical reflection is a very personal piece of writing, and it can often feel uncomfortable to share your opinions and thoughts with others. If, when you’ve finished writing, it feels somewhat awkward to share your essay with others then you’ve probably done something right. So just to round this post off, I’ll finish off with five questions I think are essential to think about while writing your IACC:
- How do your experiences map to the five domains of good scientific practice?
- How do your experiences make you a competent clinical scientist?
- How have your thoughts and behaviours been impacted by your experiences?
- How will you continue to meet the standards of good scientific practice in the future?
- How do your actions impact the patient and why is this important?
I hope this is helpful, for those of you reading and looking for inspiration to start your IACC. You’ve got this! And, as always, thanks so much for reading, stay safe and good luck!