Evaluating reflection in postgraduate GP training post Bawa-Garba: a qualitative approach

Background It has been suggested that reflection within healthcare training bears little resemblance to theoretical approaches to reflective practice described in academia. Concerns have been raised about students producing artificial entries rather than an honest review of incidents encountered. The Bawa-Garba case is anticipated to have had a significant impact on the reflective practice of postgraduate medical trainees.

Aim To evaluate the use of reflective learning logs in postgraduate general practice training in the context of the recent Bawa-Garba case.

Method Using constructivist theory, a phenomenological approach to qualitative research was applied. During February to June 2018, 11 participants were recruited — seven trainees and four trainers — from the Doncaster GP Training scheme. Semi-structured interviews were performed and the data collected was transcribed for thematic analysis as described by Attride Sterling.

Results Difficulty and challenge were identified as common themes for reflective log entries. There is support for previous findings regarding artifice, which commonly occurred in the context of evidencing curriculum coverage. All trainees expressed anxiety about the confidentiality of their reflective entries, with many describing a defensive approach to reflection following the Bawa-Garba case. International medical graduates (IMGs) were identified as being at a significant disadvantage in the current training scheme due to difficulties with language, cultural barriers, and previous experience of reflection.

Conclusion A global theme identified from the data was that reflection within GP training needs to change in order to remove bias and prevent further devaluation of reflective learning.