How to Write Better Reflections for Medical Appraisal: The Art of Reflective Practice

Charlotte Younghusband
Aug 12
3 min read

Why reflective practice matters

Reflective practice is one of the most important habits in medicine. It is also one of the areas that doctors struggle with generally, and for their appraisal.

The Academy of Medical Royal Colleges and COPMeD define reflective practice as “the process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible”

A simple structure for better reflections

A useful reflection often starts with three simple questions: what, so what and what now? “What?” is the factual account. What happened? What did you do? What was the context? Avoid writing to lengthy descriptions. We are less interested in what happened, but why it was important to you. “So what?” is the deeper part. Why did it matter? What did it show you about your knowledge, communication, judgement, teamwork, documentation, confidence or limitations? “What now?” is the part that matters most for appraisal. What will you do with that learning or from that experience?

The most common problem is that doctors stop at description. For example, “I attended a safeguarding course and learned about child protection” is not enough on its own. A better reflection would explain what part of the course was relevant to the doctor’s role, what gap in knowledge it identified, and how the doctor will apply it. For example, a GP might reflect that the course made them more aware of ‘disguised compliance’, changed the way they document parental explanations, and prompted them to review the local safeguarding escalation pathway.

Reflection does not need to be long. A few clear sentences can be more useful than a page of vague writing. The strongest reflections are specific. They name the learning point. They explain the impact. They connect the learning to future practice. A reflection on a prescribing error might explain that the doctor now checks high-risk medicines against local guidance, uses electronic alerts more carefully, and asks for pharmacist advice when prescribing outside their usual scope. A reflection on a difficult consultation might explain how the doctor recognised that they closed down the patient’s agenda too early and now uses a short pause before moving to management.

Confidentiality, candour and learning

Doctors sometimes worry that reflective writing will be used against them. That concern is understandable, particularly where a complaint or significant event is involved. However, reflecting for the purpose of your appraisal does not and should not include any sensitive or identifiable detail. It should avoid patient identifiers. It should focus on learning and changes in practice, to demonstrate insight and professional development.

What can doctors reflect on?

Good reflection can be borne out of my situations. It may follow CPD, a case review, a patient complaint, a colleague’s comment, a compliment, a significant event, an audit, a teaching session, a clinical attachment, an interview, an exam attempt, or a period away from practice. Doctors not currently working clinically can still reflect on relevant learning, such as reviewing UK guidelines, attending courses, preparing for NHS interviews, or observing clinical practice during an observership.

Showing impact on future practice

For appraisal, reflections are particularly useful when they show impact across the doctor’s scope of work. A locum GP might reflect on urgent care, prescribing, safeguarding and remote consultation skills. An IMG preparing for a first NHS role might reflect on differences between healthcare systems, consultation style, escalation pathways and working within multidisciplinary teams. A doctor working overseas but maintaining a UK licence may need to explain how their CPD remains relevant to UK practice.

The tone matters. Reflection should be honest but proportionate. It does not require self-criticism for the sake of it. It should avoid defensive wording such as “nothing could have been done differently” unless that conclusion is supported by a clear explanation. Even where the doctor feels they acted appropriately, there may still be learning about communication, documentation, expectation-setting or earlier escalation.

A simple reflective structure is: I did or experienced this; I learned this; this matters because; I will now do this. That final step is essential. Appraisers are looking for evidence of learning, insight and future impact, not polished prose.

Dr Appraisals supports doctors who may be unfamiliar with UK appraisal expectations, including international medical graduates, locums, overseas-based doctors and doctors without a designated body. If your evidence is limited, reflection becomes even more important because it helps explain your professional development in context.

Useful links on reflective practice include the General Medical Council’s reflective practice guidance and the Academy of Medical Royal Colleges reflective practice resources. These are helpful starting points for doctors who want to understand what good reflection looks like in a UK medical appraisal setting.