Foundation years: a time of reflection

feel that reflection has become a ritualistic process that does not achieve its intended purpose [2]. We believe that structured training programmes can overcome these aforementioned barriers by (i) conveying an understanding of core principles of reflective practice; (ii) instilling an appreciation of its impact on professional development and learning; and (iii) imparting metacognitive skills to junior doctors and challenging their thought processes via feedback in a supportive environment. Productive reflection is a developmental process that requires adequate training of supervisors and facilitators. Potential changes imply a large investment in resources. Organizational and cultural changes are also needed to create a safe environment to have assumptions challenged. One holistic solution would be to integrate reflective practice into undergraduate training, allowing individuals sufficient training in positive influences of reflection when beginning their careers. In a systematic review of reflective practice in the health professions, Mann et al. [3]. found that none of the 29 identified papers were randomized controlled studies. Moreover, there was a lack of significant evidence of improvement in clinical practice via reflection. However, the review showed that reflection enabled a deeper approach to learning, in that learners could process complex situations and integrate new learning to existing skills and knowledge. Whilst not isolated to junior doctors, reflective evidence can often be overlooked when progressing through one’s career, especially when only in rotations for 4–6 months. Reflection is undoubtedly essential in the effective development of the modern clinician, therefore formal training should be provided in aiding doctors to improve their reflective skills. Further randomized controlled studies are warranted to assess the efficacy of strategies to enhance reflection and its impact on clinical practice. In conclusion, To the Editor,