Embedding a patchwork text model to facilitate meaningful reflection within a medical leadership curriculum

In the UK following the Francis report there has been a focus on clinical leadership and medical engagement as it is recognised this is essential to improving patient care, safety, organisational performance and innovation.1 This has resulted in the development of competency frameworks, the inclusion of clinical leadership within medical education and leadership and management standards for all doctors.2-4 Reflection is key to good medical practice.2-6 A reflective outlook raises consciousness, prompts movement from the routine of practice to its critical appraisal and drives change. It is central to appraisal and medical revalidation.5,6,8 Revalidation is the process by which all UK doctors demonstrate to the General Medical Council, though annual appraisals, they are up-to-date and fit to practise.8 In order to provide this evidence, UK doctors complete a National Health Service reflective portfolio. The reflections are structured using the headings: Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan. For example the catalyst for reflection for an anaesthetic trainee may be performing an epidural, whilst observed by the consultant, who then ‘signs off’ for that procedure. However the current process has been perceived as a ‘tick box’ exercise.5-7 In order for reflection to become meaningful it must be critical, the challenge is how to develop a curriculum where reflection is meaningful, authentic and tailored to the individual.