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A better way of reviewing your practice

Reflective writing has been highly therapeutic for Dr Jonathan Knight and Dr Lucy Henshall.

Reflective writing reaches the parts of general practice that appraisal cannot. A bold claim, perhaps, but one that we have found to be true.

Since 2001, more than 70 doctors have attended one of the annual GP reflective writing workshops hosted by the East Anglia Faculty of the RCGP. Those who attend are introduced to a unique way of reflecting on their work life. Over a third have continued with the writing, many have attended further reflective writing workshops.

We originally signed up out of curiosity, and a nagging feeling that there must be a more fulfilling way of reviewing our practise than a mechanistic appraisal.

Informal assessment

GPs are increasingly familiar with the formal mechanisms of assessing their practice - appraisals, PDPs and revalidation are now woven into the fabric of our professional lives. Yet GPs have always had a natural inclination for informally assessing their role.

Perhaps it is our daily encounters with such a variety of patients and their situations that fuel our innate curiosity.

Writing about these encounters is not a new idea. Doctors have written stories (real or imagined) for centuries: after all, one of the first skills we learn in clinical medicine is 'taking a history'.

Learning to reflect

Reflective writing is so much more than just writing stories. It is in the process of writing that we may gain new insights or see things from a different perspective. It is not creative writing, though creativity may be found along the way.

In other words, you don't need to be a 'writer'. In fact, being too self-critical about the way that you write is one of the most common barriers to writing reflectively. Syntax, grammar, spelling and (mercifully) handwriting take a back seat - and with them any potential anxieties about writing ability.

The primary goal is to allow the stories and experiences in the cerebral cortex to find their way, unedited, via synapses, neurones and muscles, down through the arm, out through the pen and ink and, finally, on to the paper.

At the workshops, participants do this form of writing as a six-minute exercise; writing down whatever comes to mind. It's amazing just how much you can write in six minutes.

Other writing exercises may be a little more focused. For example, write about an important event in your medical life, or write about a consultation from a child's point of view. These exercises, written in the same way as the six-minute exercise, are a little longer, but not longer than 20 minutes.

The key to the success of these workshops has undoubtedly been the skill of our facilitator, Gillie Bolton, who has been involved in the workshops from the beginning.

Ms Bolton has wide experience of working with healthcare and other professionals. She has published several books on reflective, therapeutic and creative writing. Her style is humorous and wise, and her ability to get GPs, who are complete novices at writing, to write about themselves never ceases to amaze.

Reflective writing is, primarily, for the writer, not for publication or to discover the next Booker Prize winner.

The audience is the writer. But at the workshops what we write is usually shared among a small group of doctors. It is during the reading back of what we have written that we see what we missed. This process is encouraging.

Is this a form of therapy, then? Not in any formal sense, no. Reflective writing is a means of re-evaluating our medical lives.

Renewing enthusiasm

Many GPs confirm that they leave with a renewed enthusiasm for their professional practise, having thoroughly enjoyed a unique weekend.

The apprehensive thought of many at the start of a weekend workshop is 'Can I do this? Is this for me?' The answer by the end is always a 'yes'.

And as Ms Bolton herself would say: 'With this sort of writing, you can't write the wrong thing.'

- Dr Knight and Dr Henshall are GPs in Ipswich, Suffolk

Reflective writing workshops

Time Our workshops run over a weekend and we ensure that participants have time to unwind and relax from the busy working week.

Place A relaxed venue, with few distractions is essential. We use a low-key conference facility at Leiston Abbey in Suffolk, run by the music charity Pro Corda and set in the atmospheric grounds of a ruined abbey owned by English Heritage.

Facilitator Gillie Bolton's experience and gentle skills as a facilitator are invaluable.

Participants The willingness and enthusiasm of the GPs who attend always contributes to a successful workshop.




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