The Three Rs: Review, Reflection and Rumination

Keywords: reflection, perfectionism, compassion, competition, mental health

The time of year for reflection

How are you getting on with your New Year’s resolutions? Are you trying something new? Do you think you’ve made a positive change to your lifestyle or is it too early to say?

“You don’t make mistakes, mistakes make you” is a quote from a film I watched over the festive period called The Last Word and it really stuck in my mind. I didn’t realise that I was considered to be a ‘perfectionist’ (as I was informed by my cognitive behavioural therapist) because perfectionists in my mind were people who have all their ducks in a row, appear to be amazing at everything and look fabulous whilst managing all of their commitments. My lovely therapist told me that perfectionists set exhaustively high standards for themselves, which I can identify with, but when you strive to provide the best care for your patients, you aim high. I remember miscalculating a drug dose during vet school where, thankfully, the patient did not suffer any side-effects as a result, but I ruminated over this mistake and suffered long-lasting side-effects on my confidence and self-esteem. At the time, my mistake wasn’t discussed during the rotation with the clinician or my rotation mates, and I was pleased about this because I was ashamed. I certainly wouldn’t have agreed with the quote from the film at that point in my career.

A couple of years ago I attended a veterinary education symposium, VetEd and there was a brilliant keynote presentation on the benefits of the Tufts at Tech Community Clinic which is a fantastic initiative and I’ve included the link to their website in the references section at the end of this blog if you’d like to read about it. The speaker, Dr Gregory Wolfus, explained that at the end of each rotation the students are asked to review and reflect on any mistakes that were made that week. I was sat in the lecture theatre thinking what a great idea it is to help students process their mistakes in a supportive environment for others to learn from as well. Perhaps these students would agree with the quote from the film?

Remembering how ashamed I felt during one of my rotations when I made an error, I wondered if I would have appreciated this approach when I was in my early 20s. I’m inclined to say that with appropriate staff training or even seeking external expertise (from therapists or performance coaches) where students are invited to discuss mistakes and reflect on the week, would have been a more powerful tool than simply keeping a journal of the cases I’d seen, what I did, how I felt and my reflection on the situation without any feedback from anyone else. I would have benefitted from someone challenging my unforgiving thoughts about myself, a habit I employed in practice as a new grad. Ok, so why do I think it is the responsibility of universities to spend extra time and money funding these kinds of activities? Perhaps they already do. I don’t think universities alone should be involved, practices could review errors or near-misses on a regular basis with the entire team BUT it needs to be handled in a compassionate and evidence-based way, that’s why I suggested enlisting assistance from professionals in this area. I think it would be worthwhile and may help to improve retention of vets and vet nurses in practice. It would be interesting to see if the practices that have already implemented this or a similar approach have lower rates of staff turnover and/or improved staff wellbeing.

Compassion over competition. Can you have both?

I am a competitive person and I think this stems from being involved in sport from an early age but I’d like to think I’m a team player and being involved within a team that succeeds, is just as rewarding for me as being an individual winner. Also, from an early age I had aspirations to be a vet and whenever asked what I wanted to be when I grew up, the response to my reply usually contained some of the following phrases, “it’s really competitive to get a place”, “you have to be really clever” and thankfully I only heard this one a couple of times “you don’t go to the right school”. Despite not attending the ‘right school’ to gain a place as a vet student, my parents and brother escorted an excitable 18-year-old down the M62 to the University of Liverpool to study my dream degree. It didn’t take me long to realise that generally speaking, the vet students were a pretty competitive bunch. There wasn’t a limit on the number of us who could qualify as vets but the numbers game was always in play; who got the highest marks in the last set of exams? Who was the person in your rotation group who stayed the latest each day? How many surgeries have you scrubbed into? How many calvings and/or caesareans have you assisted with? On how many rotation days did you miss lunch? The people who ‘won’ these competitions, gained knowledge and experience but at what cost?

I recently read an article by Thomas Curran (Assistant Professor, University of Bath) and Andrew Hill (Head of Taught Postgraduate Programmes, York St John University) on The Conversation website titled “How perfectionism became a hidden epidemic among young people” which suggested that schools and universities should consider teaching “the importance of compassion over competition” in order to reduce mental illness. I found a blog on the RCVS Mind Matters website written by two vet students (Lucy Irvine and Erin Thomson) from the University of Glasgow who ran a wellbeing campaign last year consisting of motivational Monday messages, chatting over a cuppa, exercise events and ‘Throwback Thursdays’ where clinicians and lecturers discussed any difficulties they faced during vet school and their careers. Perhaps Professor Curran and Dr Hill would consider this a step in the right direction? I certainly do!

The reflection and compassion combo

I am generally positive about the use of reflection in a learning environment and I think that when the advantages are explained and reflection is directed in a helpful way, it can be very beneficial. We can all sit in lectures, read journals, watch webinars but how much information do you actually take in? How will you implement your new skill and/or knowledge to make good use of the time you spent completing the CPD? With practical workshops, preparing a lecture or undertaking a research project, what would you do differently next time? Are there any practice protocols that need updating as a result of what you have learnt?

Now for the combo! I am a member of several veterinary Facebook groups and I have witnessed an abundance of reflection and compassion in these groups. There are lots of clinical groups where vets and nurses ask each other for advice but two of my favourites are Veterinary Voices UK and Vets: Stay, Go or Diversify. Veterinary Voices UK was set up by Danny Chambers and Sarah Brown (rest in peace Sarah x) where discussions about issues faced by vets are highlighted. Vets: Stay, Go or Diversify is the brainchild of Ebony Escalona and is primarily focused on career advice. Both groups are supportive, reflective and compassionate (ok there’s been a couple of heated debates but generally, I have found these groups to be very helpful and the group admins do a great job) and you can post anonymously by emailing your post. Now I’m not simply trying to justify spending more time on Facebook but the RCVS are running a pilot scheme at the moment to ascertain how reflection can be incorporated into CPD. If you could take a screenshot of your contribution to a discussion, I wonder if this would count? I am looking forward to seeing the results of pilot scheme.

For me, discussions are the optimal way to reflect on learning experiences. With respect to reflecting on mistakes, I think they can either make or break you. To make you, I believe a compassionate second opinion is required. Generally speaking, vets are high achievers and high achievers are more likely to be perfectionists (Damian et al. 2017) so if you find it hard to be kind to yourself when reflecting on your day, ask a compassionate friend, colleague or family member, or join a supportive and compassionate Facebook group. Unfortunately mistakes happen from time to time in any profession, and that is part and parcel of being human. The focus should remain on learning from mistakes and preventing errors from re-occurring in a supportive environment.

How was it for you?

This was my first blog on my new website Vet Thinking Aloud and I hope that you enjoyed it! When I was planning the content for this blog, I didn’t anticipate it being an emotional start to my new website by sharing my personal struggles and discussing how inspiring Sarah Brown was and continues to be in the group Danny and Sarah set up. I think it’s important to talk about it and it has been cathartic for me to revisit and remind myself about the progress I’ve made.

I hope that reflecting on CPD will be beneficial to you in terms of reviewing the CPD you’ve completed (did you enjoy it? Did it suit your learning style?), reflecting on how you can use the information to further improve the range of your skills in practice, how you critique research papers, manage the team you work with and how you communicate. Although if you are reflecting on a mistake, I think it’s much more important for a collaborative reflection. Once you’ve reflected and learnt from your mistake, step away! Try not to let healthy reflection become unhealthy rumination.

I work from home a lot at the moment so I would very much appreciate starting a dialogue with people who would like to share their comments and thoughts on topics I’ve covered in this blog. Also, I appreciate that this content may have stirred up some unpleasant thoughts and feelings so I’ve provided links to the Samaritans and Vetlife websites below.

https://www.samaritans.org/

https://www.vetlife.org.uk/

Stacey Blease – a vet thinking aloud

 

References:

http://vetmed.tufts.edu/tufts-at-tech/

https://theconversation.com/how-perfectionism-became-a-hidden-epidemic-among-young-people-89405

https://www.vetmindmatters.org/glasgow-vet-school-wellbeing-campaign/

Damian, L. E., Stoeber, J., Negru-Subtirica, O., & Baban, A. (2017). On the development of perfectionism: The longitudinal role of academic achievement and academic efficacy. Journal of Personality, 85(4), 565-577. doi: 10.1111/jopy.12261

18 thoughts on “The Three Rs: Review, Reflection and Rumination”

  1. Awesome blog Stacey! Looking forward to reading more posts on here. I’m a bit concerned about the RCVS piloting adding “reflective practice” into CPD requirements though given the current state of our medic colleagues following the use of a medical practitioner’s reflective writings against her during disciplinary proceedings (the Bawa Garba case). Loads of medics now pretty much refusing to fill in their reflective logs and all using the stock line “I have reflected face-to-face with my supervisor but do not feel happy putting these reflections in writing”. Is that our future…?! Gwen x

    Liked by 1 person

  2. Great blog Stacey. I must admit, if asked to reflect on things as a student I probably wouldn’t have been keen! However, experience (age?!) has taught me reflection is crucial in learning – we do it all the time as vets in practice. It can be informal to ourselves, wondering how we dealt with a client/case or it can be more formal with colleagues.
    I can understand where the RCVS are coming from wanting us to reflect on our CPD. In order for individuals to learn effectively they need to go through 4 stages of a cycle – experience, reflection, concpetualisation and experimentation (Check out Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall). Also check out Taylor and Hamdy’s review on adult learning theories, where they discuss learning in medical education (http://www.tandfonline.com/doi/abs/10.3109/0142159X.2013.828153).
    Gwen does raise a really pertinent point – it shouldn’t be used to be able to punish/prosecute. It is to aid learning, identify weaknesses in knowledge or skills in order to improve.
    I also think a commonly forgotten aspect of reflection is reflecting on positive experiences. We all reflect on when things go badly – we should also reflect on when things go well too!!

    Liked by 1 person

    1. Ian! Hi! Fantastic to hear from you. Thank you for your comment. Ha ha MSc seems like a lifetime ago! I’m very well thank you, how are you? I miss beautiful Edinburgh

      Like

  3. Very interesting read and food for thought. I think reflection is an essential part of learning – whether it be in relation to CPD or mistakes made in practice. Gwen raises a good point about the potential for the RCVS reflective practice logs to be used as evidence against individuals in future and there should definitely be some form of protection (both for medics and for vets!) against this as the fear of this can on have a detrimental effect on the profession.
    Thanks for sharing your thoughts in this blog and I look forward to reading more

    Liked by 1 person

    1. Hi Alina, thank you for your comment! Yes, I agree that if people are fearful about writing or discussing their reflections, this would only stifle progress and learning opportunities would diminish.

      Like

  4. Great first blog. Thanks for writing it.
    My tip for quick positive reflection (pinched from a great mentor) is using ‘what went well’ and ‘even better if’. It can be a quick rattle through in your head or you can make it a bit longer and write it down. You can also use it to give feedback by asking others it e.g. students.
    Looking forward to your next blog.

    Liked by 1 person

    1. Hi Amy! Great advice and thank you for sharing your tip for how you reflect and also how you structure your feedback to others.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s