Doing well, getting better: facilitating physicians’ reflection on their professional performance

Physicians are expected to be committed to lifelong learning to provide the best possible care and to be accountable for their performance to earn the trust of society. Within this framework of learning and accountability, “reflecting on action and acting on reflection” is key. To gain insight into their strengths and weaknesses and to support the reflective process, physicians collect feedback from their working environment (colleagues, residents, support staff, management, patients). However, concerns are expressed that the overformalizing of professional activity may lead to a loss of personal investment and a disposition of compliance. In striving to make reflection visible and authentic, care must be taken to ensure that it is not enforced in an overly prescriptive manner, turning relfection into a tick-box exercise instead of an opportunity for learning and improving. Therefore, the central question in this PhD was: how can we facilitate reflection in such a way that physicians are supported in their lifelong learning? To find leads for the facilitation of meaningful reflection, physicians were first asked how they experienced reflective activity in daily practice. Second, a coaching system was designed and implemented in a Dutch university hospital that enabled physicians to be both accountable for their professional performance and to invest in their professional development. During an individual meeting with a trained physician or professional coach physicians drafted a personal development plan for which they were intrinsically motivated. Third, it was investigated to what extent a group conversation with colleagues with whom physicians worked on a daily basis could serve as an alternative or supplement to individual meetings. Finally, the focus shifted from the individual physician in the context of his/her physician group to the physician group in the context of the wider organization. A new feedback tool was developed and tested to evaluate physicians’ group performance.