Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK.
SFHEA School of Education, The University of Sheffield, Sheffield, UK.
Med Teach. 2021 Jun;43(6):656-662. doi: 10.1080/0142159X.2021.1887833. Epub 2021 Feb 18.
Reflection is an essential tool for postgraduate medical training, yet fear of exposing incompetence is a known barrier for engagement with reflection. In the UK, this fear may have been amplified by the case of Dr Bawa-Garba, whose reflective e-portfolio entries informed a General Medical Council investigation resulting in the loss of her licence to practice.
To identify themes GP trainees commonly explore in e-portfolio entries, and whether their reflective e-portfolio entries have changed following the Bawa-Garba case.
A phenomenological approach was applied. Semi-structured interviews continued to data saturation in a purposive sample of trainees (7) and trainers (4) recruited from a South Yorkshire GP training scheme. Transcript data were assigned to a coding framework with iterative thematic analysis.
Dominant emergent themes were 'difficulty' and 'challenge'. All trainees described reluctance to submit significant event analyses (SEAs) on mistakes and near misses for fear of jeopardising their careers. International medical graduates were disproportionately affected by the challenges reflection posed.
Following the Bawa-Garba case, trainees are disengaging with SEAs to reduce the risk of self-incrimination. Further guidance with which trainees can navigate their reflective e-portfolios is required to retain the value of reflection as a tool for professional development.
反思是研究生医学培训的重要工具，但对暴露无能的恐惧是参与反思的已知障碍。在英国，这种恐惧可能因 Bawa-Garba 医生的案件而加剧，她的电子病历中的反思条目为英国医学总会的调查提供了信息，导致她失去了行医执照。
确定全科医生培训生在电子病历条目中通常探讨的主题，以及在 Bawa-Garba 案之后，他们的反思电子病历条目是否发生了变化。
采用现象学方法。在南约克郡全科医生培训计划中，从培训生（7 名）和培训师（4 名）中进行了有目的的抽样，继续进行半结构化访谈，直到数据饱和。将转录数据分配到一个编码框架中，并进行迭代主题分析。
主要出现的主题是“困难”和“挑战”。所有培训生都表示不愿意提交关于错误和险些犯错的重大事件分析（SEAs），因为担心危及他们的职业生涯。国际医学毕业生在反思带来的挑战方面受到的影响不成比例。
在 Bawa-Garba 案之后，培训生不再参与 SEAs，以降低自我检举的风险。需要进一步指导培训生如何在他们的电子病历中进行反思，以保留反思作为专业发展工具的价值。
