Has the Bawa-Garba case had an effect on trainee engagement with reflective learning?

Short presentation

Problem

Reflective learning is integral to postgraduate medical training, appraisal and revalidation. In general practice (GP) training it is used to evidence curriculum coverage and attainment of General Medical Council (GMC) appointed competencies for progression to Certificate of Completion of Training (CCT). Fears of exposing weakness or incompetence have long been identified as a barrier for engagement with reflection. This is likely to have been amplified following the case of Dr Hadiza Bawa-Garba, a paediatric trainee who was requested to release her ePortfolio reflective entries to inform a GMC investigation which later resulted in the loss of her licence to practice.

The aim of this study is to identify themes of the reflections of GP trainees and whether their reflective practice has changed following the Bawa-Garba case.

Approach

A phenomological approach to qualitative research was applied. 7 trainees and 4 trainers were recruited from the Doncaster GP training scheme and underwent semi-structured interviews which were later transcribed for analysis. Data was assigned to a coding framework and analysed to identify dominant themes.

Findings

Entries describing mistakes and near misses were identified as most useful by trainees for developing their practice. This correlates with the dominant themes of trainee entries which were difficulty and challenge. All trainees reported knowledge of the Bawa-Garba case, describing a detrimental effect on their engagement with reflection as a result. Most notably, trainees were afraid to submit reflections on mistakes and near misses for fear of jeopardising their careers.

Consequences

This study suggests that the handling of the Bawa-Garba case by the GMC has had a detrimental impact not only on trainee engagement with reflective learning, but also on opportunities for trainee professional development. More research into how trainees might navigate their reflective practice in a way that manages these fears is required to maintain the value of reflection as a development tool.