Enabling honest reflection: a review.

BACKGROUND: Reflective practice provides a backbone to professionalism, a commitment to lifelong learning and competency-based education in the form of reflective portfolios. Changes in health care culture have promoted a move towards openness and reflection on challenging clinical encounters. ISSUE: Engagement with reflection has historically proved challenging to clinical educators. This Faculty Development Review examines this using a case study from the UK in which a postgraduate trainee was asked to disclose their reflective portfolio by a patient's legal representation. Critics have consequently questioned whether the educational benefit of reflection warrants these potential legal implications. In the context of pressure from accrediting bodies to demonstrate evidence of reflection, how can learners face this potential conflict of professional versus legal repercussions? EDUCATIONAL RATIONALE: We combine professional guidance from the UK and educational rationale from international settings to produce a guide for good practice. We offer guidance on facilitating reflection for learners in an open and honest way without diluting educationally effective critical reflection. Themes of anonymity, taking a balanced approach, seeking senior advice, focusing on learning outcomes and role-modelling are discussed. How can learners face this potential conflict of professional versus legal repercussions? TAKE-HOME MESSAGES: Integrating reflection within the curriculum improves engagement and is key to experiential learning. Clinical educators should be aware of legal and professional guidance applicable to their own context. Both educators and learners should be aware that written reflection is an educational not a clinical tool, and so requires little or no patient-identifiable data, thereby ensuring safer reflective practice.