Reflecting in Pharmacy

It is the intention of health care to ‘do no harm’. Despite this, the World Health Organization (WHO, 2007) estimates that millions of people every year experience permanent injury or even death as a consequence of medical errors. This is particularly concerning as many errors are considered preventable. Often, these errors are related to the way medications are prescribed and used.

Medical errors can be partly attributed to the failure of many health practitioners to reflect on their professional practice. According to Mamede, Schmidt, and Rikers (2006) reflective practice “…can reduce [the] likelihood of failures in clinical reasoning for solving complex cases” (p. 144). It does this by enabling the practitioner to think critically about the way they apply knowledge to real life scenarios and reassess their clinical decision making with a view to becoming better practitioners.

This is the main reason why we practice reflection at Monash: to equip you to be an evidence-based, patient-centred practitioner.

What should you reflect about?

When reflecting on an experience (such as placement observations), you want to focus on one key skill that you used and can improve. You can choose any of the problem solving, oral and written communication, empathy, reflective practice, integrity, teamwork and inquiry (POWERITInq) skills to discuss:

Problem solving
Oral communication
Written communication
Empathy
Reflective practice
Integrity
Teamwork
Inquiry

Student sample reflection

Read the student reflection samples below on teamwork. Click the Comment icons next to each paragraph to show the structure of the writing. Click again to hide the comment.

What?

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I am going to reflect on last week’s one day placement visit at one of the larger hospitals in Western Melbourne.Describes what happened.

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I was very enthusiastic and excited to be given the opportunity to visit Western Health pharmacy service at the Footscray Hospital. Western Health pharmacy service is made up of three pharmacy departments that service Footscray Hospital as well as the Sunshine and Williamstown Hospitals.Describes the emotions felt.

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The day was divided between tours of the hospital’s dispensing, clinical pharmacy, and manufacturing and quality medicines services.Evaluates what was good or bad about the experience.

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We were introduced to the head pharmacists and intern pharmacists in each of these divisions, who spoke to us at length about how each of these specialised areas work together to provide medicine services to all inpatients.Analyses why the experience was good or bad.

So what?

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Something that I noticed is that each member of staff communicates in an open and methodical way. This collaboration within and between divisions enabled the running of a smooth and efficient workflow.Analyses the event.

I also noticed that within and between each division staff members communicate regularly using phones, internal intercom and emails. It is important for me as a pharmacist-in-training to practice communicating clearly, and I can do this now at university with my assessment group. As a student, this clear communication would mean ensuring my fellow classmates understand how work will be divided and progress on each individual section. This can only be achieved through regular meetings and an online taskboard, like Trello.

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As a pharmacist, I think clear communication is important because any requests I receive from doctors need to be communicated to the whole team so they understand changes in patient medication regimes. Clear communication would also allow me to ensure I am completing tasks correctly: By communicating what I am doing or what assistance I require, I can ensure I receive appropriate training in medication dispensing, quality and safety, and thus be able to provide patients with the best advice and products. Clear communication in a hospital pharmacy team also helps minimise errors in dispensing medication, and in ensuring everyone understands the best way to advise on taking medications.Analyses how the event relates to Pharmacy.

Now what?

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Teamwork is part of everyday life, and good teamwork leads to better communication and achieving desired goals. Watching the hospital pharmacy teams interact with each other made me realise I need to focus more on developing my own interpersonal and teamwork skills, as I am quite shy and find speaking and leading in groups challenging. As such I am going to focus on my own teamwork dynamic at university.Reflects on proposed actions to improve.

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In order to improve my teamwork skills, I am going to volunteer to lead this week’s meeting for my group assignment, which is on Thursday. This leadership role will require me to organise my group’s work load for that week and ensure everyone shares tasks properly. It will require me to speak to each teammate and facilitate open discussion if issues arise. To ensure I am communicating effectively, I will ask my teammates for feedback on how I communicated, and ask them for feedback on how I can improve. I can measure improvement by then seeing what I still need to work on, and asking to lead a future meeting, so I can compare feedback.Proposes actions to improve.

Feedback

It can sometimes be daunting to receive feedback on not only your writing, but also on how you have reflected on a personal experience.

It’s important to remember that the feedback you receive from your lecturers is there to help you improve not only your reflective practice, but also the skills you will need as a pharmacist.

It’s therefore important to not take feedback personally, and rather look at it as a way to professionally grow.

Keep Start Stop

Your feedback will often be given to you using the ‘Keep Start Stop’ method. Below is an example of the feedback given to the above reflection example. Click the Comment icons next to each section to understand the components of SMART goals. Click again to hide the comment.

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KEEP - writing these honest reflections. The more you practice the better you will become in refining and improving your reflective skills. Continue to reflect on the differences and similarities between people working in different departments, as it will be interesting to reflect on whether this is related to team dynamics and/or staff selection.The Keep section is where your skills coach, lecturer, or tutor will highlight what you’re doing well in your reflections, study, and professional practice. They may make recommendations on what you can focus on in future weeks as well, as this marker has done regarding the following week’s actions.

Also continue thinking about your actions for the following week: you have mentioned honing your teamwork skills through leading a meeting, so I am interested to hear how you found the experience. From what I can see, your day at the Hospital Pharmacy was an excellent learning opportunity and has encouraged you to challenge yourself and improve your communication skills - remember this push, as a pharmacist never stops learning!

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START - to consider how you will write your reflections in regards to the different roles that pharmacists have within a hospital environment. To do this, keep a record on your next hospital placement so you can note how efficiently teams work together. Pay particular attention to the language and tone used by professional staff.The Start section is where you will be encouraged to try reflecting in a new way, or engaging with your chosen skill more. Here, the emphasis is on teamwork and communication, and thus the lecturer is highlighting the importance of looking to others to learn about professional communication and conduct.

It is great to see that you are reflecting on different ways teamwork can influence how you can refine your communication and reflective skills, and that you’re actively trying to improve. I would like to see your reflection on teamwork between your own experience of leadership and through observing the pharmacists in the Hospital Pharmacy team.

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STOP - and think about what you have learnt during this one day placement.The Stop doesn’t mean you need to stop doing something (though it sometimes might). It is there to highlight areas which need additional focus or improvement. In this case, the student is asked to take time to reflect more deeply in preparation for their next placement, and how learning from the placement can help them cope with the continued stresses of their degree.

How will you plan so you turn your intentions into actions in your next hospital placement? Additionally, how can you implement time management and dealing with unexpected pressure in regards to your university studies and completing your degree?

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It is great to see that you are aiming to be proactive in improving your teamwork skills. Always remember that your strategies in your Now what? section should be SMART (Specific, Measurable, Achievable, Realistic and Timely). Keep up the great work!Always remember that your coaches and lecturers want you to succeed and do well; their comments are there to push you to achieve more and become the best pharmacist/scientist possible.

Agreed Actions

Agreed actions in your Personalised Learning Plan (PLP) are the actions that you have taken into consideration once you have received the comments from your Skills coach. A simple way to address your agreed actions is to write a SMART goal for your proposed action.

For example, your Skills coach has commented on the use of practical ways to record your feedback so that you can at a glance see and act upon your learning as a whole. The agreed action that you have decided on could be using MyPharm as a repository, even if you are not reflecting upon something that was addressed in your feedback within a particular cycle.

Agreed actions example

Below is the Agreed Action plan the student wrote in relation to their feedback. Click on the speech bubbles to learn more about the structure of the Agreed Action.

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As I had planned, I led a team meeting and organised my group’s work load for that week. Doing this made me more aware of the importance of reflection, as I had to think about how my actions were impacting my teammates, as there was some push-back from members who were not keen on doing certain tasks.The Agreed Action is like a mini-reflection in itself, where you focus on a skill which either you or your coach identified needed more work. In this case, the student is looking at teamwork, but is applying reflection (Problem solving) to assist with analysing the skill more deeply.

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I kept this in mind as I watched the pharmacists during my next hospital placement. I noted that the team interacted closely with each other and shared tasks according to their own individual skills and attributes, which meant work was allocated according to each team member’s strengths.The student has obviously made notes while at the placement and is reflecting back on what they experienced, in a team: the importance of relying on each other’s strengths to complete work in a timely manner. This addresses the feedback of working on their own teamwork skills and on time management, as well as the link between teamwork and communication.

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Seeing this made me realise that teamwork, and leading a team, is not just about assigning work and making sure it gets finished on time; it is also about being able to facilitate a healthy working environment where team members are able to voice their concerns and interests, and have their needs met. By allowing team members to work to their strengths, the head pharmacist ensured that the team worked collaboratively and efficiently. This most recent placement, therefore enforced the importance of teamwork and communication in health care for me.The student here reflects on what they have learned during the last fortnight. This sentence demonstrates how the importance of teamwork in the healthcare profession has been solidified for the student.

References

Australian Commission on Safety and Quality in Health Care. (2013). Literature review: Medication safety in Australia. https://safetyandquality.gov.au/wp-content/uploads/2014/02/Literature-Review-Medication-Safety-in-Australia-2013.pdf

Borton, T. (1970). Reach, touch, and teach: Student concerns and process education. McGraw-Hill.

Holm, D. & Stephenson, S. (1994). Reflection- A student’s perspective. In A. Palmer, S. Burns, & C. Bulman, (Eds.), Reflective practice in nursing: the growth of the professional practitioner (pp. 53-62). Blackwell Scientific Publication.

IpAC Unit. (n.d.). Interprofessional learning through simulation. Reflective practice: A tool to enhance professional practice. Edith Cowan University. https://www.ecu.edu.au/__data/assets/pdf_file/0011/376958/User-Manual-Reflective-Practice-FINAL.pdf

Mamede, S., Schmidt, H., & Rikers, R. (2006). Diagnostic errors and reflective practice in medicine. Journal of Evaluation in Clinical Practice, 13(5), 138-145. https://doi.org/10.1111/j.1365-2753.2006.00638.x

Thamby, S. A. & Subramani, P. (2014). Seven star pharmacist concept by World Health Organisation [editorial]. Journal of Young Pharmacists, 16(2),1-3. https://doi.org/10.5530/jyp.2014.2.1

World Health Organization. (2007). WHO launches ‘nine patient safety solutions'. http://www.who.int/patientsafety/events/07/02_05_2007/en/