How honest reflection fuels performance

How often do you walk out of an exam room, a meeting with your board of directors or interaction with an employee and take the time to ask yourself, "How could that have gone better?"

Chances are there isn't time for immediate reflection, and a myriad subtle opportunities for improvement are far from mind by the time you're driving home.

It can be even more difficult to own up to missteps as the stakes get higher. Take a communication breakdown at one of the worst possible moments, such as while giving a patient bad news. When it goes poorly, it's upsetting for doctor and patient. Nobody gets to do that moment over, and there are more patients to see. So just move on, right?

Wrong, according to a new report in the Journal of Health Communication that found medical students who make a conscious effort to reflect on some of the moments they might rather forget can vastly improve their communication skills.

For the research, study directors asked 33 family medicine residents in the Tufts University Family Medicine Residency program at Cambridge Health Alliance to write "open-ended reflections" over the course of one year examining their interactions with patients. Sample entries from different phases of the project included the following:

  • I told him these events could predict dementia. He looked at me blankly and said, "events?" I realized that I have to avoid BOTH jargon and ambiguous language.
  • I wonder what point I could have picked up the right clue that he was stressed and depressed by his family situation ...
  • How do I engage the patient experience rather than trying to get to [the] "right" answer as fast as possible?

"When new physicians notice and make sense of what they may have missed in a patient interaction, they may be prompted to move forward in a different way, instead of unconsciously allowing that behavior to become the norm in future patient interactions," senior author Allen Shaughnessy, Pharm.D., M.Med.Ed., professor of family medicine at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance, said in a statement.

But these opportunities for growth are not limited to new doctors or doctors at all. And admitting imperfections does not signal incompetence.

Remember, the best of the best pilots in the world follow this practice as a daily habit. As John Foley, former lead solo pilot with the Blue Angels, explained at a recent Medical Group Management Association Conference, at the end of every practice or performance, all of the Blue Angel pilots gather in a room for a debriefing, in which they acknowledge and hold themselves accountable for any mistakes. One by one, each pilot owns up to what wasn't perfect and explains how he or she will make it better.

It takes courage to take an honest look at your work after you've put so much of your heart into it. But whether you start making a more formal effort to acknowledge and learn from your own mistakes or attempt a debriefing exercise as a practice, you'll be giving yourself the opportunity to soar higher than you may have dared imagine. - Deb (@PracticeMgt)