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None of us are perfect. The practice of medicine involves lifelong learning and change. There is acquisition of facts, practical skills and wisdom such that we are never the same from one day to the next. Life and learning are like that in general. If I put my hand on a hot plate, I reflect on the result and I change my practice. Next time I can quickly demonstrate that a transformation for better practice has occurred. Clearly therefore, reflection is a natural part of human development, learning, growth and transformation.
Doctors have always reflected. It is implicit in their training. Doctors have never, however, had to prove this to those around them. Demonstration of reflective practice (RP) is now becoming a foundation of the annual appraisal process for medical practitioners. Hitherto it has been more of a procedural, tick box exercise with doctors bringing evidence of activities that could be construed as showing RP (table 1). Increasingly, however, the public is demanding evidence that there is a transformational process occurring and that there is improvement in service provision as a result of doctors’ activities, with real change for the better. I would argue that the whole of medical practice has grown and transformed over the decades because of the reflections of doctors. Morally it would seem entirely correct that doctors should reflect constantly on their activities so that they do the right thing. The General Medical Council (GMC) and Royal Colleges see it as part of personal integrity.1 Individual hospitals and health employers increasingly consider it vital to reduce errors, improve efficiency and give the public the quality service they deserve.