Reflecting on 360 degree feedback

Critical thinking is integral to the process of reflective practice.  No doubt all effective practitioners consider the probity of their actions with some care.  However, there are few opportunities to discover what others really think of one’s skills, knowledge and actions.  Behind the safe screen of anonymity, 360-degree feedback gives a rare opportunity for patients and colleagues to give honest and robust information pertaining to the performance and conduct of a doctor. It is therefore with some degree of trepidation that many of us submit ourselves to such scrutiny.  Most of us hope for no great shocks or surprises.  However, even if the truth hurts there can surely be no better impetus for change than the harsh reality of seeing oneself through another’s eyes.  When considering this kind of reflection suddenly the revealed truth of the mirror seems less challenging.

Clinical Example

A doctor is shortly to meet with his ‘Supportive Medical Colleague’ (SMC) and receives the following free text comments in his 360-degree documentation:

‘… tends to run late in clinics and does not do his fair share of the work…’ - colleague feedback

‘… seems to be more interested in writing his notes than listening to what I had to say…’ – patient feedback

The doctor is naturally disappointed with these comments and is a little down when he is greeted by his SMC.  They share their thoughts about the demands of modern practise. The doctor admits his obsession with detailed record keeping following a complaint the previous year in which he was criticised for the poor quality of his notes.  He identifies his desire to be increasingly patient-centred and to spend more time considering his patients’ thoughts and ideas but admits that efforts to be so seem to result in longer consultations. His colleague’s comment only serves to reinforce this concern. 

Doctor and lady holding a diary that she is writing in

The SMC shares his own thoughts about the many challenges and demands in the consultation and they consider approaches that might help to address these.  They discuss the option of writing the notes when the patient has left the room and the doctor decides also to arrange to video his consultations to observe his own actions and the effect this has on his patients.  His SMC directs him to an on-line module on ‘Advanced Communication Skills’ and the doctor agrees that this might be a useful way forward.  He also decides to meet with his close-working colleagues to discuss the organisation of the clinics and to consider ways in which they can ensure a fair division of labour. He wonders whether starting his clinic half an hour earlier will help him to meet his obligations.

Please click on the link below to view screenshots of MARS entries which reflect the example above.

Colleague Feedback

Patient Feedback

Reflection Tool: Reflection involves ‘critical thinking’.  The critical thoughts of others can be amongst the most challenging and the most revealing of all.  Lonely contemplation of such thoughts can be destructive whereas the considerations of others in a trusted environment can lead to more positive outcomes.  To make good choices and to add value one must read, enquire, debate and consider… (to paraphrase A C Grayling).



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