For many GPs, written reflection is an onerous process rather than beneficial to their learning, indicating its continued use in assessment needs to be critically examined.

Written reflection produced strong feelings among participants. Research is needed to gauge how commonly these feelings are held, to allow informed decisions on the place of written reflection in education and assessment.

BACKGROUND How did that go? How could I have done that better? We use reflection to help us process our feelings, and when something has gone wrong we try to understand why. The extension of this, reflection in medical practice, is a key part of our continuous learning and considered essential for professional competence. The General Medical Council (GMC) states that doctors 'should regularly reflect on their own performance'. 1 Reflection may be verbal (for example, through discussion with colleagues), internal (thinking about what we have done), or written (unstructured, for example, in a diary, or structured by use of a pro-forma). Most GPs do find reflection valuable, reporting that it is embedded into their daily routines-at work, on the way to and from work, and at home. Some feel that reflection can help with processing thoughts and feelings, describing it as 'therapeutic' and 'cathartic' in helping to process emotionally difficult situations. Reflective writing became an obligatory part of licensing and revalidation in the UK because it is thought to provide evidence of reflective thinking 2 and show that doctors are continuing to learn. Reflections on learning activities are verified at a yearly appraisal, helping to provide the evidence for the 5-yearly revalidation that allows an individual to continue to work as a doctor. 3 The Royal College of General Practitioners recommends that documentation of reflection on learning activities is necessary so that GPs can focus on the quality, rather than the quantity, of their appraisal supporting information, 4 though it points out that documented reflection should be brief and to the point. 5

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Background The Approaches and Study Skills Inventory for Students (ASSIST) questionnaire assesses whether learners prefer a deep, strategic or surface approach to learning. This study aimed to establish the effect of time since qualification, gender and work role on ASSIST scores of General Practitioners (GPs) and GP Specialist Trainees (GPSTs). Methods An anonymous online questionnaire with demographic questions and the ASSIST survey was completed by 1005 GPs and GPSTs from across the United Kingdom. Results Of the 544 GPs and 461 GPSTs completing the survey, 96.5% preferred a deep and/or strategic approach to learning. There was a significant increase in the preference for a deep approach with time from graduation and significantly less preference for a surface approach. There was no significant change in any of the scores over the GPST years. Men had significantly higher scores for a deep approach than women. Conclusions GPs and GPSTs prefer deep and strategic approaches to a surface approach. While higher levels of GP experience are associated with a higher deep approach score and a lower surface approach score, this change is not seen during progression through GP training. Men have higher scores for a deep approach than women.