Case reports, reflective practice and learning to succeed

Abstract

Twitter: @noellehealy; @Carrie_Murph ``I've missed more than 9000 shots in my career. I've lost almost 300 games. Twenty-six times, I've been trusted to take the game winning shot and missed. I've failed over and over again in my life. And this is why I succeed.´´--Michael Jordan.Performance is a key pillar of professionalism, and reflection is a vital cornerstone in improving and achieving consistent high level performance. Expert practitioners and other elite performers are able achieve high levels of performance due to the ability to work through elaborate mental models quickly and react to situations in a faster and more effective way. MalcomGladwell popularised the idea of needing an average of 10,000 h of practice at something to achieve these levels of mastery [1].However, the act of simply doing the task over and over again is not enough to achieve `elite´or `master´status. As the ancient Greek poet Archilochus wrote, ``we don't rise to the level of our expectations; we fall to the level of our training´´; more simply put: practice makes permanent, not perfect. So how do we, and the teams we work with, ensure we are getting the most out of the ways we practice or train?Sanders points to the fact that in medical practice the processing of the `mental models´mentioned above does not come simply from repeated exposure to a variety of clinical scenarios and situations, but also through `reflection-on-action´of these scenarios and their own beliefs and perceptions of the events and outcomes [2]. It is obvious then that being able to reflect on our performances, in both our successes and failures are an important factor in improving performance and performance outcomes.However, if these processes or events are seen as too formalisedor, worse, as merely a means to progression in training, there can be a reduced motivation for meaningful engagement [2]. This can result in missing out on not only development opportunities, but opportunities to enhance individual and team performance and ensure we develop a medical workforce that are more resilient in coping with failure and setbacks [3].In this editorial, we will consider how best to encourage and foster these moments of reflection, with a focus on the benefit of preparing and reviewing clinical cases, and how case reports can act as a tool for reflective practice. Fostering the right cultureMeaningful and purposeful reflection, be it alone, with a mentor, or as a whole team can be a challenging experience, especially if things have gone wrong. A recent editorial in this journal highlighted the benefit of the use of case reports for reflection of errors or adverse outcomes [4], so that we may all learn from each other's experiences. Notably, the authors rightly pointed out