What is the What? So What? Now What? model?
It is one of the simplest reflective models used in UK healthcare. You answer three questions in order. Each moves you one step further from the event itself towards learning and action.
- What? Describe the experience: what happened, your role and the outcome.
- So What? Make sense of it: why it happened, what it shows about your practice, and what you now understand.
- Now What? Decide what you will do next, and how you will make sure it happens.
The three stem questions came from the American educator Terry Borton in 1970. John Driscoll, a UK nurse educator, developed them for clinical supervision and practice in 1994 and in later editions of his work. He linked the questions to an experiential learning cycle and added trigger questions for each stage. Rolfe and colleagues published a similar framework in 2001, so you may see the model credited to Borton, Driscoll or Rolfe depending on the source.
What questions do you ask at each stage?
The prompts below are paraphrased from common versions of the model. You do not need to answer every one. Pick the prompts that help you think about this particular experience.
| Stage | Purpose | Useful prompt questions |
|---|---|---|
| What? | Describe the experience | What happened? What was my role? What was I trying to achieve? What did others do? What was the outcome? How did I and others feel? |
| So What? | Interpret and analyse | Why did it happen this way? What was driving my decisions? What does it show about my knowledge, attitudes or practice? What guidance or evidence is relevant? What could I have done differently? |
| Now What? | Plan action | What will I do differently next time? What support or learning do I need? What might get in the way? How will I know it has worked? |
Example 1: a communication difficulty with a family
The following examples are fictional and anonymised. They show how the model works in a short reflection, the kind you might write for a portfolio or bring to supervision.
A relative of an older patient on a rehabilitation ward became angry during visiting. She said nobody had told her about a planned discharge date. I was the physiotherapist on the ward that afternoon. I explained the patient's progress, but she said she felt "talked at" and asked to speak to someone senior. I arranged for the nurse in charge to join us, and we agreed a family meeting for the next day.
Looking back, I answered her questions with clinical detail before I had acknowledged her worry. She had been left out of a decision that affected her, and she wanted that recognised first. Our discharge planning relied on the patient passing on information, but the patient had mild memory problems. I also realised that I become more technical when I feel defensive. Guidance on shared decision-making, and our ward's own discharge standard, both say families should be involved early where the patient wishes.
I now start difficult conversations by naming the person's concern before giving information. I suggested at the team meeting that we confirm, for each patient, who the family contact is and whether they have been told about discharge plans. I will ask my clinical supervisor to observe a family conversation within the next two months and give feedback.
Example 2: a short reflection after a positive experience
Reflection is not only for mistakes. UK regulators encourage reflection on positive experiences too. Here is a brief example from a junior doctor.
What? On a night shift I recognised a deteriorating patient early, from a rising early warning score and a subtle change in behaviour, and escalated to the medical registrar. The patient was treated for sepsis promptly. So What? I acted early because I had recently attended a deterioration teaching session, and because I trusted the nurse's concern even though the observations were borderline. It showed me that nursing judgement is valuable information, not just a prompt to check. Now What? I will keep asking nurses directly what is worrying them. I have offered to share the case, anonymised, at the next foundation teaching session.
Weak versus strong: how to deepen your So What?
Here is the same So What? written two ways, based on Example 1.
The relative was upset because she had not been told about discharge. Communication could have been better.
I gave clinical detail before acknowledging her concern, and I become more technical when I feel defensive. The bigger gap was a system one: we relied on a patient with memory problems to pass on discharge plans. That explains why she felt excluded and shows two separate things to change, my approach and the team's process.
The strong version explains causes, looks honestly at personal behaviour, and spots a system issue. It also leads naturally into a specific Now What?, rather than a general promise to communicate better.
When should I use this model rather than Gibbs?
Both models are widely accepted. Neither is required by the GMC, NMC or HCPC. The choice is about fit.
| Situation | What? So What? Now What? | Gibbs' cycle |
|---|---|---|
| Quick reflection after a shift or teaching session | Good fit, fast to write | Can feel too long |
| Clinical supervision or a reflective discussion | Good fit, easy to talk through | Works, but more structured |
| Significant event or serious incident | Works if the So What? is thorough | Good fit, prompts feelings and evaluation separately |
| Evidence of insight after a complaint or concern | Works with depth and specific actions | Good fit for a detailed account |
One practical point: because the model is short, it is easy to rush. If you use it for something serious, make sure So What? covers your feelings, the contributing factors and the relevant standards, which Gibbs prompts for as separate stages.
What are the most common mistakes with this model?
Because the model is so simple, the same few problems come up again and again. Checking your draft against this list usually improves it quickly.
- Spending most of the words on What? and leaving So What? as a single line.
- Writing So What? as a judgement ("it went badly") rather than an explanation of why.
- Leaving out feelings altogether, even when they clearly shaped what you did.
- Blaming others or the system without looking at your own part, or blaming only yourself and ignoring system factors.
- A Now What? that is a general promise, such as "communicate better", with no specific action, timescale or way of checking it.
- Including names, dates or unusual details that could identify a patient or colleague.
A simple test is to read your Now What? on its own. If a colleague could not tell what you will actually do differently on your next shift, it needs more detail. Another test is to ask whether your So What? would make sense to someone who was not there. If it relies on them already knowing why things went wrong, it is not yet explaining enough.
Using the model in supervision and revalidation
Driscoll developed his version with clinical supervision in mind, and it still works well there. A supervisee can bring a What?, and the supervisor helps them explore the So What? with open questions rather than answers. The Now What? then becomes a shared plan that can be reviewed at the next session.
- For NMC revalidation, the model can help you plan each of your five written reflective accounts, which are recorded on the NMC form and linked to the Code.
- For GMC appraisal, it suits shorter reflections on CPD, feedback or significant events.
- For HCPC CPD, it can structure the reflective parts of your profile if you are selected for audit.
- In every case, anonymise. Write about roles, not names, and focus on your learning.
Where to go next
How to Write a Reflective Account (GMC, NMC, HCPC) gives guided practice with this model and Gibbs, including feedback on depth and anonymisation. If you need to show insight after a concern, Insight and Remediation: Building Your Evidence explains how reflections fit with other evidence such as training and testimonials. If you supervise others, Clinical Supervision and Giving Feedback shows how to use the three questions to support a colleague's reflection.
Frequently asked questions
Who created the What? So What? Now What? model?
The three questions were first posed by Terry Borton in 1970. John Driscoll developed them for nursing and clinical supervision from 1994, adding trigger questions for each stage. Rolfe and colleagues published a similar framework in 2001. Most UK health sources call it Driscoll's model or the What model.
What is the difference between Driscoll's model and Gibbs' reflective cycle?
Driscoll's model has three stages and is quick to use. Gibbs' cycle has six stages and separates feelings, evaluation and analysis. Driscoll suits shorter reflections and supervision. Gibbs suits fuller written reflections on significant events. Both are accepted, and no UK regulator requires one over the other.
What goes in the So What? section?
So What? is the analysis. Explain why things happened, what drove your decisions, what it shows about your knowledge, skills or attitudes, and which guidance or evidence is relevant. Note personal and system factors. This section should usually be the longest part of the reflection.
Can I use What? So What? Now What? for NMC revalidation?
Yes. The NMC does not require a particular model. You need five written reflective accounts on the NMC form, each linked to the Code, and a reflective discussion with another NMC registrant. The three questions are a useful way to plan each account before writing it on the form.
How long should a What? So What? Now What? reflection be?
There is no set length. A short reflection after a shift might be a few hundred words. A reflection after a serious incident or complaint usually needs more depth, particularly in So What? Aim for enough detail to show genuine understanding and specific actions, not a word count.
Can I reflect on something that went well?
Yes, and you should. The UK regulators' joint statement on reflection encourages reflecting on positive as well as negative experiences. Reflecting on what went well helps you understand why, so you can repeat it and share it with your team.
Related courses
How to Write a Reflective Account (GMC, NMC, HCPC)
This course teaches you how to write reflective accounts that show genuine learning, for appraisal, revalidation, CPD and, where needed, a regulatory…
Insight and Remediation: Building Your Evidence
This course explains what UK healthcare regulators mean by insight and remediation, how they are assessed at each stage of a fitness to practise…
Clinical Supervision and Giving Feedback
This course explains the different kinds of supervision used in UK healthcare, how to set up a supervisory relationship that works, and how to give…
Sources and further reading
- Driscoll's model of reflection (critical reflection learning object). University of Nottingham.
- What? So what? Now what? (Reflectors' Toolkit). University of Edinburgh.
- Benefits of becoming a reflective practitioner (joint statement). Chief executives of the UK statutory health and care regulators.
- Reflective practice guidance for revalidation. Nursing and Midwifery Council.
- The reflective practitioner: guidance for doctors and medical students. General Medical Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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