Why does reflection matter for appraisal and revalidation?
Licensed doctors in the UK revalidate with the General Medical Council (GMC), normally every five years. To do so you take part in an annual appraisal covering your whole scope of practice, and your responsible officer makes a recommendation to the GMC. Reflection is what turns a folder of certificates and feedback forms into evidence that you are learning and keeping up to date.
The GMC's guidance on supporting information asks you to collect certain types of information, reflect on it, and discuss it with your appraiser. Without reflection, a course certificate shows only that you attended. With it, the certificate shows what you learnt and how your practice changed.
What do I need to reflect on for GMC revalidation?
The GMC lists six types of supporting information. Over your revalidation cycle you collect each type, reflect on it and discuss it at appraisal.
| Supporting information | What the GMC expects (summary) |
|---|---|
| Continuing professional development | Ongoing learning across your whole scope of practice, with reflection on what you learnt and its impact. |
| Quality improvement activity | Involvement in activity that reviews and improves care, such as audit, case review or a QI project, with reflection on the results. |
| Significant events | Declare and reflect on every significant event you were involved in since your last appraisal. If there were none, say so. |
| Feedback from patients or those you care for | Collected once per revalidation cycle, with reflection on what it tells you. |
| Feedback from colleagues | Collected once per revalidation cycle, with reflection. |
| Compliments and complaints | Declare and reflect on all formal complaints since your last appraisal, and reflect on other feedback where it offers learning. |
Your appraisal portfolio also includes items such as your personal details, a description of your practice, previous appraisal records, a personal development plan, and probity and health statements. Local appraisal systems vary, so check what your designated body asks for.
How do I structure a reflection for appraisal?
The GMC does not require a set format. Guidance produced jointly by the GMC, the Academy of Medical Royal Colleges, COPMeD and the Medical Schools Council offers a simple three-part template: what, so what, and what now. Most appraisal systems use similar headings.
- What?: In two or three sentences, describe the learning activity, event or feedback. Keep it brief and non-identifying.
- So what?: Explain why it mattered. What did you learn about the topic, about yourself, or about the system? How might it affect patients?
- What now?: Say what you have done or will do differently, and how you will know it has made a difference. Link it to your personal development plan where relevant.
Some doctors like to link each reflection to the four domains of Good Medical Practice, which has applied since 30 January 2024: knowledge, skills and development; patients, partnerships and communication; colleagues, culture and safety; and trust and professionalism. This is optional, but it helps you see gaps across your portfolio.
Example: a weak and a strong appraisal reflection
The fictional example below is about patient feedback for a specialty doctor in an outpatient clinic. Both versions are short. The difference is in specificity and action.
I received my patient feedback this year. Most of the scores were good and above the average. A few patients said they felt rushed. I will try to spend more time with patients. Overall I am pleased with the results.
What: My patient feedback was mostly positive, but four free-text comments said appointments felt rushed and two said they left unsure about the next steps. So what: I had focused on the scores and nearly missed this pattern. On reflection, I usually summarise the plan while typing the clinic letter, so patients may not hear it clearly. Patients who leave unsure are less likely to follow plans or know when to seek help. What now: I now stop typing for the final two minutes, summarise the plan in plain language, and ask the patient to tell me what they will do next. I have started offering a copy of the clinic letter to every patient. I will ask the clinic nurse for informal feedback in three months and review the comments at my next feedback round.
How do I reflect on CPD and quality improvement?
CPD and quality improvement are where most doctors have the most material, and where reflection is most often thin. You do not need to reflect on every lecture or e-learning module. Choose the activities that changed what you do, confirmed a practice you were unsure about, or exposed a gap.
- For a course or conference, name one or two specific points you took away and how you have used them since.
- For reading, say what prompted it, such as a clinical question from a patient, and what you concluded.
- For an audit or QI project, describe your role, what the results showed, what changed, and whether a re-audit is planned.
- For teaching you delivered, reflect on the feedback and what you would change next time.
- For learning with peers, such as case discussions or learning sets, note how colleagues' views changed your thinking.
Try to show a link between your learning and your personal development plan. For example, if last year's plan included improving your confidence with a particular procedure, your CPD reflections this year should show progress towards that goal. Appraisers find it much easier to sign off a plan when the reflections tell a clear story from one year to the next.
How should I reflect on a significant event or complaint?
The GMC defines a significant event as any unintended or unexpected event that could have harmed, or did harm, one or more patients. Your organisation may call it a patient safety incident or serious incident. You must declare every one you were involved in, including as part of a team, but you can focus the discussion on those with the most learning.
- Keep the facts brief. Detailed factual accounts belong in the incident report and clinical record, not your reflection.
- Say what your role was and what you learnt, including any human factors, such as fatigue, handover or workload.
- Describe what changed, for you and for the system, and your part in any review or governance meeting.
- If the event is part of a pattern, say so. The GMC expects you to be aware of patterns in events recorded about your practice.
- For complaints, focus on what the patient's experience taught you, even if you disagree with parts of the complaint.
Can my reflections be used against me?
This is one of the most common worries, especially since high-profile cases in recent years. The joint reflective practice guidance says the GMC does not ask doctors for their reflective notes to investigate a concern. It focuses on facts and evidence.
The same guidance points out that recorded reflections are not legally privileged. A court may ask for them if they are relevant. This is why reflections should rarely include factual details that are not already recorded elsewhere or discussed with the patient or family.
- Anonymise patients and colleagues.
- Focus on learning, not a detailed account of the case.
- Never write anything you would not be comfortable explaining.
- Take advice from your defence organisation, employer or legal adviser if a disclosure request is made.
Common mistakes, and tips for international medical graduates
Doctors who trained outside the UK sometimes come from systems where appraisal was a formality or where admitting a gap felt risky. In UK appraisal, honest reflection on difficulties is expected and is not a mark against you.
- Uploading certificates with no reflection, or the same sentence for every item.
- Reflecting only on positive feedback and skipping the uncomfortable comments.
- Leaving everything until the week before appraisal, when the learning is no longer fresh.
- Covering only part of your practice. Include private, locum, teaching or management work too.
- Using long academic language. Plain and specific is better.
- Making plans with no follow-up. Next year, reflect on whether last year's changes worked.
Where to go next
If you want more structured practice, How to Write a Reflective Account (GMC, NMC, HCPC) includes further worked examples using common models. Appraisal and Revalidation Explained walks through how appraisal works and what evidence each regulator expects. Good Medical Practice: Professional Standards for Doctors applies the four domains to everyday clinical situations, which can help you link your reflections to the standards. Always check current GMC guidance and your designated body's local requirements.
Frequently asked questions
How many reflections do doctors need for appraisal?
The GMC does not set a number. You need to reflect on each type of supporting information across your revalidation cycle, and on every significant event and formal complaint since your last appraisal. Quality matters more than volume. A few well-chosen reflections that show learning and change are more useful than many brief ones.
Do doctors need 50 CPD credits a year?
No. The Academy of Medical Royal Colleges' 2023 CPD principles say there is no regulatory requirement to collect a particular number of CPD credits each year. Some Royal Colleges still give guidance on credits, so check your college. What matters for appraisal is that your CPD covers your whole practice and that you reflect on it.
What if I have had no significant events this year?
The GMC says you must state this at appraisal. You should then reflect on your local significant event or serious incident process, or on what you do to reduce the risk of events happening. This shows engagement with patient safety even without a specific incident.
How often do doctors need colleague and patient feedback?
Once in each revalidation cycle, which normally lasts five years. You should reflect on the results and discuss them at appraisal. Many doctors collect feedback earlier in the cycle so there is time to make changes and show the effect before revalidation.
Does the GMC ask for reflective notes in fitness to practise cases?
Joint guidance from the GMC and partners says the GMC does not ask doctors for their reflective notes to investigate a concern. However, reflections are not legally privileged and a court can request them. Keep reflections anonymous and focused on learning, and get advice from your medical defence organisation if a request is made.
What is a good structure for a doctor's reflective note?
A simple structure is what, so what, and what now. Briefly describe the event or activity, explain why it mattered and what you learnt, then say what you will do differently and how you will check the change has worked. Many appraisal systems use headings similar to these.
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…
Appraisal and Revalidation Explained
This course explains the difference between appraisal and revalidation, and sets out what the GMC, NMC, HCPC and GPhC each expect from the…
Good Medical Practice: Professional Standards for Doctors
This course explains the GMC's Good Medical Practice (2024), the core standards every doctor registered in the UK must follow. It works through the…
Sources and further reading
- Guidance on supporting information for appraisal and revalidation. General Medical Council.
- The reflective practitioner: guidance for doctors and medical students. Academy of Medical Royal Colleges, COPMeD, GMC and Medical Schools Council.
- Core principles for continuing professional development (2023 update). Academy of Medical Royal Colleges.
- Colleague and patient feedback for revalidation. NHS England.
- Good medical practice (2024). 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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