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Managing the threat to reflective writing
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  1. John Launer
  1. Correspondence to Dr John Launer, Associate Editor, Postgraduate Medical Journal, London, UK; johnlauner{at}aol.com

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Reflective writing in medical education is facing a significant threat. This has resulted from a tragic and very high profile case in the UK involving the death of a child.1 Many readers will already be familiar with the case of Jack Adcock, a 6-year-old boy with Down’s syndrome and cardiac problems who died of sepsis. They are also likely to know the name of the paediatric trainee who cared for him, Dr Hadiza Bawa-Garba. The main details of the case are that Dr Bawa-Garba made some individual errors in caring for Jack, in a wider context that also involved mistakes and misunderstandings by others, as well as multiple systems failings and staff shortages. She was subsequently found guilty of manslaughter through gross negligence and given a suspended prison sentence. Initially she was also suspended from the medical register for 1 year but was then struck off following an intervention by the General Medical Council (although this is pending an appeal). These judgements were welcomed by Jack’s family and sections of the British press, but have led to a range of serious concerns among doctors, particularly those in training.

One of these concerns relates to the capacity of courts and juries to make fair judgements about highly complex clinical events.2 Another is the legal risk that individual doctors face when working within depleted or even dysfunctional work settings, as they increasingly do in the UK. However, the reason that reflective writing has come under threat is because some reflections written down in the days following Jack’s death may have contributed in some way to Dr Bawa-Garba’s conviction and erasure. Medical trainees are now questioning whether it is still …

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