How Do I Write a Reflection for Appraisal and Revalidation? A Guide for IMG Doctors
Every licensed doctor in the UK is expected to reflect on their practice, have an annual appraisal and revalidate with the GMC. Many international medical graduates (IMGs) reflect constantly but have never been asked to write it down, or to bring it to an appraisal. This guide explains what a good reflection looks like, how to keep it safe, and how it fits into appraisal and revalidation if you are not in a training post.
Quick answer
Write a reflection by keeping the description short and spending most of your words on learning and change. A simple structure is What? (brief, anonymised facts), So what? (why it happened, how you felt, what you learned) and Now what? (a specific change and how you will check it worked). Store it in your appraisal portfolio, never in the patient's record.
What you will learn in our free Reflective Practice, Appraisal and Revalidation course
'Evidence of reflective practice' and 'commitment to CPD' are on almost every NHS person specification. Learn how UK doctors reflect, prepare for appraisal and revalidate. Our free online Reflective Practice, Appraisal and Revalidation course is written for NHS doctors and international medical graduates. You study at your own pace in 6 short modules, with worked examples, interactive exercises and a short quiz at the end. There is no sign-up, and your progress is saved so you can stop and come back.
The 6 modules
Why reflection matters: What is reflective practice?, Why reflection matters, What can you reflect on?
How to reflect well: A simple model — What? So what? Now what?, Gibbs' reflective cycle, Good reflection vs weak reflection, Writing reflections safely, Your turn — write a reflection
Appraisal: how it works: What is NHS appraisal?, Preparing for your appraisal, The appraisal meeting
Supporting information: The six types of supporting information, CPD — what counts?, Significant events, complaints and compliments, Feedback from colleagues and patients
Revalidation: Revalidation — keeping your licence to practise, Revalidation for international doctors
Your PDP, CV and interviews: Your personal development plan (PDP), Reflection on your CV and at interview, Download your reflection and PDP
By the end of the course you will be able to
Explain why reflective practice matters for patient safety, learning and your career
Use a simple model (What? So what? Now what?) and Gibbs' cycle to write focused reflections
Write reflections that are honest, anonymised and safe, in line with UK guidance
Describe the purpose and process of NHS appraisal, and prepare for it
Collect the six types of supporting information the GMC expects
Explain revalidation, designated bodies, responsible officers and suitable persons
Write a SMART personal development plan
Describe your reflective practice confidently on your CV and at interview
Why it helps your NHS application
Write reflections that are short, useful and safe — with good and weak examples side by side
Understand appraisal, the six types of supporting information and revalidation before your first NHS post
Leave with a written reflection and a SMART development plan you can download
How to write it on your NHS application
In your CV and on NHS Jobs or Trac: list it under "Courses and CPD" (or in the training and courses section of the form), for example:
Reflective Practice, Appraisal and Revalidation, online CPD course, CareerPro UK. Certificate of completion, [month and year]; verifiable online, ID CP-XXXXXXXX.
In your supporting statement: show what you learned and how you use it. For example (adapt it so it is true for you):
"I reflect regularly using structured models, and I completed an online course on reflective practice, appraisal and revalidation so that my portfolio is ready for UK appraisal."
At interview: the course also prepares you for questions such as "Tell us about a mistake you made. What did you learn?"
Your certificate of completion
When you pass the quiz, you can download a certificate pack:
A verifiable PDF certificate of completion with your name, the course, your CPD time and a QR code that shortlisters and appraisers can scan
An appraisal-ready reflective note, pre-filled with the course learning outcomes
A ready-to-paste line for your NHS Jobs or Trac application and CV, and a one-click "Add to LinkedIn" button
Studying is free. The certificate pack is a one-off £5, and you pay only after you pass
Online course — does not replace GMC or designated body requirements for appraisal and revalidation.
What a reflection is, and what the GMC expects
Reflection is thinking about an experience in a structured way so that you learn from it and change, or confirm, what you do. It applies to things that went well as much as to mistakes. A difficult family meeting that went better than expected is worth reflecting on, so that you can repeat what worked on purpose.
The main UK reference is The reflective practitioner, guidance produced jointly by the Academy of Medical Royal Colleges, the Conference of Postgraduate Medical Deans (COPMeD), the GMC and the Medical Schools Council. In plain terms, it says:
Reflection matters for your wellbeing, your development and the quality of patient care.
There is no required number or type of reflective notes; the reflective process is what counts.
Notes should focus on learning outcomes and action plans, not a full account of events. Factual details belong in other records, such as incident reports and the clinical notes.
Reflection does not replace formal processes for reporting significant events or serious incidents.
Good Medical Practice (2024), which came into effect on 30 January 2024 and is organised into four domains, sets the professional standards your reflections can link to. Domain 1 is knowledge, skills and development; domain 2 is patients, partnership and communication; domain 3 is colleagues, culture and safety; and domain 4 is trust and professionalism.
Simple models: What? So what? Now what? and Gibbs
You do not need a complicated framework. Two models cover almost everything.
What? So what? Now what? This three-question model suits most everyday reflections on a case, a course, a piece of feedback or a hard shift.
What? Two or three factual, anonymised sentences.
So what? The real thinking. Why did it happen? Consider personal factors (knowledge, tiredness, assumptions) and system factors (handover, staffing, IT). What did you learn? Linking to a guideline or a senior's advice strengthens this part.
Now what? A specific action. "I will be more careful" is not an action; "I now check renal function before prescribing any renally cleared drug" is.
Gibbs' reflective cycle (1988). For a bigger or more emotional event, such as a serious incident, a death that affected you or a conflict with a colleague, Gibbs gives six stages: description, feelings, evaluation, analysis, conclusion and action plan. The separate "feelings" stage helps because fear or embarrassment often shapes what we do.
A useful rule for either model: if your description is longer than your learning and action, rewrite it.
A worked example: weak versus strong
Weak: "Busy night. Patient with chest pain on the ward. ECG done late because nurses were busy. Patient was fine. Learned to be quicker."
Stronger:
What? On a busy night shift, an ECG for a patient with new chest pain was done 50 minutes after my review because the request was not clearly communicated. The ECG was normal and the patient came to no harm.
So what? I had asked for the ECG in passing, without stating the urgency or naming a person, and I did not check it had been done. Delays in ECGs for chest pain can be dangerous. The busy ward was a factor, but so was the way I made the request.
Now what? I now ask a named person directly, state the urgency and set a time to check. I shared this at our junior doctors' meeting, and we added an "urgent ECG" prompt to the night handover sheet. I will ask the nurse in charge in a month whether delays have reduced. (Domain 3: colleagues, culture and safety.)
The stronger version is still short. It names no patient or colleague, separates facts from opinion, considers both personal and system factors, and ends with a change that helps others too.
Keeping reflections anonymised and safe
Some doctors worry that honest reflection could be used against them. The GMC states on its disclosure of reflective notes page that it does not ask a doctor to provide their reflective notes in order to investigate a concern about them. However, the same guidance explains that learning portfolios and revalidation records are not legally privileged, and that a court might request them if they are considered relevant. That is a reason to write carefully, not to stop reflecting.
Anonymise thoroughly. Leave out names, dates of birth, hospital and NHS numbers and bed numbers. The guidance notes that removing a name is often not enough if other details could identify someone in combination, such as a rare condition plus a date and ward.
Keep facts brief. Record what you learned, not a timeline. Full facts belong in the incident report and clinical notes.
Write about your own learning, not your judgements of colleagues. "The result was not seen until 8am" is factual; "nobody bothered to check" is opinion.
Store it in your portfolio or appraisal system, never in the patient's record.
Follow the formal route as well. If the event was an incident, report it through your trust's system and speak to your supervisor. If you are worried about any request for your notes, seek advice from your medical defence organisation.
Appraisal and revalidation for non-training doctors
Doctors in training follow the ARCP process. If you are a specialty doctor, a trust or clinical fellow, a locum or in another non-training role, you will normally have an annual whole-practice appraisal with a trained appraiser, usually another doctor who is not your line manager. Appraisal is a supportive, developmental conversation, not a test. In England it usually follows NHS England's Medical Appraisal Guide 2022 (MAG 2022).
According to the GMC, revalidation is how licensed doctors show they are up to date and fit to practise. Each year you collect supporting information and discuss it at appraisal; every five years your responsible officer makes a recommendation to the GMC, which then decides whether to revalidate you.
Designated body: the organisation that supports your appraisal and revalidation and appoints a responsible officer, usually your employing NHS trust. Locum agencies and independent providers can also be designated bodies.
Responsible officer (RO): an experienced senior doctor, often the medical director, who makes your revalidation recommendation to the GMC.
Suitable person: a GMC-approved licensed doctor who can make the recommendation if you have no responsible officer.
No connection at all: doctors with neither still have annual appraisals but must also submit an annual return to the GMC and complete a five-yearly assessment.
The GMC describes six types of supporting information: continuing professional development, quality improvement activity, significant events, patient feedback, colleague feedback, and compliments and complaints. Formal colleague and patient feedback are needed at least once in each revalidation cycle. Your reflections are what turn a pile of certificates into evidence of learning.
First steps for IMGs: in your first month, log in to GMC Online and check your designated body and revalidation date. If the connection is missing, contact your employer's revalidation team straight away. Ask when your first appraisal is due, and start a folder of anonymised reflections from your first week. If you change employer, check that the connection moves with you.
Using reflections on applications and at interview
Person specifications regularly ask for "evidence of reflective practice" and "commitment to CPD". A single specific example scores far better than the phrase itself. Interviewers often ask "Tell us about a mistake you made" or "How do you keep up to date?", and the same What? So what? Now what? structure works for spoken answers: keep the event short, show you were open and reported it, explain why it happened, and finish with a concrete change. Our guide to writing an NHS supporting statement as an IMG shows how to place these examples, and why NHS job applications get rejected covers common evidence gaps.
Our free Reflective Practice, Appraisal and Revalidation course walks you through writing your own reflection and a personal development plan (PDP), step by step. It is an independent study guide and does not replace GMC guidance or your designated body's requirements.
Start the free course
The course is split into short modules on why reflection matters, how to reflect well and safely, how NHS appraisal works, the six types of supporting information, revalidation, and writing a SMART PDP. It is free to study, includes a quiz, and offers an optional verifiable certificate and a reflective note for your appraisal: start Reflective Practice, Appraisal and Revalidation. If you would like your NHS application reviewed and rewritten (£35), email cvreviewexperts@gmail.com.
Frequently asked questions
How many reflections do I need for appraisal?
The GMC does not set a number of reflective notes. Quality matters more than quantity, so a few short, specific reflections that show learning and change are better than many brief entries.
Can the GMC use my reflections against me?
The GMC says it does not ask doctors for their reflective notes to investigate a concern about them. However, reflective notes are not legally privileged and a court could request them, so keep them anonymised, factual and focused on learning.
What is the difference between a designated body and a responsible officer?
The designated body is the organisation, usually your employing trust, that supports your appraisal and revalidation. The responsible officer is the senior doctor at that organisation who makes your revalidation recommendation to the GMC.
Which reflective model should I use?
What? So what? Now what? suits most everyday reflections and is quick to write. Gibbs' reflective cycle gives more structure for significant or emotionally difficult events because it has a separate stage for feelings.
How often do non-training doctors revalidate?
Revalidation normally happens every five years, based on annual whole-practice appraisals. You can check your revalidation date and connection in your GMC Online account.
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