Reflecting on the theory of being a pragmatic activist – published 31st Jan in BMA News

My wife and I got married 2 days after graduating  from Medical School and after our honeymoon we moved to a small town to start our junior doctor jobs in a smallish District General Hospital. The Postgraduate Dean, was however, really keen on educational theory and the first thing that he had us do was a psychometric test to find out what type of learners we were.


I had always thought I was a pragmatist. I like solving problems. In fact my wife often has to tell me that I need to stop and just listen to her instead of trying to solve any problems. Perhaps my patients would tell me the same if I listened long enough to them?


But of the psychometric test, I was pleasantly surprised that I scored equally on the ”Theorist”, “Pragmatist”, “Reflectivist” and “Activist” areas. Despite thinking I was a pragmatist learner, this made sense to me, because I seemed to learn in Medical School through lots of different ways; I didn’t write heaps of notes, but remembered lectures, looked up conditions I had seen in hospital at the end of each day, practised MCQ questions for hours and very occasionally read a textbook.


We were the first cohort to go through the Foundation Programme and part of that process was the dreaded, evidence-light portfolio. There were mandatory skills to have signed off, case discussions and recording of observed consultations. On top of these we were required to carry out reflective practice on cases that we had been involved with.


Both the case discussions and the consultation observations were analysed in a reflective style and so the emphasis of the portfolio was undeniably reflective. There was no other way to pass the portfolio, than being reflective. The portfolio requirements continued through our second year as doctors, on through GP training (as an e-portfolio) and now with my revalidation portfolio.


I had the opportunity to redo the same psychometric test during my GP training. Interestingly, to me anyway, I had found that I was no longer a well-rounded learner, but a “Reflective Learner”. This just left me with lots and lots of questions. Had all the reflecting I had done, that I had to do, in my career as a doctor forced me to become this type of learner? Or had I pragmatically become more reflective in order to jump through educational hoops? If I didn’t have to keep a reflective portfolio in the future, would my reflective tendencies reduce? Should medical students be better prepared for a life of reflective practice? Should future doctors be screened to make sure that they are able to learn in a reflective way? Or at least be pragmatic…



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