How to choose what to write about in a reflective account

Most clinicians do not get stuck on how to reflect. They get stuck on what to reflect on. You sit down to write a reflective account for your portfolio or your revalidation, the cursor blinks, and every experience from the last two years feels either too small to bother with or too big to face. The choice of experience is the part people skip past, yet it quietly decides how useful the finished account will be.

A well chosen experience does half the work for you. A poorly chosen one leaves you padding out a description of something you learned nothing from. This is a short, practical guide to choosing well.

Why the choice matters

Reflection is a way of turning experience into learning you can show. If the experience you pick did not actually teach you anything, no reflective model will rescue it. You will end up describing events rather than reflecting on them, which is the single most common weakness in reflective writing.

The opposite is also true. When you pick an experience that genuinely changed how you think or practise, the writing tends to flow, because you are describing something real that happened inside your own head. The learning is already there. You are just putting it into words.

What makes an experience worth reflecting on

You are looking for an experience with something to learn from. In practice, the strongest candidates share one or more of these features.

• A decision point. A moment where you had to choose between options, especially under uncertainty or time pressure.
• A surprise. Something that did not go the way you expected, whether the outcome was good or bad.
• Feedback. A comment from a patient, a relative, a colleague or a supervisor that stuck with you, or that you initially disagreed with.
• A change in practice. Something you now do differently, and can point to the reason why.
• A near miss or a good catch. An error that was caught before it reached a patient often teaches more than a smooth shift.
• A genuinely positive outcome. Reflection is not confession. A case that went well, and that you can explain, is a legitimate and underused choice.

If an experience has none of these, it is probably a weak choice, however dramatic it was.

What the regulators actually ask you to choose from

Knowing the boundaries of what counts makes the choice easier.

If you are registered with the NMC

NMC revalidation asks for five written reflective accounts. The NMC says each one can be about your continuing professional development, a piece of practice-related feedback, or an event or experience in your practice, and in each case how it relates to the Code. The Code is built around four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust.

The NMC is clear that these accounts do not need to be lengthy or written in an academic style. You can simply note what you learned, how it changed your practice, and how it relates to the Code. You must also be careful not to include anything that could identify a patient, a service user or a colleague.

If you are registered with the HCPC

The HCPC does not set a number of reflections or tell you how often to reflect. Reflection is one of the activities that can count towards your continuing professional development, and there is no set way to do it. The HCPC provides a reflective practice template and a summary of models, but you are free to adapt them to your role.

The HCPC's own guidance emphasises quality over quantity, and makes the point that reflection is valuable for positive experiences as well as difficult ones. So your task is not to find the most serious incident you can. It is to find the experience you can learn the most from.

A simple method for choosing

If you are staring at a blank page, do not try to pick the perfect experience in one go. Do this instead.

1. List five or six candidate experiences from the last cycle. Do not judge them yet. Just get them down.
2. Score each one out of five for learning. How much did it actually change your thinking or practice?
3. Score each one for relevance to your scope of practice, and for the NMC to the Code.
4. Check each one for safety. Can you write about it without identifying anyone? Is it currently the subject of a complaint, investigation or legal process? If so, take advice before using it.
5. Pick the highest scorer that is safe to write about. Not the most dramatic. The most instructive.

A worked example

A community practitioner needs one more reflective account and lists three options: a cardiac arrest attended months ago, a routine medication review, and a challenging conversation with a relative who disagreed with a discharge decision. The arrest scores low for learning, because it went by the book and taught little that was new. The medication review scores moderately. The difficult conversation scores highest: it forced a change in how the practitioner explains decisions to families, links clearly to communication and to preserving trust, and can be written up with all identifying details removed. The practitioner chooses the conversation. The dramatic case was the obvious pick, but the instructive one made the better account.

Experiences to approach with care

Some experiences are better suited to a different setting than a written account for audit.

• Your most distressing case. If an experience is still raw, a formal account for audit is not the place to process it. Reflection should help you learn, not force you to relive distress. Choose something you have enough distance from to think clearly.
• Anything under investigation. If an incident is the subject of a complaint, a coroner's process or an employment matter, speak to your union or manager before writing anything down.
• Anything you cannot anonymise. If removing the identifying details would leave nothing meaningful, pick a different experience.

If reflecting on a difficult shift brings up more than you expected, that is worth taking seriously rather than pushing through. Your occupational health service and your union are there for exactly this. The Samaritans are also available at any time, free, on 116 123.

Once you have chosen

When you have your experience, the rest gets easier. Pick a model you are comfortable with, write in your own voice, keep it anonymised, and focus on the learning rather than the retelling. The account does not need to be long. It needs to be honest and specific.

Choosing well is most of the battle. Get the experience right and the reflection tends to write itself.

Reflectory is built for the moment after you have chosen your experience. It interviews you about it, one question at a time, and turns your answers into a reflective account in your own words, with identifying details screened out and an AI assistance disclosure built in. You stay the author. If the blank page is the hard part, it can help.