Reflective practice at the CT1 anaesthetics interview means telling one real story, saying what it changed, and showing you know the rules about recording reflection. ANRO's 2026 scoring guidance defines the domain as the capacity to reflect on events and experience and draw learning from them, and reserves its top score for candidates who describe how they used reflection to change practice.

Key takeaways

  • Reflective Practice is one of three Clinical Judgement station domains, worth 5 marks from each of two assessors
  • ANRO scores four rows: the candidate's example, feedback, the outcome of the reflection, and the principles of reflective practice
  • A 5 requires 'how they have used reflection to change practice' and 'examples of sharing learning from reflection beyond local team, eg regionally/ nationally'
  • The Academy of Medical Royal Colleges and COPMeD define reflective practice as thinking analytically about anything relating to professional practice with the intention of gaining insight and using the lessons learned
  • The What? So what? Now what? framework is the structure that guidance names, covering thinking, feeling and doing
  • Reflection cannot substitute for reporting: The Reflective Practitioner says reflection must not override the processes needed to record, escalate or discuss significant events and serious incidents

What does the reflective practice domain score?

The reflective practice domain scores four separate things, and most candidates prepare only the first. ANRO's 2026 guidance lists candidate experience, feedback, the outcome of reflection, and the principles of reflective practice as its four rows.

  • Candidate experience: a 3 is 'Good example of scenario they have reflected upon'; a 5 adds 'how they have used reflection to change practice'
  • Feedback: a 4 asks for 'examples of formal feedback i.e MSF . 360 appraisal, GREATIX, etc'; a 5 asks for personal feedback and how it was used to improve
  • Outcome of reflection: a 3 describes reflection leading to a positive professional change; a 4 shares learning within local teams; a 5 shares it beyond the local team, regionally or nationally
  • Principles of reflective practice: a 3 requires awareness of GMC guidance on being a reflective practitioner, a 4 adds tools, support, individual and group reflection, openness and honesty and notes including anonymisation

ANRO adds a footnote to the descriptor that candidates are not expected to cover all aspects, and the question asked determines which apply. However, knowing all four rows tells you what to add when an assessor asks you to say more.

What makes a good example to reflect on?

A good reflective practice example is specific, personal and changed something you still do differently. ANRO's failure descriptor is a candidate who 'could not give a clinical or nonclinical scenario that has changed their practice demonstrating reflection'.

The guidance is generous about what counts. The Reflective Practitioner, published jointly by the Academy of Medical Royal Colleges, COPMeD, the General Medical Council and the Medical Schools Council, says any experience, positive or negative and however small, can generate meaningful insight.

In practice the strongest reflective practice examples for anaesthetics are near misses and handovers rather than catastrophes, because you were genuinely involved in them and you can describe the change without exaggerating your role.

How do you structure a reflection out loud?

Use What? So what? Now what?, which is the framework the national guidance names. The Reflective Practitioner describes it as one simple way to structure reflections, whether of a single event or a period of time.

  • What? focuses on your thoughts at the time, what you were thinking when you took the action or made the decision
  • So what? considers the significance of what happened, the values and feelings at the time and why it mattered
  • Now what? looks at the processes and opportunities that help you learn from it, the future actions and how you use them to develop
  • The guidance summarises the three as thinking, feeling and doing

Spoken, that maps neatly onto about four sentences. It also keeps a reflective practice answer from becoming a clinical narrative, which is the commonest way the domain is lost.

What does a worked spoken answer sound like?

A worked reflective practice answer runs about ninety seconds and ends with something that changed. Here is one you could say aloud.

'As a foundation doctor I handed over a post-operative patient at the end of a night shift and said only that they were stable. Six hours later they deteriorated, and the day team had not been told about a difficult intubation the previous evening.'

'Thinking about it afterwards, I had given a handover that was accurate and useless. I had described the patient as they were rather than what the next team needed to watch for, and I felt uncomfortable because the omission was mine and it was avoidable.'

'What changed is that I now hand over with situation, background, assessment and recommendation, and I always state the one thing I am worried about overnight. I asked my supervisor for feedback on two handovers afterwards and used what they said to shorten them.'

'I also raised it at our departmental teaching, because the same gap had caught others, and our handover sheet now has a line for anticipated problems. I documented the learning in my portfolio without any patient identifiers, because reflective notes should focus on the learning rather than the facts of the case.'

What do assessors want you to say about feedback?

Assessors want a named piece of feedback, what you did with it, and evidence that you seek feedback rather than receive it. ANRO's descriptor for a 4 names multi-source feedback, 360 appraisal and excellence reporting as examples of formal feedback.

The descriptor for a 2 is a candidate who understands the concept of feedback but has 'no personal evidence of engaging with feedback'. That is the trap: everybody agrees feedback is important, and the mark is for an instance.

According to The Reflective Practitioner, doctors in training should discuss the experiences they plan to reflect on with clinical and educational supervisors, because discussion makes the learning more meaningful and demonstrates engagement.

What should you say about GMC guidance on being a reflective practitioner?

Say that you know reflection is a professional expectation and that you know the rules about what goes in a reflective note. ANRO's reflective practice descriptor requires awareness of GMC guidance on being a reflective practitioner from level 3 upwards.

  • A reflective note does not need to capture full details of an experience; it should capture learning outcomes and future plans
  • When keeping a note, information should be anonymised as far as possible, and removing a name, age or address alone is unlikely to be enough
  • The GMC does not ask a doctor for their reflective notes in order to investigate a concern, and a doctor may choose to offer them as evidence of insight
  • Reflective notes are not subject to legal privilege and can be required by a court, so they should focus on learning rather than a full account of the case
  • Group reflection often leads to ideas or actions that improve patient care

The Reflective Practitioner also defines reflective practice, with COPMeD, as the process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements.

How do you reflect on an event without breaching confidentiality?

You reflect on the learning and leave the facts where they belong. The national guidance says factual details should not be recorded in reflective discussions but elsewhere, in accordance with the organisation's policies.

In an interview that translates into removing anything that would identify the patient, the colleague or the hospital, and describing your own actions rather than allocating blame. Sharing original, non-anonymised information with a supervisor is different and is expected.

That said, reflection is not a substitute for the duty of candour. The guidance says all doctors have a professional duty to be open and honest with patients and those close to them when something goes wrong, which is a separate process from personal reflection.

What is the difference between reflecting and reporting?

Reflecting is what you learned; reporting is what the organisation must know. The Reflective Practitioner states plainly that reflection cannot substitute or override the processes necessary to discuss, record and escalate significant events and serious incidents.

ANRO's own descriptor asks for that distinction at the top of the domain: a 5 shows understanding of the other processes required to record and escalate significant events and serious incidents. So the sentence 'I submitted an incident report and separately reflected on it' is worth saying.

The Royal College of Anaesthetists reinforces the same pair in its 2021 curriculum, which sets Stage 1 capabilities on critical incident reporting, learning from pre-briefs and debriefs, and the duty of candour.

Which reflective practice answers lose marks?

The answers that lose marks are the ones with no outcome, because outcome is a whole row of the descriptor.

  • 'I always reflect on everything.' ANRO scores that as a poor example of a scenario used to demonstrate reflective practice
  • A story with no change. The 3 descriptor requires a reflection that led to a positive professional change
  • An example where someone else made the error and you learned nothing about your own practice
  • Naming a reflective model and then not using it, which reads as preparation rather than practice
  • Describing a serious incident with identifying detail, which suggests you do not know the anonymisation rules
  • Saying reflection replaced an incident report. The guidance says it cannot

How this comes up at the CT1 anaesthetics interview

Reflective practice is scored in the clinical judgement station, which runs 15 minutes after 5 minutes of reading, with two assessors scoring independently. It sits beside clinical judgement and decision making and working under pressure, each worth 5 marks per assessor.

  • It is usually asked as its own question after the clinical scenario, so have one example ready and a second in reserve
  • Answer at the level of a doctor about to start CT1: your own handover, your own consent conversation, your own missed deterioration
  • Close your clinical answer with one line on what you would document and report, which signals the domain without hijacking the scenario
  • Paper notes are permitted in the station, so the skeleton of your example can be written down

anaestheticinterview's 340 questions include reflective practice prompts with AI-marked spoken practice against the same domains, which is how you find out whether your example ends with a change or merely with a feeling.