Victoria Hewitt

Victoria Hewitt

Specialist Palliative Care Physician and Curriculum Director, MSc in Oncology and Palliative Care, Newcastle University. Special interest in safe medicines management at end of life. Always learning.



  • This has given me a structure to constructively use feedback. thank you

  • I don't reflect-in-action sufficiently. From the video it seems to me that emotional response drive these reflections and whilst I might acknowledge the feeling is there I don't reflect upon it at the time (or as soon as is appropriate).

  • I used to be very disciplined about recording my reflections in a journal but once covid hit I was just too busy. Then everything became very overwhelming and I just couldn't find a place to start reflections again. This has reminded me how much I benefited from those reflections so I will start again

  • Not strictly speaking a reflective practice framework as such, but I find I connect best with Argyris and Schon's double loop learning model. Basically it requires you to consider what you think you are doing (espoused theories) against what you are actually doing (theories in practice). The gap between the two is where the reflective learning lies.

  • It's fairly typical that users aren't involved much in the design of a healthcare service. This is inspiring and I story I will share now

  • I'm Victoria, I'm a palliative care physician and clinical educator. I'm involved in a few pieces of work where design thinking could come in useful - hard to know which to focus on for this exercise

    Hopes: This course will unlock some of the areas where projects I've have been working on have become stuck

    Fears: being overwhelmed, not understanding...

  • Which learning outcomes was the junior trainee aiming to achieve? If the LOs were all knowledge-based a presentation could be appropriate, although this is a small group so there was an opportunity to discuss and explore the topic, for instance through problem-based learning. The description suggests a range of experience within the trainee group so there's...

  • Everything starts with the learning outcomes and the underpinning theory or theories. The method should align to this, including the tools. Too often the tool drives the teaching - especially for online teaching.

  • Social constructivism - observing, digital storytelling. Observing patient stories can be powerful learning experiences because they connect on an emotional level with this topic and this can very impactful educationally and in terms of raising awareness and changing practice

  • There's an even higher level to Blooms taxonomy - create. For postgraduates this can be appropriate, particularly where the underpinning pedagogy is a social constructivism or community of practice.

  • The concept Communities of Practice are more specific than the description above - people come together with a shared purpose and work with mutual endeavour with shared artefacts. It is more than sharing an interest.

  • In addition to the points presented by others the supervisor should consider whether there's something going on in this trainee's life outside of work which is affecting them.

  • if someone comes to you with an immediate concern about patient safety you have to take it seriously and investigate. This trainee may have a valid concern, in which case you would have to provide appropriate cover on the unit on that day. You may also be uncovering an educational need for the trainee concerned or another issue (eg anxiety, caring...

  • I am on an IPE working group and I find so much resistance from the professionals themselves, who don't seem to want to give up silo learning, despite all the evidence to support IPE. Sometimes there's confusion that IPE means learning across specialities of the same professional group rather than across professionals "belonging" to the same speciality. I've...

  • For the past few years I have been working to develop IPE and make it more prominent within my organization. All my teaching at the postgraduate level is IPE. It's great in theory but my experience doesn't match.

  • Organisational culture is so important. if the organisation does not support learning at all levels and at every opportunity it can be extremely difficult to stay motivated.

  • Yes I have. I recall one trainee I supervised who had a triggering event and fell into difficulty very quickly. It was a balance between maintaining compassion for their situation without falling into "fix-it" mode that we, as doctors, can be prone to. Don't be afraid to seek support for yourself, as supervisor, as well.

  • I use different models depending on the situation. The one minute model is good for day-to-day, "on the job" feedback - my unit is very much geared around this sort of clinical supervision. For formal meetings I'd use Pendleton's rules. I also lead a MSc programme and I'm going to try out ALOBA on our group assignments and SET-GO for formative assessments...

  • I agree. If you are lucky enough to have built a good relationship with the person giving feedback with established trust on both sides it's so much easier. Sadly, we are under so much pressure at the moment that this is becoming more difficult to achieve

  • One stakeholder group which is often forgotten are the patients themselves - particularly if they are children or if their voices are infrequently heard/ hard to reach. This is why I found the earlier video telling the story of the last child to be affected by polio in Peru so powerful.

  • Hi Kelly - I hadn't considered media outlets but of course they are important in the world today.

  • Is it when stakeholders connect and find common interest to in the policy? There's the "what's in it for me" and then the "what's in it for us" - I see policy engagement as the coming together of these two perspectives

  • One cannot ignore either the devastating effect some of the malaria eradication interventions had on the environment

  • I echo everything which has been posted here already and I would like to add something - energy for change. Who has the energy to drive changes forward and to maintain momentum when their are gains and barriers? How can we create, build and sustain energy for change?

  • Creating a shared vision and being respectful of other's position

  • For me its the importance of engaging people at all levels - from the powerful stakeholders at the top of the organisation to those who do the "leg work". What comes across strongly in the History of the Alliance is that all these different stakeholders seemed equally committed and of equal importance to realising the vision although they do this in different...

  • The vision for polio eradication was strong and united many to the cause, but it needed powerful and wealthy stakeholders to invest in it initially, after a successful "pilot". The circumstances were also right - it aligned to other initiatives and programs, so you need to be aware of what is happening in the wider healthcare and political arenas.


  • Conflicting political agendas. Even when everyone shares the vision, conflicting demands mean its difficult to secure financial support or human resources. It can become very lonely and exhausting

  • Interesting and relevant themes for me relate to a specific project which I have have been working on for some time.
    1 - Power of engaging - getting key stakeholders to "buy into" the idea and the project
    2 - Vertical and integrated approaches - this is where I find myself becoming overwhelmed in the complexities!
    3 - Importance of context -particularly...

  • In my organisation everything has to go up the chain of command. This exercise has shown me that I’m going to make sure I get noticed at the top, in amongst all the other “noise” that goes to the CEO.

  • I completely agree. In my case I’m not seeking a salary rise per se, but I would like to be paid proportionate the the amount of work I do.

  • @NicholasWindsor I really like these word substitutions, thank you. I also try to replace "but" with "and" - much more positive

  • Gymnast, club level, preparing for competition
    1) Link round-off and backflip on beam
    2) Land a round-off to back somersault in floor routine tumbling section
    3) Practice positive self-talk routine before every training session

    Goals 1 and 2 relate to elements that will gain extra difficulty points in competition. Goal 3 relates to mental practice that...

  • There are a few different versions of SMART goals and they aren't equivalent. For instance, A can mean "achievable" and here it's "agreed" but these are very different terms. In SMARTER I've seen E=exciting, extending and evaluated and R= reviewed and rewarding. This is very confusing, particularly if you are familiar with the SMART in a different context. ...

  • I have had a range of experiences of setting goals - some were too big and wiped my self-confidence, some too small and as a result I quickly became bored with my training. Now I have found a system which works for me - I like to set myself challenges. Ride 300 miles in 30 days, do 20 HIIT workouts in a month, do a core session every other day for a month. ...

  • Motivational self-talk. I would make Geoff’s wife aware of any self-talk she may hear or be aware of and reassure her that it is part of his therapy, as there is a risk it could be misinterpreted as cognitive impairment. However, my experience is that when someone is frustrated and upset, as Geoff is, they can snap at loved ones who are seen to be fussing or...

  • Phoebe’s self-talk is negative and it’s affecting her confidence in her physical abilities. Reframing the self-talk could be
    “Comfort zones are boring”; “I deserve to be in this squad”; “Tiredness equals hard training”; “This is what I came for”; “I am strong than how I feel right now”

  • A psychotherapist once tasked me to stop using the word "should" - it was extremely difficult!

  • Overt self-talk could give away a weakness that an opponent might then exploit.

  • I still feel a bit "clunky" with PETTLEP - like everything, I need to practice, practice, practice!

  • Patients may have other co-morbidities which affect their physical and mental abilities. They are likely to be of lower levels of overall physical fitness than athletes and more likely to be living with disease-related symptoms such as pain, fatigue, nausea and vomiting and cognitive impairment

  • Ibrahim has a lot of other things going on in his life and it would be easy for him to drop the running if he is tired, short of time, stressed out or fed up. I would therefore use mental practice to keep him motivated and I would draw upon a time where he really enjoyed exercise, ideally a recent running session that went well to match the task and his...

  • For Phoebe I think we are looking at mental practice to control her emotional responses and I would set it in the context of a training session and in the 1st person. From the case history it seems to be that the first barrier she needs to negotiate is her reaction to being over-taken by older, more experienced training partners. I would schedule it into her...

  • Speaking from my experience of gymnastics and track and field events, action observation can demonstrate and improve technique. Relatively small issues such as split legs or incorrect foot position can make a massive difference to performance and it allows the athlete/ gymnast to focus on one improvement area at a time to avoid feeling overwhelmed

  • I get really anxious watching my daughter do competitions, to the point where she sometimes asks me not to go because I make her nervous. I know it isn't fair and I know she would like me to be there so it's something I'd like to work on n this course.

  • When I first got a road bike I really struggled clipping in my shoe cleats and I fell over a lot and lost confidence. I learnt vicariously by watching other riders.

  • Hi I’m Victoria and I’m a physician - mainly doing this course to support my daughter who is a keen track and field athlete but also hoping to pick up some tips to maintain my own exercise routine

  • Making effort to ensure the team identifies as a single entity with a common purpose

  • I try to reframe conflict as dialogue. It's an opportunity to see an issue from a range of perspectives. I will explain that we all see the problem from our own viewpoint and that by putting these perspectives together we get a holistic, all-round understanding of the issue under debate. Usually this works but sometimes people are opposed and don't back...

  • Great idea!

  • Over the years of working in culturally diverse teams I learnt to decenter but I never knew it was a formal term. I remember one incident where a team member was tasked to do work outside of her remit and she was unhappy about it. I felt I was supporting her by pointing this out to the team but it made her very upset. This made me upset because I felt she...

  • Victoria Hewitt made a comment

    This exercise has made me aware that I am naturally interdependent and high-context but due to my upbringing/ medical training I have become independent and low-context. I wrote down the way I am now but something deep inside me there was a yearning to be my natural self. This surprises me, I hadn't expected it. I shall reflect on this more I think.

  • Yes, I tend to agree @İzzet - your comment reminded me to go back to week one where we covered cultural norms in business meetings. I wonder if there is a better way conduct the meeting from the start, as you suggest?

  • Learning more about inclusive team practices

  • This week has really energised me. It made me realise that I really enjoy learning about people, hearing their stories, finding out what makes them tick. However, this week has also taught me that for some cultures this can be incredibly intrusive and disrespectful.

  • I really like to think of cultural diversity as a resource @OlgaG - thank you for articulating this so beautifully

  • Definitely. I'm currently working with a team in Ethiopia and we have a great relationship. We communicate in English but every so often someone may ask to speak Amharic. I just listen but I don't know what they are saying. This means we have to have trust in each other and this is a positive thing. We have put a lot of effort into this, building a shared...

  • I identify with this @AnkeKraemer - as an online educator with students all over the world on each course. I sit down and work out the spread of time zones when I schedule live tutorials. Sometimes it's late at night and I know I'm so tired from a day's work that I am not my best self. It makes me feel bad that I'm not as fresh as I should be for my students.

  • This definitely resonates with me. In one of the GVTs to which I belong there is a fault line between those who are co-located on the main site and those who are at a distance. Even though COVID means we cannot be in the same room, the "on-site" people are still able to meet in smaller groups or even in passing. Some peripheral people have disengaged...

  • I agree, Claire. I've been working in a GVT for about 10 years but COVID gave us permission to show our human side a but more. We have a rule that reminds us that we are being invited into someone's home or office. This almost immediately led to greater respect and understanding - we all sort of relaxed a bit more.

  • One thing that I learnt last week from Hofstede Insights was that some cultures find the British sense of humour is frequently difficult to understand (I'm a Brit). I hope you don't mind me sharing this, but as I watched the video I couldn't help thinking of one of the classic meeting scenes in the BBC comedy W1A. I watched it again with fresh eyes after...

  • I think there's a risk that the 3 same-genders/ same-culture would form an in-group so I'm saying strong fault line.

  • I am a doctor and my day-to-day experience resonates with relative status. Senior doctors are nearly always and implicitly leaders through their legitimacy and influence as much as authority. In some cultures this is an explicit expectation of a doctor, in others it isn't. I have seen a lot of tension between senior doctors in the same team or service...

  • It depends what you mean by easier... if it's a task-to-finish team it can be easier if you all speak the same language/ use the same jargon/ share "short-cut" understandings. If the team has to find solutions to complex problems then diversity brings more perspectives, more experiences, more insights and thus is more innovative. I always find the latter...

  • Working in a culturally diverse team has broadened our horizons and made us see the bigger picture - finding new solutions and uncovering issues we weren't aware of. The downside comes when the organisation wants us to do things in a set way for no obvious reason

  • Working virtually with a diverse range of team mates

  • I reacted to the person telling the story on the radio more than the story itself. Watching the video made me aware that my causal interpretation was one of sensationalist and subjective reporting rather than objectivity. I was making an internal attribution about the reporter

  • As others have rightly said the casualty should not be moved (speaking here as a doctor). This isn’t what concerned me though about this piece. What concerns me is the way this report centres on the fact that the driver is an attorney. Is this relevant? I don’t know but it makes me feel a bit uneasy that the driver is portrayed in such a bad light without...

  • I compared UK and Ethiopia, as I am in the process of forming a partnership with colleagues in Ethiopia. This was such a useful exercise because it highlighted a huge difference in individualism-collectivism, which I will be mindful of going forwards. I assumed Ethiopia was much more Masculine than the UK but in fact the scores are identical.

  • I think they are all culturally diverse in different ways.

  • Hi - I'm Victoria and I'm a physician and an educator. I mainly teach online courses to qualified healthcare professionals, which means I work with staff and students from all over the world. I joined this course because I want my teaching to be a meaningful experience for all my students. Also (perhaps most importantly) I want to be an active participant...

  • For me it’s when you share laughter. When you can smile and laugh together it’s a signal that you’ve moved beyond the formal

  • I chose Goal 3: Health because I am currently working with partners in Ethiopia to develop palliative care services. This work aligns most closely to target 3.8: universal health coverage and also 3.5: substance abuse because part of our work will involve safe opioid prescribing. I doubt very much these targets will be achieved by 2030 because healthcare is...

  • Big picture
    S: I am curriculum direct for a suite of educational programmes.

    T: I was recently tasked to increase student numbers on one of our courses.

    A: After discussing this with my team we decided the learning design needed to be changed. I identified an opportunity to innovate and take a fresh approach to the subject concerned. I approached...

  • What do you think makes a learning activity into a great experience for young people?