The start of a new year often brings a natural pause in clinical work as appointment books begin to fill again and new routines are made. It’s the ideal time to pause and reflect before the busyness takes over once again, asking yourself: What went well last year? What did I learn? What did I miss? Case reviews are the best way to answer those questions so that you can move forward with confidence. It’s not about fault-finding or replaying decisions, but instead reflecting on clinical reasoning, recognising patterns, and understanding how small choices, such as assessment and communication, can shape patient outcomes over time. As a new year begins, case reviews are a great way to reflect on the past and improve patient outcomes for the months ahead.

When many clinicians hear the phrase case review, they picture formal presentations, never-ending notes, or high-risk cases. In reality, the most valuable case reviews often happen between patients, during a commute home, or in a quick conversation with a colleague that starts with, “Can I run something past you?”

Reflective review does not have to be time-consuming, and often, just a few questions are needed:

• Did my initial assessment capture the full picture?
• Was my clinical reasoning clear: to myself and to the patient?
• Did I adjust the plan when progress stalled, or persist for too long?
• What influenced my decisions in the moment?

Many clinicians instinctively find themselves doing this. Referred to as ‘Reflection-in-action’, this is a strong characteristic in expert practitioners: being able understand and adapt in the moment. But for many physiotherapists, without a framework as a guide, it can be hard to follow through. With a bit of structure, reflections steer away from “What went wrong?, to “What can I learn?”  Clinical decision-making is shaped by a series of small judgements made over time: what we prioritise in the assessment, how quickly we progress the load, when we adjust the plan, or how we respond when a patient’s experience does not match expectations. Reflection helps bring those decisions into focus.

When clinicians step back and look across multiple cases, patterns begin to emerge. Certain presentations may consistently respond well to early education and reassurance. Others might plateau when progression is delayed or when goals are not revisited. Recognising these patterns strengthens clinical reasoning and reduces the need to rely on trial-and-error alone.

Over time, regular reflection builds confidence. Clinicians develop a clearer understanding of why they choose certain pathways and when to change direction. This results in faster, more confident decision-making, particularly in complex cases.

So, where do you begin?

A good starting point is to review cases that did not progress as expected. These might include patients who plateaued, presentations that recurred, or situations where outcomes felt slower than anticipated. These cases often highlight gaps in assessment, load progression, or expectation-setting that are easy to overlook.

At the same time, success cases shouldn’t be ignored. Reviewing why a patient progressed smoothly or returned to activity confidently can help identify what worked particularly well. Was it the way goals were framed early on? The progression strategy? Understanding success allows clinicians to replicate effective approaches more consistently across their caseload.

Case selection does not need to be perfect. The aim is not to analyse every detail, but to choose cases that raise questions. For case review to genuinely improve clinical outcomes, it needs to be simple enough to use regularly. Overly detailed templates or lengthy write-ups often get ignored when workloads increase. A short, consistent framework allows reflection to remain focused and relevant.

1. Assessment: What are you reflecting on? Useful prompts include: Was my working diagnosis flexible enough to evolve? Did I consider relevant lifestyle factors early on? Reviewing assessment decisions often highlights where assumptions were made or important details were missed.
2. Intervention: Here, the focus shifts to how decisions unfolded over time. First, ask yourself whether the experience was a positive one or a challenging one. Questions might include: Did my treatment plan align with the patient’s goals? How did I respond when progress slowed? Did I adjust load, education or approach early enough?
3. Outcome: Looking back, now is the chance to reflect on what played out. Did you work effectively? Were expectations realistic and clearly communicated? Did the patient leave with confidence?
4. Looking forward: Now is your chance to look forward. What did you learn from this event? How will it affect your practice in the future? Are there lessons to be learned?

The Health & Care Professions Council even has a handy Word Document you can download and fill in. But it’s important to note, your case review doesn’t need to be written. You might use this as a guide to make notes, record voice memos, or engage in peer discussion. What matters is creating the habit, so case reviews become second nature.

This individual reflection does have limits. When clinicians review cases alone, blind spots can persist. Discussing cases with peers introduces different perspectives, highlights alternative pathways and normalises uncertainty as a shared professional experience. Some of the most effective discussions occur during brief handovers, mentoring catch-ups, or informal debriefs after complex cases. For early-career clinicians, team review offers reassurance and guidance; for experienced practitioners, it provides opportunities to reflect on ingrained habits and evolving best practice.

The most important thing is to make sure something comes from your reflection. The easiest way to do this is to translate each case review into one or two specific actions. These might be changes to assessment questions, clearer goal-setting language, earlier progression markers, or more explicit discharge planning. Keeping these changes small makes them easier to trial and evaluate. Over time, this process refines clinical instincts and supports faster, more confident decision-making. Repeated case reviews may also reveal patterns such as inconsistent education, unclear progression criteria, or gaps in follow-up. Addressing these can improve outcomes across an entire caseload rather than on a case-by-case basis.

Case review is not about revisiting the past with regret or aiming for perfection. It is about learning from experience. At the start of a new year, reflective review offers clinicians a chance to pause, take stock and take action for the year ahead.