The nMRCGP e-portfolioThe nMRCGP e-portfolioWhat to put in?What to put in?

Dr Andrew AshfordDr Andrew Ashford

Programme Director, West Programme Director, West Essex VTSEssex VTS

In this session …In this session …

We will consider (? reflect on):-We will consider (? reflect on):-WHY an e-portfolio?WHY an e-portfolio?WHO might look at itWHO might look at itWhat makes you fit to practice?What makes you fit to practice?Writing “meaningful” entriesWriting “meaningful” entriesWriting a PDP that works (for you!)Writing a PDP that works (for you!)

WHY an e-portfolio?WHY an e-portfolio?

Simply…Simply…

The RCGP needs evidence of your The RCGP needs evidence of your fitness to practice!fitness to practice!

It is where “…the GPStR records their It is where “…the GPStR records their learning learning in all its forms and settingsin all its forms and settings””

Who will be looking at it?Who will be looking at it?

Your trainer / educational supervisorYour trainer / educational supervisorThe Deanery ARCP panel (yearly)The Deanery ARCP panel (yearly)

A Patch Director or Director of GP A Patch Director or Director of GP trainingtraining

A Programme Director (PD)A Programme Director (PD)A lay member… yes, a member of the A lay member… yes, a member of the

PUBLIC!PUBLIC!

… … and if things go very wrong, a and if things go very wrong, a committee at the GMC (more lay committee at the GMC (more lay members of the public!)members of the public!)

SO… those looking in areSO… those looking in are

YouYouYour immediate educational Your immediate educational

supervisors and PDssupervisors and PDsPMETB & the DeaneryPMETB & the DeaneryThe publicThe public

What would YOU want to see?What would YOU want to see?

Competence?Competence?

““BrilliantBrilliant with morphine, that Shipman with morphine, that Shipman fellow!”fellow!”

... But would you have trusted him to ... But would you have trusted him to give you some?give you some?

Competence?Competence?

Mr Slick is the Mr Slick is the rudestrudest, most , most arrogantarrogant surgeon I have ever met …surgeon I have ever met …

… … but if I ever need a hemicolectomy I but if I ever need a hemicolectomy I want him operating on me and no-want him operating on me and no-one elseone else

A difficult balanceA difficult balance

Within our profession:-Within our profession:-

““Serious weaknesses in a doctor’s Serious weaknesses in a doctor’s practice are accepted if they are practice are accepted if they are balanced by major strengths”balanced by major strengths”

(Liam Donaldson)(Liam Donaldson)

GMC Duties of a DoctorGMC Duties of a Doctor

““treating every patient politely”treating every patient politely”““listening to patients & respecting listening to patients & respecting

their views”their views”““keeping professional knowledge & keeping professional knowledge &

skills up to date”skills up to date”““recognising the limits for your recognising the limits for your

professional competence”professional competence”

GMC Duties of a DoctorGMC Duties of a Doctor

““acting quickly to protect patients acting quickly to protect patients from risk if you have good reason to from risk if you have good reason to believe that you or a colleague may believe that you or a colleague may not be fit to practice”not be fit to practice”

Recasts the definition of good medical Recasts the definition of good medical practice (Liam Donaldson)practice (Liam Donaldson)

Character?Character?

LovelyLovely guy, Mr Bodgit (FRCS) – kind, guy, Mr Bodgit (FRCS) – kind, honest, always does what he says honest, always does what he says he’ll do, tells it as it is, wonderful he’ll do, tells it as it is, wonderful bedside manner (etc)bedside manner (etc)

... But I wouldn’t let him near me with ... But I wouldn’t let him near me with a scalpela scalpel

Fitness to practiceFitness to practice

At a personal level this boils down in At a personal level this boils down in the end to one thing…the end to one thing…

Whether the public TRUST you to do Whether the public TRUST you to do the jobthe job

… … are are youyou TRUSTWORTHY?TRUSTWORTHY?

TrustworthinessTrustworthiness

Based onBased onCHARACTER (what you are as a person)CHARACTER (what you are as a person)COMPETENCE (what you can do)COMPETENCE (what you can do)

““If you have faith in my character but If you have faith in my character but not in my competence, you still not in my competence, you still wouldn’t trust me” wouldn’t trust me”

(Stephen Covey)(Stephen Covey)

Character and CompetenceCharacter and Competence

You need both!You need both!

Both can be evidenced in the e-Both can be evidenced in the e-portfolioportfolio

Evidence for character..?Evidence for character..?

Oh yes!Oh yes!

If you are frequently late, bunk off If you are frequently late, bunk off early, let people down, or display early, let people down, or display “jobsworth” attitudes…“jobsworth” attitudes…

Your CSR reports will reflect this! Your CSR reports will reflect this! (and probably your PD will be calling (and probably your PD will be calling you in for some discussion)you in for some discussion)

Common difficultiesCommon difficulties

What makes a meaningful log entry?What makes a meaningful log entry?What the heck is a reflective entry?What the heck is a reflective entry?How do I do a PDP – and what should How do I do a PDP – and what should

I put into it?I put into it?

Log entriesLog entries

To start with …To start with …

START !START !

AnythingAnything is better than nothing (you is better than nothing (you won’t be “failed” on it, and at least won’t be “failed” on it, and at least your ES can give you some feedback!)your ES can give you some feedback!)

Quality not quantityQuality not quantity

One good quality reflective entry may One good quality reflective entry may be worth 20 poor / descriptive onesbe worth 20 poor / descriptive ones

……but aim for at least one clinical entry but aim for at least one clinical entry per weekper week

+ a tutorial / VTS half-day topic+ a tutorial / VTS half-day topic

+ something else+ something else

Covering the CurriculumCovering the Curriculum

You cannot do this without regular You cannot do this without regular log entries!log entries!

The ARCP panel always looks at this!The ARCP panel always looks at this!

FAIL!

ReflectionReflection

Observing the operations of ones Observing the operations of ones own mind (with a view to discovering own mind (with a view to discovering deeper truths about oneself)deeper truths about oneself)

Careful reasoned thinking – linking Careful reasoned thinking – linking personal experience to theories / personal experience to theories / experiences of othersexperiences of others

ReflectionReflection

Critical stance – what might be? – Critical stance – what might be? – can I improve on original?can I improve on original?

Analyses / evaluates personal Analyses / evaluates personal experience, attempts to generalise / experience, attempts to generalise / propose theories / heuristics for propose theories / heuristics for future usefuture use

Gibbs’ model of reflection Gibbs’ model of reflection (1988)(1988)

Description What happened?

Feelings What were you thinking about?

Evaluation What was good &

bad about the experience?

Analysis What sense can you

make of the situation?

Conclusion What else could you have done?

Action Plan If it arose again, what would you

do?

Johns 1994Johns 1994

DescriptionDescription

Write description of experienceWrite description of experience

What are the key issues What are the key issues

Johns 1994Johns 1994

ReflectionReflection What was I trying to achieve?What was I trying to achieve? Why did I act as I did?Why did I act as I did? What are the consequences of my actions?What are the consequences of my actions?

For the patient and familyFor the patient and family For myselfFor myself For people I work withFor people I work with

How did I feel at the time?How did I feel at the time? How did the patient feel about it?How did the patient feel about it? How do I KNOW how the patient felt about it?How do I KNOW how the patient felt about it?

Johns 1994Johns 1994

Factors influencing your decision-Factors influencing your decision-making and actionsmaking and actions

What internal factors influenced them?What internal factors influenced them?What external factors influenced What external factors influenced

them?them?What sources of knowledge did – or What sources of knowledge did – or

should – have influenced them?should – have influenced them?

Johns 1994Johns 1994

Alternative strategiesAlternative strategies

Could I have dealt better with the Could I have dealt better with the situation?situation?

What other choices did I have?What other choices did I have?What would be the consequences of What would be the consequences of

these other choices?these other choices?

Johns 1994Johns 1994

Learning from the experienceLearning from the experienceHow can I make sense of it in light of How can I make sense of it in light of

past experience & future practice?past experience & future practice?How do I feel NOW about it?How do I feel NOW about it?Have I taken effective action to Have I taken effective action to

support myself & others as a result of support myself & others as a result of it?it?

How has it changed my way of How has it changed my way of knowing in practice?knowing in practice?

What do we learn from?What do we learn from?

Experientially in the workplace:-Experientially in the workplace:-Things that “could have gone better”Things that “could have gone better”Disasters & “near misses”!Disasters & “near misses”!Things that went surprisingly well!Things that went surprisingly well!Watching others do it wellWatching others do it wellWatching others do it badly (and Watching others do it badly (and

picking up the pieces afterwards)picking up the pieces afterwards)

So ask yourself…So ask yourself…

SO WHAT?SO WHAT?

““How did I feel about this?” – and record How did I feel about this?” – and record itit

““Did this force me to think differently Did this force me to think differently about my approach?”about my approach?”

““If so – WHY?If so – WHY?

““What could/should I do differently next What could/should I do differently next time?” – specific action / mental time?” – specific action / mental approachapproach

Examine successes too!Examine successes too!

If something went surprisingly well, If something went surprisingly well, ask yourself “WHY?” – tease out the ask yourself “WHY?” – tease out the reasons or componentsreasons or components

Then you – and others – can Then you – and others – can hopefully replicate them in the futurehopefully replicate them in the future

NOW write your log entryNOW write your log entry

Aiming to demonstrate BREADTH of Aiming to demonstrate BREADTH of experience and learningexperience and learning

But also DEPTHBut also DEPTHA few key “nuggets” which EVIDENCE A few key “nuggets” which EVIDENCE

your learningyour learningSpecific changes Specific changes

What comments might the What comments might the Educational Supervisor add?Educational Supervisor add?

The PDPThe PDP

WHY?WHY?

Essential component of NHS Essential component of NHS appraisalappraisal

ARCP panel requires one! – to assess ARCP panel requires one! – to assess “maintaining performance, learning “maintaining performance, learning & teaching”& teaching”

PDP – what is it?PDP – what is it?

A prioritised statement of your A prioritised statement of your personal learning needs for the year, personal learning needs for the year, and how you propose to meet themand how you propose to meet them

A living document!A living document!

What is ARCP looking for?What is ARCP looking for?

Evidence of – you’ve guessed it –Evidence of – you’ve guessed it –

REFLECTIONREFLECTION

PDP – SMARRT entriesPDP – SMARRT entries

S S – Specific– SpecificM M – Measurable– MeasurableA A – Achievable– AchievableR R – Relevant– RelevantR R – REFLECTIVE– REFLECTIVET T – Time-limited– Time-limited

““Send to PDP”Send to PDP”

If following boxes completedIf following boxes completed

““What further learning needs…”What further learning needs…”““How and when…”How and when…”

E-Portfolio “Don’ts”E-Portfolio “Don’ts”

Not completing the logNot completing the logWriting about things that are nothing Writing about things that are nothing

to do with the curriculumto do with the curriculumUsing the log as a place to air Using the log as a place to air

discriminatory, slandering or extreme discriminatory, slandering or extreme views – the “rant”views – the “rant”

How to meet the ARCP panel!How to meet the ARCP panel!

No PDP…No PDP…No “minimum” WPBA assessmentsNo “minimum” WPBA assessmentsNo OOH…No OOH…No CPR cert…No CPR cert…Poor quality entries (that don’t improve Poor quality entries (that don’t improve

with time)with time)Little or no curriculum coverageLittle or no curriculum coverage… … or just the unlucky 10% (quality or just the unlucky 10% (quality

control)control)

Further readingFurther reading

““Help” link L side e-portfolioHelp” link L side e-portfolioRCGP WebsiteRCGP WebsiteGoogle “E-portfolio Tips and Google “E-portfolio Tips and

Wrinkles” (S E Scotland Deanery) Wrinkles” (S E Scotland Deanery)