1. The nMRCGP e-portfolio What to put in? Dr Andrew Ashford Programme Director, West Essex VTS

2. In this session … We will consider (? reflect on):- WHY an e-portfolio? WHY an e-portfolio? WHO might look at it WHO might look at it What makes you fit to practice? What makes you fit to practice? Writing “meaningful” entries Writing “meaningful” entries Writing a PDP that works (for you!) Writing a PDP that works (for you!)

3. WHY an e-portfolio? Simply… The RCGP needs evidence of your fitness to practice! It is where “…the GPStR records their learning in all its forms and settings”

4. Who will be looking at it? Your trainer / educational supervisor Your trainer / educational supervisor The Deanery ARCP panel (yearly) The Deanery ARCP panel (yearly) A Patch Director or Director of GP training A Patch Director or Director of GP training A Programme Director (PD) A Programme Director (PD) A lay member… yes, a member of the PUBLIC! A lay member… yes, a member of the PUBLIC! … and if things go very wrong, a committee at the GMC (more lay members of the public!)

5. SO… those looking in are You You Your immediate educational supervisors and PDs Your immediate educational supervisors and PDs PMETB & the Deanery PMETB & the Deanery The public The public

6. What would YOU want to see?

7. Competence? “Brilliant with morphine, that Shipman fellow!”... But would you have trusted him to give you some?

8. Competence? Mr Slick is the rudest, most arrogant surgeon I have ever met … … but if I ever need a hemicolectomy I want him operating on me and no-one else

9. A difficult balance Within our profession:- “Serious weaknesses in a doctor’s practice are accepted if they are balanced by major strengths” (Liam Donaldson)

10. GMC Duties of a Doctor “treating every patient politely” “treating every patient politely” “listening to patients & respecting their views” “listening to patients & respecting their views” “keeping professional knowledge & skills up to date” “keeping professional knowledge & skills up to date” “recognising the limits for your professional competence” “recognising the limits for your professional competence”

11. GMC Duties of a Doctor “acting quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice” “acting quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice” Recasts the definition of good medical practice (Liam Donaldson)

12. Character? Lovely guy, Mr Bodgit (FRCS) – kind, honest, always does what he says he’ll do, tells it as it is, wonderful bedside manner (etc)... But I wouldn’t let him near me with a scalpel

13. Fitness to practice At a personal level this boils down in the end to one thing… Whether the public TRUST you to do the job … are you TRUSTWORTHY?

14. Trustworthiness Based on CHARACTER (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 not in my competence, you still wouldn’t trust me” (Stephen Covey)

15. Character and Competence You need both! You need both! Both can be evidenced in the e-portfolio Both can be evidenced in the e-portfolio

16. Evidence for character..? Oh yes! If you are frequently late, bunk off early, let people down, or display “jobsworth” attitudes… If you are frequently late, bunk off early, let people down, or display “jobsworth” attitudes… Your CSR reports will reflect this! (and probably your PD will be calling you in for some discussion) Your CSR reports will reflect this! (and probably your PD will be calling you in for some discussion)

17. Common 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 I put into it? How do I do a PDP – and what should I put into it?

18. Log entries To start with … START ! Anything is better than nothing (you won’t be “failed” on it, and at least your ES can give you some feedback!)

19. Quality not quantity One good quality reflective entry may be worth 20 poor / descriptive ones …but aim for at least one clinical entry per week + a tutorial / VTS half-day topic + something else

20. Covering the Curriculum You cannot do this without regular log entries! You cannot do this without regular log entries! The ARCP panel always looks at this! The ARCP panel always looks at this!

21. FAIL!

24. Reflection Observing the operations of ones own mind (with a view to discovering deeper truths about oneself) Observing the operations of ones own mind (with a view to discovering deeper truths about oneself) Careful reasoned thinking – linking personal experience to theories / experiences of others Careful reasoned thinking – linking personal experience to theories / experiences of others

25. Reflection Critical stance – what might be? – can I improve on original? Critical stance – what might be? – can I improve on original? Analyses / evaluates personal experience, attempts to generalise / propose theories / heuristics for future use Analyses / evaluates personal experience, attempts to generalise / propose theories / heuristics for future use

26. Gibbs’ model of reflection (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?

27. Johns 1994 Description Write description of experience Write description of experience What are the key issues What are the key issues

28. Johns 1994 Reflection 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 family For the patient and family For myself For myself For people I work with For 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?

29. Johns 1994 Factors influencing your decision-making and actions What internal factors influenced them? What internal factors influenced them? What external factors influenced them? What external factors influenced them? What sources of knowledge did – or should – have influenced them? What sources of knowledge did – or should – have influenced them?

30. Johns 1994 Alternative strategies Could I have dealt better with the situation? Could I have dealt better with the situation? What other choices did I have? What other choices did I have? What would be the consequences of these other choices? What would be the consequences of these other choices?

31. Johns 1994 Learning from the experience How can I make sense of it in light of past experience & future practice? How can I make sense of it in light of past experience & future practice? How do I feel NOW about it? How do I feel NOW about it? Have I taken effective action to support myself & others as a result of it? Have I taken effective action to support myself & others as a result of it? How has it changed my way of knowing in practice? How has it changed my way of knowing in practice?

32. What do we learn from? 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 well Watching others do it well Watching others do it badly (and picking up the pieces afterwards) Watching others do it badly (and picking up the pieces afterwards)

33. So ask yourself… SO WHAT? “How did I feel about this?” – and record it “Did this force me to think differently about my approach?” “If so – WHY? “What could/should I do differently next time?” – specific action / mental approach

34. Examine successes too! If something went surprisingly well, ask yourself “WHY?” – tease out the reasons or components If something went surprisingly well, ask yourself “WHY?” – tease out the reasons or components Then you – and others – can hopefully replicate them in the future Then you – and others – can hopefully replicate them in the future

35. NOW write your log entry Aiming to demonstrate BREADTH of experience and learning Aiming to demonstrate BREADTH of experience and learning But also DEPTH But also DEPTH A few key “nuggets” which EVIDENCE your learning A few key “nuggets” which EVIDENCE your learning Specific changes Specific changes

36. What comments might the Educational Supervisor add?

37. The PDP WHY? Essential component of NHS appraisal Essential component of NHS appraisal ARCP panel requires one! – to assess “maintaining performance, learning & teaching” ARCP panel requires one! – to assess “maintaining performance, learning & teaching”

38. PDP – what is it? A prioritised statement of your personal learning needs for the year, and how you propose to meet them A prioritised statement of your personal learning needs for the year, and how you propose to meet them A living document! A living document!

39. What is ARCP looking for? Evidence of – you’ve guessed it – REFLECTION

40. PDP – SMARRT entries S – Specific S – Specific M – Measurable M – Measurable A – Achievable A – Achievable R – Relevant R – Relevant R – REFLECTIVE R – REFLECTIVE T – Time-limited T – Time-limited

41. “Send to PDP” If following boxes completed “What further learning needs…” “What further learning needs…” “How and when…” “How and when…”

42. E-Portfolio “Don’ts” Not completing the log Not completing the log Writing about things that are nothing to do with the curriculum Writing about things that are nothing to do with the curriculum Using the log as a place to air discriminatory, slandering or extreme views – the “rant” Using the log as a place to air discriminatory, slandering or extreme views – the “rant”

43. How to meet the ARCP panel! No PDP… No PDP… No “minimum” WPBA assessments No “minimum” WPBA assessments No OOH… No OOH… No CPR cert… No CPR cert… Poor quality entries (that don’t improve with time) Poor quality entries (that don’t improve with time) Little or no curriculum coverage Little or no curriculum coverage … or just the unlucky 10% (quality control) … or just the unlucky 10% (quality control)

44. Further reading “Help” link L side e-portfolio “Help” link L side e-portfolio RCGP Website RCGP Website Google “E-portfolio Tips and Wrinkles” (S E Scotland Deanery) Google “E-portfolio Tips and Wrinkles” (S E Scotland Deanery)