ADVANCED MASTERY OF THE e-PORTFOLIO

1. ADVANCED MASTERY OF THE e-PORTFOLIO HDR 4.11.10

2. SET OBJECTIVES • WHY this topic? • WHAT DO YOU WANT TO GET OUT OF TODAY?

3. Programme • Objectives • Changes to the eportfolio • Engaging with the eportfolio • What to do pre ES meeting • Why do trainees go to panel-what happens at a panel? • Naturally Occurring evidence. • Log entries-How to make better reflection. • Exercises on reflection and validation

4. UPDATE Eportfolio v5 • Need to sign‘Probity: Professional Obligations’, ‘Health: Professional Obligations’ and ‘Educational Agreement’ need to be signed at the start of Training in a Deanery. If you change Deanery, you will need to resign these. You will not be able to enter Learning Log entries without these three being signed • . Your Educational Supervisor will not be able to start a review, without countersigning the Educational Agreement. • Probity: Convictions and disciplinary actions, and Health: Regulatory and voluntary proceedings now must be signed for each review. There will be a review by review option for you to sign these. You cannot accept a review without signing them

5. UPDATE Eportfolio v5 • ES must create a review before you can update your self assesssment • Educational Supervisor's review - Educational Supervisors cannot sign & submit a review unless the Trainee has completed the Competences Self-Rating. • Expanded rating scales-relate to stage- • NFD – Below Expectations; NFD – Meets Expectations; NFD – Above Expectations • Competent for Licensing • Excellent • Reviews come in RDMP clustering model

6. RDMp Clustering Model Relationship Diagnostics Practising Holistically Data Gathering & Interpretation Communication & Consulting Skills Making a Diagnosis Making Decisions Professionalism Clinical Management Maintaining an Ethical Approach to Practice Managing Medical Complexity Working with Colleagues & in Teams Fitness to Practice Community Orientation Primary Care Admin and IMT Maintaining Performance Learning and Teaching Management

7. E –portfolio Version 6.0 – Planned release date - early August 2011 It was agreed that major changes to the ePortfolio will only be introduced at the start of a new ST year. Version 6.0 will be the next major update, and will be released in early August 2011. • The list of work for Version 6.0 is still very much a work in progress, but at the moment we are planning to address the following: • A major review of the curriculum and its likely impact on the ePortfolio • A review of the Learning Log functionality and linkage • A review of the Case Based Discussion (CBD) WPBA tool • Minor aesthetic improvements e.g. text display and layout of tables • Housekeeping of the database and updating coding for the website

8. Engaging with the E-portfolio Common Reasons Why Trainees don't make effective use of their e-portfolio • • do not understand its value (both in terms of assessment, i e for others, and in terms of recording experiences and reflection, i e for self • does understand its value but hasn’t got into a routine of doing it, in which case may need rather explicit suggestion of a routine   • does understand its value but thinks can’t find the time in his busy job • does understand its value but is lazy and/or disorganised • doesn’t know how to do it – in this case, he might need to look at someone else’s.  You could get permission from one of your other supervisees to show him/her theirs? Mainly the reflective aspects. •  confused by moving goalposts! 

9. Engaging with the E-portfolio • Make entries personal • How many/often?- 2 -3 per week avoid clustering • Quality not quantity • Have it open in surgery –so that can do brief one liner notes at end on relevant cases and develop later

10. Trainee suggestions to engage in e-portfolio • What do I write? -familiarise with curriculum headings and competences and what they mean to use as framework to follow • Time issues- • consider coming in half an hour early each day during your hospital or GP post to add log entries • load the e-portfolio at the same time as you do your GP surgery; in that way you can add 'rough notes' on interesting patients you see and you can then 'smarten' them up later • -use your half day admin time to add in entries • use 'gaps' in your daily hospital work as opportunities to add stuff on • - if it takes ages to drive home (because of rush hour traffic eg after half day release), consider pulling over and adding some stuff on until the traffic dies down. Of course, you may wish to invest in mobile broadband to do this. • Change your attitude: many of you hate the eportfolio and feel sick at the thought of it. But the e-portfolio is here to stay. If one cannot change the e-portfolio, then perhaps one needs to change oneself. Change your attitude and adapt to it. The more you start looking at it positively, the less it will impact on you negatively. LIKE LIFE!  • Typing skills –consider typing tutor ('Mavis Beacon Teaches Typing' - type this into somewhere like Amazon; costs less that £20.) or digital dictation software eg Dragon Naturally speaking. 

11. Suggestions re quantity Non WBPA MINIMUM criteria to be achieved prior to the end of the ST year ST1 • 96 quality log entries (10 pages of the e-portfolio) and 12 SMART PDP entries • Reflections on post held, 2 Presentations, 6 x SEA ST2 • 112 additional quality log entries (12 additional pages of the e-portfolio and an additional 18 SMART PDP entries - Running total = 22 pages of e-portfolio entries and 24 SMART PDP entries. Reflections on post held, 4 Presentations, 12 x SEA ST3 • 144 additional quality log entries (15 additional pages of the e-portfolio) and an additional 18 SMART PDP entries - Running total = 37 pages of e-portfolio entries and 36 SMART PDP entries. Reflections on post held, 6 Presentations, 18 x SEA, 1 x two cycle audit

12. PDP Linking • Try and write PDPs in terms of either what knowledge, skills or attitudes you need to develop. • Remember, you can "send" outstanding things from your learning log entries to your PDP - use it because it saves you writing it all out again for your PDP. • If you don't have time to write out the PDP completely, why not just add something 'quick and dirty' for the time being to serve as a signpost for you to smarten up later? • Whilst you dont have to be too comprehensive, you do have to be specific.

13. SMART PDP • The SMART model was developed by psychologists as a tool to help people set and reach their goals. It’s a simple approach that lends itself to creating good PDP entries in your e-portfolio. • Specific • Measurable • Attainable • Relevant • Time-bound

14. SMART • Specific Is your goal well-defined? Avoid setting unclear or vague objectives; instead be as precise as possible. • Instead of: To be a better GPMake it specific: To develop my consultation skills, especially those relating to communication. • MeasurableBe clear how will you know when you have achieved your goal. Using numbers, dates and times is one way to represent clear objectives. • Instead of: Feel better about my consultationsMake it measurable: Better PSQ outcomes and achieving more COT competencies during assessment.

15. SMART Attainable • Setting yourself impossible goals will only end in disappointment. Make your goals challenging, but realistic. • Instead of: Master consultation skills by the end of the monthMake it attainable: I will go on a consultation skills course and read ‘The naked consultation’. Relevant • Try and step back and get an overview of all the different areas of your life: Academic, Personal and Career. Consider how relevant each objective is to the overall picture. Time-bound • Set a time scale for completion of each goal. Even if you have to review this as you progress, it will help to keep you motivated. • Instead of: I will address these issues.Make it time-bound: By the end of the my current post I will have been on the course and read the book.

16. STRs-PRE ES meeting • Arrange meeting! Ask ES to create a review. • log and share an e-portfolio entry entitled Ed Sup Rev current date. Attach: • COT & CBD competency mapping • HDR spreadsheet and sick leave/all leave spreadsheet. List complaints. • Ensure CSR report done. • Ensure self rating assessment and PDP up to date. • Ensure compulsory assessments (inc MSF in modular posts)?include NOE • Ensure last objectives achieved. • Ensure declarations all signed off

17. Deanery Guidelines ES How Many ES Meetings and When? • ST1: 2 meetings in first post, 1 meeting in second  (i.e. 3 for that year: 1 informal + 2 formal) • ST2: 1 per 6m post (ie 2 for that year: both formal) • ST3: 1 per 6m post (ie 2 for that year: both formal) •  So, especially during the period Feb-Aug of every year (as that is when most trainees will move onto the next ST stage) make sure you have had your second ES meeting before the end of May

18. WHY do STs get referrred to central Deanery panel • Majority incomplete evidence eg • out of hours sessions, • patient satisfaction questionnaires and • other workplace based assessment tools. • NOE(Naturally Occurring Evidence) • Confusion modular posts /LTFTT • Clustering minimal evidence.

19. ARCP PANEL OUTCOMES • SATISFACTORY –FOR PROGRESSION OR CCT • OUT OF PROGRAMME • MAINLY SATISFACTORY-ARCP NOT COMPLETED;FEEDBACK TO TRAINEE TO OBTAIN MISSING EVIDENCE-PANEL CHAIR REVIEWS EVIDENCE 2W LATER. • POSSIBLE OR LIKELY UNSATISFACTORY-ARCP NOT COMPLETED ;WRITTEN EVIDENCE TO DEANERY RE REASONS • ONLY ONE OUTCOME PER TRAINEE IN EACH ARCP CYCLE

20. OOH • There is the service commitment to out of hours work that is specified for each training post. Not attending OOH sessions is a probity issue. • In an Innovative Training Post (ITP) most ITPs will have the same monthly (6 hour) session of OOH work as normal GP training posts. Some will have on call commitments to the modular component of their post – eg on labour ward or hospice. make clear in the portfolio. If no OOH sessions logged panels will find the portfolio unsatisfactory. (PSQ also due in modular posts) • Documentation of learning in OOH sessions -linking that to chapter 7 of the GP curriculum – Care of the Acutely Ill. • One trainee documented 2 OOH sessions in two months prior to panel. A total of only 3 patients had been seen in these two sessions. This was considered to be unsatisfactory. • Clustering/demand

21. OOH cont Advise to document for each OOH • The type of session – telephone triage, visiting doctor, base doctor • The number of patients seen. • A selection of the most interesting patients • The significant learning points and, • Link these to the curriculum(esp care acurtely ill)

22. Naturally Occurring Evidence 1) Significant Event Analysis – 3 per 6 month post – file under Significant Event Analysis 2) Reflection on key learning points from each post – file in Reading – expected length 1 side A4 3) Audit or QoF review or NPMS Project – x1 in 3 year training – file in Audit/ Project

23. NOE (cont) 4) Case study – 2 per year – file in Audit 5) Statement of Total Leave Taken – file in courses/certificates 6)Attendance Record at VTS teaching – supplied by VTS administrator 7) Complaints and adverse incident reports – if any. File in Professional Conversations

24. Learning Log Role of the Learning Log • Your learning log is your personal learning record. Log entries that you choose to ‘share’ can be read and commented on by your clinical or educational supervisor. These entries will contribute to the evidence that your educational supervisor will consider at your 6 monthly educational supervision meetings.  • Maintaining your log is therefore just as important as completing your formal assessments. • Log entries can contribute to your evidence in two ways.  They determine your curriculum coverage and contribute to the evidence in the 12 competency areas if they are ‘validated’.

25. Learning Log When linking to curriculum headings take care to look at the learning objectives in the relevant curriculum statement and ask yourself: • - does my log entry provide evidence that relates to the specific learning objectives in this statement? • Although in many cases an individual entry may merit more than one curriculum heading, try to ensure that you don’t choose inappropriate ones. • Greater reflection and ability to validate against competences is likely with clinical encouters;SEA rather than lectures or tutorials( which can still be useful for curriculum coverage)

26. Log entries Log entries should on average show: • evidence of critical thinking & analysis, describing own thought processes • self awareness demonstrating openness and honesty about performance and some consideration of feelings generated • evidence of learning, appropriately describing what needs to be learned, why & how • appropriate linkage to curriculum • demonstration of behaviour that allows linkage to one or more competency areas

27. Gibbs Reflective Cycle

28. Reflection template

29. Reflective Writing: role and functions • To maximise the effectiveness of experiential learning • To evaluate one’s practice • To promote critical thinking • To facilitate the integration of theory with practice • To generate theory • To evaluate a learning activity • To demonstrate that learning has taken place

30. Reflective writing: description • What were the significant background factors to this experience? • Describe the experience – Sequence of events – Actions – Observations • What essential factors contributed to the experience?

31. Reflective Writing: analysis • What were the consequences of my actions? • How do I feel about the experience? • What factors influenced my decision and actions? • What knowledge influenced my decision and actions?

32. Reflective Writing: evaluation What went well; what went badly? Could I have dealt better with the situation? What other choices did I have? What would have been the consequences of acting on these other choices?

33. Reflective Writing: action plan How should I change my practice? Behaviour Standards, procedures • Should I suggest changes in policy? • What constraints may exist? Review changes and their effects!

34. Reflective Writing: new perspectives • What have I learnt from this experience? • How has this experience affected my thinking?

35. Validation Why does validating entries matter? • The learning log helps to balance the educational portfolio and provides additional evidence of learning and progression, capturing evidence from learning opportunities in the workplace. • There is no limit to the number or quality of entries that trainees can make in their eportfolios, but not all of them can or should be validated. For example, attendance at VTS seminars. Entries which cannot be validated may still be useful for curriculum coverage. • Once validated, each entry then forms part of the trainee’s evidence of progression. • Entries are validated against the 12 areas of the competency framework.

36. Validation What does validating an entry mean? the entry fulfils the following two requirements: • a) It addresses one or more of the 12 competence areas • b) It demonstrates meaningful reflection • By validating a log entry you are confirming that this is valid evidence of learning in an appropriate competency area. You are not making a judgement about whether that competence has been achieved. • Who Reads entries and validates-ES or CS?

38. Example of a good log entry Current Selections • Professional competences 4 Making a diagnosis • Professional competences 5 Clinical management • Curriculum statement headings 8 Care of children and young people • Curriculum statement headings 15 Cardiovascular problems

39. What Happened? A 2 week old baby was brought to the surgery with a history of a few days of coryzal symptoms and poor feeding. The parents thought that the baby had a viral infection. I examined the baby and thought that she had some crepitations on the left lung. She was also tachypnoeic and tachycardic. I was concerned about this baby as she was not feeding well and the parents mentioned that she had been more sleepy than usual. I discussed the case with the paeds registrar on call, who said it sounded like bronchiolitis and suggested conservative management. However I stressed that I felt this baby needed to be assessed as she was not well and eventually the paeds registrar agreed to see the child. 

40. What happened subsequently • While in the children’s emergency department, the baby had a cardiorespiratory arrest, was resuscitated and transferred to a hospital in London. She had coarctation of the aorta and left basal consolidation of the left lung. She was subsequently operated on and is now progressing well in intensive care.

41. What did you learn? • To be aware that accurate assessment of a baby is vital as they can be seriously unwell and only display non-specific symptoms. I am very glad that I insisted on sending the baby to hospital despite the objections of the paediatric registrar. It felt very awkward at the time, but it has taught me to trust my judgement and I will find it easier to be more assertive next time

42. What will you do differently in the future? • On reflection, the baby arrested while she was in the CED. The parents took her there by car. I could have arranged a blue light ambulance to take her to hospital. However, although I thought she was unwell, I did not expect such a serious underlying problem and she was certainly not looking like a baby that was about to arrest.

43. What further learning needs did you identify? How & when will you address these? Record created Comments Need to refresh my memory re: congenital heart disease & its presentation in neonates. GP notebook & paediatric textbook, in the next couple of weeks. 15/12/2009 21:24:32 [16/12/2009 18:50:36]  (Educational Supervisor)  You did extremely well here, recognising the baby was not well and sticking by your own clinical judgment when a more specialist doctor was suggesting an alternative. This can be a difficult thing to do and in this case saved this baby’s life. Well done. An example of a good reflective log entry

44. Example of a good log entry Current Selections • Professional competences 4 Making a diagnosis • Professional competences 5 Clinical management • Curriculum statement headings 8 Care of children and young people • Curriculum statement headings 15 Cardiovascular problems

45. An example of a good reflective log entry • How does this compare with your entries. • Are the curriculum statements valid? • What can you learn form this?

46. E portfolio • Look at own entries in groups of 3. • How does your reflection compare against the criteria? • Do you think these are correctly linked? • Could these be validated against competences? • How could you improve your entries? Provide examples.

47. Reflection and validation exercises • Eportfolio j smith2 • Password jsmith2 • Dr Pauline example • Can use dummy system • The username is trainer1The password is rcgp

48. PLENARY • ANY LEARNING TO SHARE • FEEDBACK FORMS • FUTURE LEARNING NEEDS