ADVANCED MASTERY OF THE ePORTFOLIO
HDR
4.11.10
SET OBJECTIVES
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WHY this topic?
WHAT DO YOU WANT TO GET OUT OF
TODAY?
Programme
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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
UPDATE Eportfolio v5
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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
UPDATE Eportfolio v5
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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 SelfRating.
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
RDMp Clustering Model
Relationship
Diagnostics
Data Gathering &
Interpretation
Practising Holistically
Communication &
Consulting Skills
Making a Diagnosis
Making Decisions
Professionalism
Maintaining an Ethical
Approach to Practice
Working with Colleagues
& in Teams
Clinical Management
Managing
Medical
Complexity
Fitness to Practice
Community
Orientation
Primary Care
Admin and
IMT
Maintaining Performance
Learning and Teaching
Management
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.
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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:
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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
Engaging with the E-portfolio
Common Reasons Why Trainees don't make effective use of
their e-portfolio
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• 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!
Engaging with the E-portfolio
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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
Trainee suggestions to engage in e-portfolio
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What do I write? -familiarise with curriculum headings and competences and
what they mean to use as framework to follow
Time issues
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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 eportfolio, 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.
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
PDP Linking
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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.
SMART PDP
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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.
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Specific
Measurable
Attainable
Relevant
Time-bound
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SMART
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Specific
Is your goal well-defined? Avoid setting unclear or
vague objectives; instead be as precise as possible.
Instead of: To be a better GP
Make it specific: To develop my consultation skills,
especially those relating to communication.
Measurable
Be 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 consultations
Make it measurable: Better PSQ outcomes and
achieving more COT competencies during assessment.
Attainable
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SMART
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 month
Make 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.
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STRs-PRE ES meeting
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Arrange meeting! Ask ES to create a review.
log and share an e-portfolio entry entitled Ed Sup Rev
current date. Attach:
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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
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
WHY do STs get referrred to central
Deanery panel
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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.
ARCP PANEL OUTCOMES
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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
OOH
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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
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)
Naturally Occurring Evidence
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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
NOE (cont)
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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
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’.
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)
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
Gibbs Reflective Cycle
Reflection template
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
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?
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?
Reflective Writing: evaluation
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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?
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!
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Reflective Writing: new perspectives
• What have I learnt from this experience?
• How has this experience affected my thinking?
Validation
Why does validating entries matter?
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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.
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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.
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.
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Who Reads entries and validates-ES or CS?
Competence Area
MSF
PSQ
COT
Communication and consultation
skills
x
x
x
x
x
x
Practising holistically
CbD
CEX
CSR
x
x
x
Data gathering and interpretation
x
x
x
x
x
Making a diagnosis/decisions
x
x
x
x
x
Clinical management
x
x
x
x
x
Managing medical complexity
x
x
x
Primary care admin and IMT
x
x
x
x
x
x
Working with colleagues and in
teams
x
Community orientation
Maintaining performance,
learning and teaching
x
x
x
Maintaining an ethical approach
x
x
x
Fitness to practise
x
x
x
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
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.
What happened subsequently
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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.
What did you learn?
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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
What will you do differently in the
future?
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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.
An example of a good reflective log
entry
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What further learning needs did you
identify?
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How & when will you address these?
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Record created
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Comments
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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.
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
An example of a good reflective log
entry
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How does this compare with your entries.
Are the curriculum statements valid?
What can you learn form this?
E portfolio
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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.
Reflection and validation exercises
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Eportfolio j smith2
Password jsmith2
Dr Pauline example
Can use dummy system
The username is trainer1
The password is rcgp
PLENARY
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