Naturally Occurring Evidence (NOE) in ePortfolio
During your time as a GP Trainee it is your responsibility to provide evidence of your learning and
professional development towards your ultimate goal of independent practice as a GP. Writing
Learning Log entries within your ePortfolio largely provides this ‘Naturally Occurring Evidence’.
Reflective writing is a rehearsal for and of professional practice - a bit like a flight simulator for a
pilot learning to fly. The more you think and write about a particular scenario and "rehearse" in your
mind what you did, about the consequences of your actions, what you have learned, how this
learning has influenced/improved your future practice etc., then the more patterns of behaviour are
imprinted in your mind.
When writing these log entries you are expected to link them to one or more RCGP Curriculum
Statement headings. Writing log entries is not an assessment of your medical knowledge. The AKT
(Applied Knowledge Test) does this. Curriculum Statements put the log entry into context. Your log
entry allows you to describe your professional skills but these skills are contextual and cannot
necessarily be transferred from one clinical area to another. Just because you can show a good level
of holistic care and communication skills in a consultation with an elderly patient this does not mean
that you can do the same in a psychiatric or paediatric consultation. Placing the consultation in the
correct clinical setting (i.e. linking it to a curriculum statement) enables the ES and Deanery to see
whether the trainee is trying out their professional skills across all clinical areas.
The following guidance has been written to give you examples of the sort of log entries the Deanery
would expect
1. Significant event analysis:
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File under Significant Event Analysis in your ePortfolio
A Significant Event should have significant personal involvement; it is suggested that there is balance
between SEAs which focus on individual learning and those which deal with team issues and
improving systems of care. The format we require is a recent development for appraisal for GPs.
This has the advantage that you will be familiar with what is being expected of GPs before some of
them have started to use it.
If you attend an SEA meeting and you record this in your learning log, you should file that under
lecture/seminar, because you should reserve the significant event analysis heading for SEAs that you
had personal involvement in.
Guidance for Significant Event Analysis
Features of a good learning log entry for significant event analysis
2. Reflection on key learning points from each post:
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File under Courses/Certificates
Concise summary of learning points, including reflections on learning achieved (in terms of
knowledge, skills and attitudes), and how this relates to a career in GP. This reflection will result in
new learning objectives for next posts. (Expected length up to one page A4).
Guidance for reflection on a post
3. Audit or Reflection on QOF:
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File under audit/project
There is no formal requirement by the RCGP or Deanery ARCP Panel for a Trainee to do an audit but
regular audit activity is a requirement for Appraisal of fully qualified GPs. Therefore we would
recommend that a trainee does perform a GP audit so that they enter independent practice with the
correct knowledge and skills for the rest of their career. Although evidence of audit activity can be
recorded when in a hospital post it is best to obtain audit experience when in a GP Training post.
If no audit is performed then the trainee must provide evidence of knowledge and understanding of
the audit process. This can be for instance a reflection on QOF
QOF reflection. Choose one quality indicator – e.g. new QOF indicator or one where performance is
sub optimal. Examine and clarify the issues with reference to literature including suggestions to
improve performance.
If attending an audit or QOF meeting and record these in the learning log, and should file them
under lecture/seminar. The audit/project heading should be reserved for audits etc that have been
personally carried out.
Guidance for Audit
Features of a good learning log entry for audit / project
4. Case study or presentation
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File under Lecture/Seminar
This can be a presentation of a clinical case study, literature review, a research project, a discussion
paper or notes review; such a presentation may have been given in a departmental setting or VTS
group.
Key points considered in the assessment of this work are:
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discussion of how practice relates to the evidence base
demonstration of relevance to career in GP
Remember, if you do a departmental or VTS presentation, this can be mapped to curriculum
statement 3.7; teaching, mentoring and clinical supervision.
(A set of power point slides with no discussion or reflection will be judged inadequate)
Guidance on Presentation / Case Study
Features of a good learning log entry for presentation / case study
OOH Requirements in GP Post
Expected OOH Experience
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36 hours per 6 months in general practice placements in ST1/2 and 72 hours for ST3
are considered the minimum exposure for GP Trainees (pro-rata).
Phone triage is acceptable for part of out of hours experience.
The trainee should experience all aspects of OOH unscheduled care including
telephone triage, visiting by car and working in emergency surgeries.
The GP Trainees educational supervisors are expected to check the number of OOH
sessions during the formal review of the ePortfolio.
The Trainee must keep a record of hours and details of all sessions worked by writing
Learning Log entries.
For further information please see the Resources and Information page of the
Wessex School of General Practice:
http://www.wessexdeanery.nhs.uk/gp__primary_care/resources_and_information.aspx
Child Protection
This is a very important part of General Practice and to that end all GP trainees should be able to
demonstrate their knowledge, skills and attitudes towards Child Protection issues. The RCGP has
produced a toolkit to help professional development in this area:
http://www.rcgp.org.uk/clinical_and_research/circ/innovation__evaluation/safeguarding_children_
tookit.aspx
It is anticipated that GP Trainees will write about Child Protection cases as they gain experience of
them in practice whilst in hospital or GP posts. Alternatively, Trainees might consider it appropriate
to write reflectively about Child Protection issues from a theoretical standpoint based on their own
reading, courses/lectures attended etc.
CPR & AED training
The RCGP examination regulations state that CPR & AED update training performed in a GP Post is
valid for three years and therefore as a minimum all trainees will need to undertake such training
when working in a GP practice at least once in the three years before they finally apply for their CCT.
For further details please see:
http://www.rcgp-curriculum.org.uk/mrcgp/cpr_aed.aspx
Attendance at a CPR & AED update training session should be recorded in the Trainee’s Learning Log
under Courses/Certificates and a copy of the course certificate scanned and attached to the log
entry as evidence of successful achievement of the required skills.
Guidance on writing Learning Log Entries
Guidance for Audit
This guidance is set out in a way that matches the audit option in your learning log in the ePortfolio.
Audit work is best performed in GP Posts but can be done at any time throughout your GP Training
rotation. It is expected that each year you will record audit activity, reflecting on its relevance and
how the experience is likely to influence your future professional practice
What was the subject and aims of the audit/project?
Describe the topic chosen and what you hoped to learn by studying this topic. State the specific
question that you were hoping to answer
What led to this subject being chosen?
Explain how this subject relates to your work in General Practice and the particular post you were
working in when you did the audit or project.
Describe how the results of the study have the potential to alter your future practice, and how the
study relates to the literature.
What did you learn?
Describe the results of your study and relate them to your own development and to the practice you
are working in.
What will you do differently in future?
This needs to cover the domains of knowledge, skills and feelings and include suggestions of
personal change as well as possible system changes
What further learning needs did you identify?
Describe needs for learning and development that come out of the audit. These should be described
in terms of knowledge, skills and feelings. The needs should be SMART (i.e. specific, measurable,
achievable, realistic, timely). What you write in this section and the next should be transferable to
your PDP
How and when will you address these?
The plans should be realistic and fit into your schedule; your response here should be clear not
vague.
Features of a good learning log entry for audit/ project
What was the subject and aims of the
audit/project?
Clear statement of a specific and
answerable question
What led to this subject being chosen?
Clearly expressed account of relevance
to their own practice and the organisation
they are working in. Related to literature.
What did you learn?
Brief account of the results and how they
feed back to the practice. Personal
learning points clearly identified
What will you do differently in future?
Definite and specific plans for future
practice expressed in terms of personal
change and system changes and
phrased in terms of knowledge, skills and
feelings
What further learning needs did you
identify?
Demonstrates ability to express learning
needs that are specific, measurable and
achievable, and relate to the reflection on
the subject of the audit/ project
How and when will you address these?
Realistic and definite plans described
Guidance for reflection on post
You should write one reflection on key learning points for each post that you complete. File the
reflection in the courses/ certificates section of the learning log on your ePortfolio
We would like you to reflect on your learning during the post you have just completed. A short
document, about one side of A4, will suffice.
What knowledge have you gained?
Do you need to do anything so that this knowledge can be used in a GP context?
What skills have you gained?
Do you need to do anything so that these skills can be used in a GP context?
How has the post and the last 4-6 months affected you as a person?
How have you managed this personally?
What plans do you need to develop for self care in the light of this?
Reflecting on all these areas what do you need to do to ensure that in the next post you gain the
most personally and in knowledge and skills?
Guidance on presentation/ case study
This guidance is set out in a way that matches the lecture/seminar option in your learning log
on the ePortfolio. You are expected to do at least two such entries in each year of your
training.
What was the subject and aims of the lecture/ seminar?
Describe briefly the clinical case or the topic of your presentation.
State the specific question that you were hoping to answer
What did you learn?
Describe what you learnt from doing the presentation or case study. In a case study this learning may
be what you learnt about the patient, their condition, and your role as a GP Trainee in their care. For a
presentation your learning may relate to the topic in question and to the process of preparing the
presentation: what were your main messages, how did you get them across?
What will you do differently in future?
Describe this in terms of knowledge, skills and feelings: include suggestions for personal change as
well as possible system changes
What further learning needs did you identify?
Describe needs for learning and development that come out of the audit. These should be described
in terms of knowledge, skills and feelings. The needs should be SMART (i.e. specific, measurable,
achievable, realistic, timely). What you write in this section and the next should be transferable to your
PDP
How will you address these?
The plans should be realistic and fit into your schedule; your response here should be clear, not
vague.
Features of a good learning log entry for presentation/ case study
What was the subject and aims of the
lecture/ seminar?
Clarity of expression of the important
features of the case studied or topic
presented
What did you learn?
Brief account of what has been learnt
and how this relates to the individual’s
development as a GP Trainee
What will you do differently in future?
Definite and specific plans for future
practice expressed in terms of personal
change, and possibly system changes,
phrased in terms of knowledge, skills and
feelings
What further learning needs did you
identify?
Demonstration of the ability to express
learning needs that are specific,
measurable and achievable, and relate to
reflection on the learning described
above, in the context of their own
development.
How will you address these?
Description of realistic and definite plans
Guidance for Significant event analysis (SEA)
We expect that you will make at several SEA entries in your learning log each year. These
entries will be assessed by your Educational Supervisor and by the ARCP panel that views
your portfolio when you are due to progress.
“Significant event” is often used as a synonym for something going wrong. You can include
positive significant events if you wish. You may also include events that were consequent on
the actions of someone in the team that you work in. The key thing is that they are significant
to you and they affect you.
There are two essential elements in a significant event. One is the story of what happened,
the consideration of how it could happen, and changes made to procedures and protocols in
the light of this. The other is the emotional effect it has on the people involved. You need to
write about your feelings and those of any patient and colleagues(s) affected, and how they
are managed, as well as the mechanics of the event.
The data entry form on the portfolio for significant events has seven sections, here is some
guidance on what is expected in each of these.
What happened?
Briefly outline the story of a significant event that affected you. The description should be clear and
appropriately comprehensive.
What issues are raised by this significant event?
Explain why you chose this event, why is it significant to you?
How does it affect you, in procedural and emotional terms?
What was done well?
Describe the events and your reaction to them.
This description should be in terms of knowledge, skills and feelings
What was not done well?
Describe the events and your reaction to them.
This description should be in terms of knowledge, skills and feelings
What could be done differently in future?
Again, answer this question in terms of the domains of knowledge, skills and feelings and include
suggestions of personal change as well as possible system changes. Please describe definite plans
for the future rather than a list of possibilities. How has the significant event influenced your
professional practice?
What further (personal) learning needs did you identify?
Describe needs for learning and development that come out of the significant event. Again these
should be described in terms of knowledge, skills and feelings. The needs should be SMART (i.e.
specific, measurable, achievable, realistic, timely). What you write in this section and the next should
be transferable to your PDP
How and when will you address these?
The plans should be realistic and fit into your schedule, your response here should be clear not
vague.
Features of a good learning log entry for significant event
What happened?
Clarity of expression of salient features of the
significant event
What issues are raised by this
significant event?
Demonstrates relevance of the event to the
working practices of the individual and the team.
Demonstrates reflection, and appreciation of both
personal and procedural aspects of the event.
What was done well?
Reflective description in terms of knowledge, skills
and feelings
What was not done well?
Reflective description in terms of knowledge, skills
and feelings
What could be done differently in
future?
Reflective description in terms of knowledge, skills
and feelings
What further (personal) learning needs
did you identify?
Demonstrates ability to express learning needs
that are specific, measurable and achievable, and
relate to the reflection on the significant event
How and when will you address these?
Realistic and definite plans described