Opportunity knocks

I have not posted anything here for months – years in fact. With a lack of any progress in improving the ePortfolio, the constant disappointments became too draining. I diverted my energy to other things. But I am still involved in training and the MRCP, and at every meeting, on every subject, I bring up the ePortfolio. I point out the problems it causes, and highlight the barrier it creates to meaningful educational feedback and support.

Change occurs at a glacial pace in postgraduate training, and with resources so constrained there has been little appetite for investing in an ePortfolio fit for purpose. But once again there is a glimmer of hope. Change is happening in internal medicine. The Shape of Training and Future Hospital Commission reports have led to important discussions within the Royal Colleges, HEE and the GMC. A new curriculum is being written for internal medicine, with a review of the assessment methods in use. There is a clear and coherent focus on reducing the burden of assessment, moving away from meaningless tick-boxes of atomised tasks, to more outcome-focused holistic assessment of ‘competencies in practice’.

This change in assessment methods will only achieve its’ aims if the technology is there to support it. An ePortfolio should make the task of capturing, organising and presenting data that feeds into assessment decisions easier, for trainees and assessors. This is an opportunity to modernise, to support trainees and educational supervisors and demonstrate that their time is valued.

This is an opportunity to invest in the future of medical training. I hope those with the purse strings don’t let us down.

 

Tipping point for the NHS ePortfolio?

The ePortfolio is infamous in the world of UK postgraduate training, with few fans and many critics. But where did it come from, and where is it going?  

Where did it come from?

The ePortfolio began as a pilot project, developed by a group within NHS Scotland, a special NHS Health Board. It has expanded beyond anyone’s imagination at the time and now has thousands of users across multiple specialities and multiple stages of training.

Unfortunately the perception of users is that the ePortfolio is unintuitive, time consuming, frustrating and of limited educational value. This frustration is due to views on the competency-based training and assessment system we find ourselves in, poor communication about the reasons behind and timeframe of proposed changes, as well as the software itself.

Where is it going?

A major development has occurred, which has fallen under the radar of most trainees and trainers but potentially has major implications for all. NES have recently published a review paper, in which they acknowledge that the financial and political constraints of being situated in an NHS Health Board mean they cannot do what they need to. They cannot hire the right people for the right time period, or invest in significant improvements to their product. In essence they are unable to function as a technology company and therefore struggle to effectively deliver a technology-based product.

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The review proposes three options:

Option 1:  Do nothing – NES continues to manage and operate ePortfolio directly on a day-to-day basis within the existing management structure and operating constraints.

Option 2:  Further development within NES – To identify and cost the changes required to develop management and financial arrangements within NES to help promote opportunities for the future development of ePortfolio.

Option 3: Joint venture with a third party – NES enters into a joint venture with a third party to transfer operational management of ePortfolio to a third party and retain some level of joint ownership and control over future direction.

Option 1 doesn’t sound great: the status quo is no good. Option 2 might be better but still seems very limited. Option 3 is potentially a major opportunity but includes lots of uncertainty, unknowns and possible risk. And still does not necessarily solve the problem of there being no overview of ALL ePortfolio systems used by ALL doctors and the need for interoperability and future-proofing. The option of an outright was sale is also mentioned but is the less favoured option by NES.

Third parties must register their interest by July 31st, and submit proposals by September 13th. We will then hear the results by October 31st.

All current users should follow developments with interest, and ensure their Royal College makes the right decisions on their behalf. The Royal College of Physicians has a user group and actively seeks the opinions of trainees and supervisors. Other Colleges should follow their lead. Any change potentially has major implications for the thousands of doctors who love to have the ePortfolio.

Back up now!

There is great uncertainty as to the future of the ePortfolio. Considering the importance of the data within it in terms of future job progression and prospects, I would make sure you’ve backed up your data. You’re only option is to download a PDF, but this is better than nothing. And remember to make sure anything in your personal library also exists somewhere else. You never know what the future might hold…

Read the NES Review paper. 

Money makes the world go round

It’s been a while since I blogged, but that doesn’t mean that nothing has been happening. I continue to participate in the RCP ePortfolio group with our next meeting coming up in July so please pass on anything you want me to feedback to them. Also, the teams behind Meducation and Podmedics have joined forces and launched a kickstarter to start developing Oportfolio: a free, open source ePortfolio, designed by doctors for use from medical school to retirement. Is this a game-changer? It could be….

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All doctors need a way to log their achievements and learning. But an ePortfolio should be more than a collection of paperwork mandated for an appraisal or revalidation. It should support an individual in a constant process of self-reflection and improvement, and enhance something that is at the heart of learning – a relationship. The day when trainees and supervisors talk with enthusiasm and joy about their ePortfolio will be a happy one. I can’t wait to see this happen, but looking around at the software available across all specialities and all levels of training it feels a long way off. Why?

Money, money, money

One of the biggest barriers to change is constrained resources. We all know there is not much cash around at the moment in the NHS, and education in particular has suffered. Trainees have complained that the ePortfolio they use is not good value for money, but there is a limited amount that the Colleges (who hold the purse strings) can invest. So how much does the ePortfolio cost?

Photo credit: Images_of_Money http://www.taxbrackets.org/(Creative Commons)

Photo credit: Images_of_Money http://www.taxbrackets.org/(Creative Commons)

In 2012 the NES ePortfolio (the biggest provider) cost it’s customers (Royal Colleges,the Foundation Programme etc) over £600,000. That was just one year. Good software costs money: it is created by talented professionals whose time and expertise is valuable. Putting a number on what good value is for the ePortfolio would be arbitrary  However, if the users think it’s not good value, then it isn’t. They don’t value it, and therefore are less likely to engage with it. Disaster.

Due to the current way in which medical ePortfolios are funded, the only way to make them better, add features and speed up the development of the app would be to pour lots of money in. This is because the funding model depends on the customers (Colleges) individually specifying changes and paying for them in terms of developers’ time. These costs are on top of the day to day running costs. Unless this funding model radically changes, NES will never be able to deliver the kind of ePortfolio doctors are clamouring for. The team at NES have been fantastic in engaging with trainees and encouraging calls for change, but they are constrained by their location in an NHS Scotland Health Board and their lack of power over their own organisational and financial structures.

Don’t be shackled to the past

An important point made by Ben, a NES developer on an open Linked.in thread is that trainees only see one part of structure of the ePortfolio. There is a lot behind the sterile pages of mini-cexs, in terms of levels of access, account types, administration and data reporting. But the counter-question to this is, is that where we should be directing our money? Should we be paying for complicated layers of access structures, or should we trade this for better functionality? It is time for a fundamental shift in our conception of an ePortfolio, putting the learner at the centre. We have the opportunity to re-imagine what an ePortfolio could be and mustn’t let the structure of the current system dominate our thinking.

Open source – what’s all the fuss about?

Some are fearful of open source projects but there is already precedent in the NHS for open source software; for clinicians working directly with software developers to iteratively create things of beauty. If you have not seen OpenEyes before, click and behold! OpenEyes even holds patient data securely, so any alarmist worries about trainee data in an open source system can stop right here. It is fantastic to see new, agile ways of working emerging as successful – and anything has to be better than the NHS’s previous track record on IT projects!

Oportfolio

The Oportfolio team are creating an open source ePortfolio. This means the code will be open for anyone to use. They are not in it for the money. Their motives (paraphrased by me after many conversations with Ed and Jeremy at NHS Hackdays and online) are:

  • a wish to help those who work in the NHS (for the ultimate benefit of patients)
  • an interest in how technology can support education
  • a passion for creating beautiful software.

Oportfolio will available to any doctor in the NHS, including those who are currently not affiliated to a College and therefore have no ePortfolio at all. The potential gains to the NHS are huge in terms of money, and doctor-time. More intangible benefits include: trainee and educator happiness; and more fulfilling postgraduate training.

Ultimately, happier, more reflective, better educated and informed doctors give better patient care. And that’s something you can’t put a price on. 

So whether Oportfolio becomes the best thing since sliced bread and is adopted by all healthcare professionals in the NHS, or whether it is never adopted but creates  pressure for change in the current systems that can no longer be ignored, it will have been a success.

The plan is for the end product to be free to users, but to get started they need a little seed money. I’ve just put my money where my mouth is to help get it off the ground. I hope you do the same.

What can you do?

The RCP are listening – what do you want to tell them?

A few months ago I participated in the first Royal College of Physicians (London) ePortfolio reference group. This group has been established to increase the trainee voice in the ePortfolio development process, and should be celebrated and welcomed. The RCP is leading the way in engaging trainees to make sure their educational experience is as good as possible. Does your College have trainee representation? If not, you should ask them why not…..

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At this meeting we discussed many areas, and tried to keep things positive, focusing on what changes could be made that would make the ePortfolio better for trainees. The RCP agreed to take these issues forward to a meeting with the NHS ePortfolio providers NES:

1. Development of an API to allow integration with third-party tools

It is great that the RCP were willing to take this on and discuss this as a priority with NES. There are lots of apps being developed (including many at NHS Hackdays) which help trainees to capture their learning, for example in log books. There is currently no way that this data can be incorporated into the ePortfolio. Since NES does not have the capacity to create additional software, allowing third party software to interface would be a major step forward in increasing the functionality of the ePortfolio.

2.  HTML5 app to concentrate on work place based assessments

As you may be aware there is now finally an app! Amazing! But at present it can only log reflective practice and send tickets. The group agreed that WPBAs/SLEs should be the priority for the next release of the app.

3. Development of summary views of data to support ARCPs

The current summary overview is unimaginative and unhelpful for ARCPs and PYAs. I have heard too many stories of trainees still having to print their portfolio, or send documents separately. In my own ARCP last year the panel could not find all the evidence they needed and I had to send it as PDFs afterwards. There should be a better way for the trainee to curate the content of the ePortfolio on an ARCP page. It should be possible to define the requirements for ARCP fulfilment and then demonstrate how these have been met. The data should be displayed in an easy to view at-a-glance way so that ARCP panels can rapidly see and access what they need.

4. Change to how ePortfolio roles are created so they are cumulative

Rather than having to switch between roles and select one, with different access levels for each type of access account. This is particularly important for those with significant assessor roles in addition to trainee roles.

Please let us know your thoughts on these issues, and tell us what your priorities are so that we are well prepared for the next meeting, hopefully in June/July. I’m looking forward to hearing how these issues were received and what plans are in place for taking them forward.

We have a real opportunity to raise issues, focus the priorities of those with the purse strings and effect change. Don’t stay silent! 

You can give your feedback in a number of ways:

  1. Comment here (below this post)
  2. Talk to the JRCPTB ePortfolio team
  3. Talk to the your Foundation Programme school
  4. Give feedback to NES directly on Twitter
  5. Give feedback to NES about the app specifically 

There’s an app for that

After much complaining it is great to be able to be positive about the NHS ePortfolio. Developer Ben from NES has been working on an app which is now available in beta version. It is html5 so whether you’re an apple or android user it should work on your device. You can download it right now, have a go and provide feedback to make sure the next iteration is even better.

Go to this site on your device: app.nhseportfolios.org  and login with your usual password.

At the moment the functionality is limited. It supports reflective logs and ticketing, but does not allow offline completion of assessments such as mini-Cex. I also could not get it to store data within the app to synch later initially as it made me synch before I could logout, or data was lost. I also got stuck inside the app and couldn’t get back to the rest of my iPhone. This was a bit of a nightmare – stuck in the ePortfolio forever! It would be great to hear if anyone else had these problems or if it was just me! I have since managed to use it without crashing – phew! 

You can send your feedback to:  app@nhseportfolios.org 

An app is long overdue and does not fulfil all of our ePortfolio dreams yet, but it’s a start and should be celebrated. Hopefully, by testing and getting feedback before further work, the app will fulfil the needs of users and make logging evidence of our skills and learning experiences fit the realities of our working lives. And perhaps this agile way of working might permeate back to the rest of the ePortfolio. A girl can dream…..

Shape of Training – influence the next 30 years of medical training!

You have only days left to shape medical training for the next 30 years.

The Shape of Training review aims to plan how doctors should work and train in the next 30 years. This is your chance to directly tell decision-makers what you want postgraduate training to look like.

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  • Should we have more generalists and fewer specialists?
  • Should there be a speciality of General Internal Medicine (distinct from Geris)?
  • Should all medical trainees CCT in GIM before starting speciality training?
  • Should more specialities dual-accredit and therefore contribute to the acute take (hello Rheumatology, Dermatology, Renal, Oncology……)?
  • Should F2 be abolished?
  • Is training flexible enough?
  • How can trainees be supported to learn from their experiences?  
  • Is the balance right in the current system between training and service provision?

I have strong views on many of these questions (the answer to the last one is NO!)

“This review takes place in a rapidly changing environment. Medical and scientific advances, evolving healthcare and population needs, changes to healthcare systems and professional roles, the push towards more care provided in the community, the information and communications technology (ICT) revolution, and changing patient and public expectations will all affect how doctors will practise in the future. We therefore need to consider what these changes mean for the way doctors are trained.”

The survey is long, but is so important that it’s worth the effort. I recommend you put aside some time, make an extra large cup of tea, and really dedicate some brainpower to your answers. This is the best chance you will ever have of influencing the shape of medical training. Don’t let it slip through your fingers.

In particular I would consider mentioning your views on WPBAs and the ePortfolio in questions

  • 13: How do we make sure doctors in training get the right breadth and quality of learning experiences and time to reflect on these experiences?  (Better software in which reflection could be logged on the go, and reflections could be tagged and organised/visualised/shared more flexibly would help. Time spent with mentors instead of filling in paperwork would also be great)
  • 14: What needs to be done to improve the transitions as doctors move between the different stages of their training and then into independent practice? (Interoperability of ePortfolio systems would be a start)
  • 18: Are there other changes needed to the organisation of medical education and training to make sure it remains fit for purpose in 30 years time that we have not touched on so far in this written call for evidence? (yes…..)

Go on. Respond… 

NHS Hackday and the oPortfol.io

This weekend I was at NHS Hackday. Doctors, other healthcare workers, students, patients, organisations and software developers came together in their free time to make stuff that could make the NHS better.

Thanks to @londonlime

Thanks to @londonlime

I was astounded by the last Hackday. I didn’t think my expectations could be surpassed. They were.

The projects were diverse, aiming to solve everyday problems at all levels of the NHS. You can see the list on the Google doc and they’ll be on the wiki soon. The highly deserved winner was OpenHeart. The team used the amazing open source electronic health record at Moorfields Hospital, Open Eyes, and adapted it for use in Cardiology. The end result was stunning. It will save hours of doctors’ time, will create patient records that are much more understandable for patients themselves and for GPs, and will improve communication and therefore the quality of care.

Another favourite was Dementia scrapbook, an app to allow family and friends to contribute to a virtual scrapbook of memories and reminders. It has an easy to use touch interface that can be used by carers or people with dementia themselves. Dementia is common and this takes a very patient-centred approach to solving problems many of us may face in the future. I hope to see it available soon on the app store.

Cellcountr, initially hacked at the Liverpool hackday, was built on with additional features such as data visualisation and a customisable keyboard. It will be launched in the next month at a Pathology conference, and will then make a real difference to doctors, and their ability to accurately diagnosis patients with haematological conditions.

So what did we do? We created oPortfolio, an open API which allows trainee doctors to record learning events online, offline and on the go. It includes a webapp, a mobile-friendly site, an iPhone app, and an android app that all synch data. From nothing to all this in 36 hours! The team were incredible: full of talent, patience, and creativity.

Oportfolio

What does it do?

It solves an immediate need to log learning events on the go (see examples below). It lays the foundation for a more complex system to log assessments and meetings. With (quite a bit) more work it could be a simple open portfolio that doctors who are not currently in a training programme (eg LATs, people doing fellow jobs in between F2 and speciality training) could use to track their professional development. The funding model would have to be clarified as development and hosting is not free! It could also be an arena to experiment with and showcase new ways of organising a professional portfolio that could usefully feed into the debate on what and who a portfolio is for. It could highlight how different systems talking to each other and 3rd party apps and plug-ins have the potential to improve a core product. Another fabulous creation was Quicklog, an app to log personal development in performing procedures on the go. They built in data visualisation to encourage reflection and chart progress. It would be fantastic if the data from Quicklog could be integrated into a portfolio system. Anyone who is interested (and understands it!)  should look at the code on github for oPortfolio and Quicklog!

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What does it not do?

It is not a replacement for the current ePortfolio system(s). The NES ePortfolio and others (eg surgical portfolio) are complex structures build up over years, with thousands and thousands of pounds of investment. Many have questioned whether they are value for money and I can’t answer that but good software does cost. Existing systems have  layers of access rights and methods of data extraction since these were priorities for the bodies who paid for them. They have cloud hosting and data security. People have spent years making them do what they do and it would be crazy to think they could be replicated in a weekend. They have their problems and must be improved but they are here to stay until a better alternative exists.

The focus of building a model Oportfolio was the user experience. If it was developed further it could fulfil a need for trainees who are not in a current training programme, who currently use various cobbled together documents on Evernote, phone notes apps, word documents and paper to record their learning and showcase their achievements when applying for jobs. With regular end-user input it could be beautiful, and a joy to use!

I am sure that our exploits this weekend will appear highly challenging and controversial to some. But I am not controversial. I have always highlighted the frustrations felt by trainees (which are well known) but advocated for engagement with all interested parties: individual trainees, trainers/educational supervisors, LETBs, Trusts, Royal Colleges, current ePortfolio provider NES, the GMC and HEE. We need to get our heads together and think about what the future of training will look like, what tools are needed to enhance learning, and how they will be funded.

The NHS can’t keep putting up with unintuitive, inflexible IT that doesn’t match the realities of practice. As demonstrated at NHS Hackday; intelligence, enthusiasm, creativity, a few humous sandwiches and some coffee can create magic. But that magic needs support and investment to make it sustainable. Muir Gray says change in the NHS will come from the bottom up. He is one of a few inspirational people at the top supporting projects in which frontline staff make a difference. We could do with a few more like him….