Monthly Archives: July 2012

An app-ortunity

Quite reasonably I have been asked how an NHS ePortfolio app would benefit doctors, and what it would have to do to be worth any investment. In my opinion the need for an app is driven by the need to make WPBAs more relevant. An app would put control back in the hands of trainees, and make life significantly easier for trainers/assessors. This would reduce resentment towards WBPAs and would save an unimaginably huge amount of time for a stressed, squeezed, overworked profession.

The current situation:

I am doctor in training (this covers everyone who is not yet a Consultant/GP partner). I am required to complete a certain number of WPBAs to progress. One day I am at work and am on call admitting new patients to hospital. I think I’ve made a pretty thorough assessment of a patient with a condition I’ve not encountered before and ask my Consultant if, after presentation of the case on the post-take ward round they can fill in a mini-CEX. They say yes.

I present my case during the round and the Consultant provides some useful immediate feedback on my assessment, including a recommendation to read a recent review on the subject in an academic medical journal. However, the Consultant has another 7 patients to review after this and can’t stop to find a computer, login, wait for it to load up, access the NHS ePortfolio website, login and complete the assessment. “Send me a ticket” they say, with a genuine intent to complete is as soon as possible. My shift gets busier and after 13hours at work I go straight to bed when I get home. The next day i am very busy and forget to send the ticket via email. I remember when I get home but realise I don’t know the Consultant’s email address. It’s a weekend so I’m not in for another 2 days. I set a reminder with an alarm on my phone and on Monday the alarm prompts me to retrieve the email  from the hospital system and I send the ticket from the NHS ePortfolio site.

A week later the assessment has not been completed and I send a reminder. Three days after this I bump into the Consultant in the lunch queue and gently remind them about the mini-CEX. They make excuses, feel bad, and promise to do it ASAP.

A week after this the Consultant finally has some time for admin and discovers my reminder email in their inbox. They login and struggle to remember anything about the patient or the feedback they gave me. They have an overall impression of whether I’m any good or not and complete the assessment mainly based on this overall view, rather than the specifics of the case we discussed. I get an email to say that the assessment has been completed. At a later date I login and read the comments, which are brief, and get no educational benefit from the recording of the episode. I do however feel less stressed as that’s one less assessment to get ticked off. I can’t remember the author of the review recommended by the Consultant and never quite get round to searching for it.

A possible future situation:

One day I am at work and am on call admitting new patients to hospital. I think I’ve made a pretty thorough assessment of a patient with a condition I’ve not encountered before and ask my Consultant if, after presentation of the case on the post-take ward round they can fill in a mini-CEX. They say yes.

I present my case during the round and the Consultant provides some useful immediate feedback on my assessment. I get out my smartphone and login to the NHS ePortfolio app. I bring up the mini-CEX form and we complete it together adding comments based on the feedback the Consultant has just given, including the recommendation to read a recent review by author X in journal Y. There is a prompt to enter the Consultant’s email address so that they can validate the mini-CEX as an accurate representation of the assessment, and I input this as the Consultant dictates it. I save the form. The Consultant continues with the post-take ward round. I continue to admit new patients.

When I get home my phone picks up my wifi signal, and the ePortfolio app automatically synchs with my account so that the mini-CEX is uploaded. An email is sent to my Consultant and me to inform us of this new entry on my ePortfolio. I don’t have to waste time chasing up multiple assessments like this, so actually get round to looking up the review recommended by the Consultant, and learn something that will benefit my future patients.

It is essential that an NHS ePortfolio app:

  • is cross platform (iPhone, android etc)
  • can perform most functions offline with synching later with the main site. Most NHS hospitals have no wifi and poor phone sinal coverage. If an app required wifi it would be of no use to many, many, users

Another possible function would be to record reflection-in-action – essentially quick notes about things that happen that are particularly challenging, satisfying etc. There would then be scope to comment on this in the portfolio later (reflection-on-action).  Professionals must be reflective to learn and develop, but there is debate around the value of writing down these reflections. An app would at least make the process easier for those that wished to do this.

Oh, and of course ideally it would be free. But I’d pay £0.69 to make my life easier, wouldn’t you?

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The NHS ePortfolio fan club

A recent twitter post directed me to the blog of Dr Fiona Pathiraja, which I encourage you to read. She asks:

Am I the only member of the ePortfolio fan club? If the recent vitriol on Twitter is anything to go by, one would be forgiven for thinking that the fan club comprises n=1.

She suggests that much of the negative press is unfair, and that medics don’t know how lucky we are, especially when compared to the private sector.

However, looking more closely her comments are a mix of praise for the concept of an ePortfolio itself, the structured nature of medical training programmes, and the job security that so many others rightly envy. She is honest about the shortcomings of the NHS ePortfolio in its current form and the need for change.

Of course, the ePortfolio is far from perfect. The end user is typically generation Y and expects technology to have the beautiful aesthetics and seamless functionality of their i-products. Improving functionality e.g. linking curriculum items to assessments, and aesthetics is essential for an improved ePortfolio.

This is exactly the point. We expect more. We deserve more. It is time for investment in the NHS ePortfolio to bring its functionality and aesthetics into the era of generation Y.

She also goes beyond the technical aspects of the current ePortfolio and makes requests for: a better and more transparent evidence-base for assessment tools including WPBAs; more training for supervisors on use of assessments; and the need to treat medics as adult learners:

As a cohort of intelligent, motivated young people, we are able to take responsibility for adult learning, but need to be treated like adults in order to do so.  If the ePortfolio gods are listening—engage with us, take constructive feedback, and try to improve the portfolio to inspire the medical generation Y.

I couldn’t have said it better myself. This site is a first step in connecting users, developers, and Royal Colleges.  If we can all work together to effect these changes, I might just join the fan club myself!

Competency: necessary but not sufficient

This site is primarily a forum for highlighting limitations and frustrations with technical aspects of the the NHS ePortfolio. However, inevitably the discussion often broadens to problems with the ethos of training, or how it is perceived, and specific problems with the tools currently used to assess trainees. I was pointed in the direction of this paper by Dr AnneMarie Cunningham via Twitter. It highlights some of the issues with respect to the limitations of competency-based assessment of complex professional abilities.

A few points that struck a chord were:

* Competence does not necessarily predict performance

The sum of what professionals do is far greater than any parts that can be described in competence terms

* How do we assess “trustworthiness?”  –>  otherwise known as “the granny test”? The question “would you trust this doctor to care for your unwell grandmother?” may be a better test of trainee progress than any competency test

* The idea of trust reflects a dimension of competence that reaches further than observed ability. It includes the real outcome of training—that is, the quality of care

*  Innovation of postgraduate training should focus on expert appraisal of performance in practice

I hope that those responsible for postgraduate training engage trainees and ensure any future changes are; appropriate, of benefit to trainees and trainers, are evidence-based and “real-world tested.” A common theme from trainees is that current training is tick-box, uninspiring and lacks true mentor/mentee relationships. Olle Ten Cate’s paper contributes to this debate by highlighting the concept of trust and the complexity of assessing professional activities.

Postgraduate training can be better. But it requires enthusiastic mentors who are given the time, support, and freedom to educate and inspire the next generation of doctors.

All ePortfolios are equal, but some are more equal than others

The NHS ePortfolio is not the only kid on the block. Since starting this site I have been pointed in the direction of some alternatives (thanks for all suggestions). There are specific requirements for NHS trainees which mean that it is more likely we will always all have to use the same software, rather than being able to break out and use different versions. Most obviously this is the need to collate standard Workplace Based Assessments. However, we can window shop, and return with a long shopping list…

1. The GPs didn’t just get mad, they got creative

This site seems to have been created due to a need for a FREE ePortfolio tool that could do 360 degree appraisals, and have the ability to log a number of different types of CPD activity. Clearly very GP focused, and I can’t get in to see how user-friendly and intuitive it is. The testimonials make it sound great! Likely to be limited in scope, flexibility and future directions as created for a specific purpose and audience. I get the impression it’s aimed at GP Partners more than trainees (who have to use the NHS GP Portfolio).

2. Pebblepad

Claims to be able to fulfill multiple functions which sounds good:

  • Assessment (formal and informal)
  • Advancement (promotion or transition)
  • Appraisal (self – peer – 360)
  • Accreditation (professional bodies)
  • Application (course, job, funding)
  • Articulation (informative story telling)
Looks quite corporate, not easy to move from different areas of content. Seems to have been well thought out and to have considered the need to be able to display the contents in a useful way, and export this for multiple purposes. Has flexibility in terms of what content can be stored, including files, pictures and links. But somehow still doesn’t feel like what I’m looking for.  

3. Mahara

Aims to be a learner-centred Personal Learning Environment. Specific features include the ability to choose which aspects of the portfolio are public and private; the ability to create a digital CV; a blogging area (maybe it’s better than calling it reflection?) and the ability to interface with Moodle. Also, it’s Open Source. We love Open Source! Mahara ticks a lot of boxes for me, especially the fact that there has been some thought about how to display features in a very visual way, but it feels a little juvenile. And it is difficult to see content – it requires lots of clicks to do anything. The fewer the clicks the lower my frustration levels!

4. Googlios

Of course, why did I not realise that Google would be ahead of the game on this? The Googlio comes the closest to my idea of how the NHS ePortfolio should look and feel.  It is easy to navigate, with different sections accessed in multiple ways, meaning very few clicks to do anything. It presents an individualised “showcase” of what’s inside with a standard set of bits of information, but with the ability for the individual to highlight their most significant achievements and curate their own “front page”. It works with Googledocs, Word and Excel so the information contained within it is exportable for other purposes, and documents can be dynamic (I’m thinking about the great potential for a log-book here). It is easy to embed links, blogs, and other content from all sorts of different applications, and they are displayed in a helpful way. It’s not perfect as it needs a timeline amongst other things. But they completely sold me by using Leonardo da Vinci as inspiration. “The Googlio philosophy could transform 21st century education, using 21st century tools. This has the potential to stir a return, a revolution, a rebirth, a revival of educational renaissance.” I’m not really sure what this means but I’m excited. This is the kind of model the NHS ePortfolio team should follow. ePortfolio Gods, please look at this!

I have now used Googlios (or Google sites as it’s also called) to create my own teaching portfolio. Having spent a while getting to grips with the interface I remain a big fan. The NHS ePortfolio has a lot to learn about user satisfaction…

I was also directed to the Academy of Medical Royal Colleges project MIPS, which aims “to develop an initial set of ePortfolio standards to encourage modularisation of systems and secure interoperability between ePortfolio systems (NHS, Collegiate and others).” I think this is a word-y way of saying they want to lay down some ground rules for how ePortfolios should work, and how they should work together. Sounds great! And it’s so great to see a project like this working across Colleges and specialities. We all have a core set of very similar needs, so should be pooling resources and ideas. I can’t see any signs of progress or deadlines on the site, however. Hopefully there’s lots going on with this project in the  shadows…

Know of an ePortfolio you think is better? Have experience of using one of those featured above? Comment below.

NB. Since writing the original post I have also been directed to an NHS Hackday presentation on standards for an ePortfolio and  a site defining  Government IT standards, which look like great starting points for agreeing standards that must be achieved in using data, including that in the ePortfolio. Lots to think about.

Why is it so slooooooooooow?

The site is very, very slow. It does not look like a complex site; there are no videos to run, there is only one page loaded at a time, it is not running complex algorithms. My IT/tech knowledge is in the “below expectations” category, but I gather there are a few issues that need to be resolved:

  • Some pages are big (even though they may not look it) – the lovely tech people are working on making them smaller so that they will run quicker
  • They way the site is constructed makes any individual action slow to complete  as it requires multiple clicks and refreshes – this is being addressed for the infamous linking process, but needs addressing for all functions
  • NHS computers are slow. The lack of IT investment is staggering, considering the amount of data we deal with in health care systems. But I don’t think I can fix the entire NHS’s IT systems so you will have to continue to struggle on your desktop at work. However, much of the ePortfolio content is generated at home, where most people have decent broadband speeds. If I can run twitter, BBC iPlayer, Waitrose online shopping and Ottolenghi’s recipes at the same time with no problems why is the ePortfolio site still so slow….?

  • ……apparently the ePortfolio is hosted on the NHS network. This is old, slow, and limits the speed of the site. It also has very limited capacity to cope with surges (which are inevitable ie pre-ARCP). A great option would be to move it to a Cloud. This is what everyone is doing these days. Big data needs big storage and there’s a lot more space in the Cloud. So what’s the problem? Let’s do it! To move the hosting to a Cloud needs investment, ie money. We need to persuade the Colleges that they need to fine some spare cash to sort this out. And soon.

You can help by leaving a comment. Go on….

A vision of a better (ePortfolio) world

When I log into my ePortfolio it looks like this:

wow. inspiring.

I would like it to look more like this :

 

Wow! At least a little more inspiring!

This example is just an afternoon’s cut and pasting in an attempt to highlight small changes that could be made, using existing content within the site that would improve the experience for users. There is a much bigger debate around the concept of the portfolio, WBAs, and how we train, test and inspire trainees; but I’ll save that for another post…

Where’s my Logbook?

Surgical trainees already have an e- logbook that has been designed by clinicians, for clinicians.

A logbook is essential for a surgical trainee. But development of skills in certain procedures is also important for many medical specialities eg Bronchoscopies, Endoscopy, Angiography. Most trainees resort to creating an excel spreadsheet that is then uploaded to the “personal library” section. This is very dis-satisfying as in order to update it a whole new file has to be uploaded. It is also difficult for assessors to find and view, and so is often never looked at, with a cursory “how many Bronchs have you done?” being asked at ARCP. An ideal situation would be a page where you could rapidly add a procedure list or individual procedure with data fields for patient no, procedure, and comments (which would be flexible in allowing reflection on any difficulties or complications; or key learning points).

The surgeons even have an app which allows offline data entry and synching with the main site; is encrypted; and can be backed up. It has it’s problems, most notably the fact that it is only available for iPhone, but it is leagues ahead of anything on offer for physicians.

Come on, if the surgeons can do it….