News from the trenches

If you have not yet already seen the blog by Dr Fitz “NHS ePortfolio WPBAs in CMT: are they educationally useful?” I recommend you make yourself a cup of tea and have a read. He has taken a significant amount of time out of his day as a medical trainee to document his experiences of using WorkPlace Based Assessments (WPBAs) in the “real world.” He has done this not because he likes to rant, but because he is genuinely interested in how he can support his own learning, and ensure that the assessments he undertakes are valid and useful. He is like many of us – he wants to be a better doctor – but wonders whether the system currently helps or hinders this.

teacup

Dr Fitz seems representative of many Core Medical Trainees (CMTs). In 16 months he has undertaken 51 assessments (ACATs*, CbDs*, miniCEXs*, DOPS* and Teaching Assessments) and 2 rounds of MSFs* (360 degree assessments) with 35 responses from colleagues in all. This is a little more than the minimum requirement for his ARCP (annual appraisal) and is a good bank of data on which to reflect. Well, it should be. Dr Fitz looks in detail at the contents of his ePortfolio and wonders what it really tells him. Of particular concern is the documented feedback that is at the heart of these assessments:

“Unfortunately the stats don’t look good. Over the course of 9 ACATs, covering the management of 55 patients over 12 months, I received 127 words of feedback. That is 14.1 words per ACAT and 2.3 words per patient seen. About 6 tweets.”

He is quick to point out that this does not necessarily reflect the amount or quality of verbal feedback he received, but

“…the educational benefit of my on-calls and the instruction I received from my consultants was separate to, not part of, my ACATs.”

Sadly the story is very similar for his CbDs, miniCexs and DOPS. The quality of the feedback documented on his ePortfolio is poor, and is of no use to him when he reviews his ePortfolio to prepare for his ARCP and consider what should be on his Personal Development Plan (PDP).

His conclusion is balanced and reflects the feelings of many trainees who have commented here previously:

“Overall, my experiences of the NHS ePortfolio assessments for CMT is that whilst they may act as a record of learning, they fail to be a useful educational tool in themselves. This is mainly due to the discord between how they are supposed to be completed and how they are completed in practice. Teaching, supervision and education is happening, but it is in spite of WPBAs rather than because of them.”

enthusiasm for portfoliosHe doesn’t end there and has several suggestions for improvements. They mirror comments already on this blog and range from urgent technical improvements (really, do I have to mention an app yet again?), to faculty development. This is just the kind of input Training Programme Directors, and National Programme leads want and need. Trainees have reasonable and real concerns about their training, and are engaged and enthusiastic about improving it.

Harnessing this enthusiasm will be vital.

If you haven’t already contributed to the Shape of Training review please do so. This is a collaboration between several higher bodies including the General Medical Council, Medical Education England, the Academy of Medical Royal Colleges, the Medical Schools Council, NHS Scotland, NHS Wales and the Conference of Postgraduate Deans of the UK. The review is considering what changes are needed to postgraduate medical training to make sure it continues to meet the needs of patients and health services in the future. This includes options to support greater training and workforce flexibility, and how to address the tensions between obtaining training and providing a service. You have until February to make your voice heard.

* ACAT= acute care assessment tool, CbD = case-based discussion, miniCex = mini Clinical encounter, DOPS = directly observed procedure

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