Category Archives: People in charge

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. 

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 

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… 

Where’s your user group?

A major contributor to trainees’ frustration with the ePortfolio has been the lack of user feedback. Trainees and trainers using the system day in day out have not had a clear and accountable way to give feedback to the Colleges which purchase the ePortfolio on their behalf. Those at NES managing the system, and the developers weaving their magic in binary don’t necessarily know how it is used on the front line. It has certainly not been an agile development process.

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But there is no point looking back. We are here and must consider how we make things better for the future. Change is slow but it is possible.

The JRCPTB/Royal College of Physicians have actively responded to the pleas of trainees and have created an ePortfolio reference group.

The objectives of the group are to:

  1. Provide feedback and appropriate consultation to the JRCPTB on issues of ePortfolio management including performance, usability and required features.
  2. Assist the JRCPTB in the prioritisation of developments to ensure they are delivered in the best order for all our stakeholders.
  3. Ensure JRCPTB is informed of changes to training that may influence how or when the ePortfolio is used
  4. Assist JRCPTB where required in creation and delivery of appropriate communication about the ePortfolio

The group comprises ten members:

  • 3 trainee representatives – one to be from CMT
  • 3 local administrators from different areas of the UK and represent both Trust and Deanery administrators
  • 3 clinicians from different specialties
  • 1 JRCPTB administrator

In fact there are 4 trainee representatives. Lucky me, I am one of them! You can get in touch with me here, or on Twitter. You can also email the JRCPTB directly with your ePortfolio-related ideas: ePortfolioideas@jrcptb.org.uk.

This is a great step forward. If you’re a physician trainee you now have a direct line of communication to the JRCPTB to influence their decisions. It’s not perfect, it’s not agile, but it’s a start.

If you are not a physician trainee perhaps you should ask your College where your user group is……

Progress

Things have been a little quiet on the site lately, and you would be forgiven for wondering whether I have lost interest in the NHS ePortfolio. You may have started to think that nothing is being achieved, and therefore not bothered to comment or contribute to the discussion.

Don’t believe it!

Progress may be slow, but real change takes time. Quick fixes are great and can have a major impact on functionality. Remember the problems with being unable to link to multiple curriculum items? Fixed! See the tech improvement shopping list for other modifications that have already happened. Quick fixes are also visible and keep up enthusiasm and morale. But they don’t address the route causes of problems and don’t change systems. Changing systems takes time.

A major breakthrough has been the creation of an ePortfolio reference group at the Royal College of Physicians. You can apply to be a member of this panel and get your voice heard directly by the College. Not a member of the RCP? Then ask your own College if they have a user group you can join. And if they don’t have one, ask why not. The systems imposed on trainees are currently not fit for purpose, and we need to make sure people in charge understand this.

Dont forget that NES, the group who run the NHS ePortfolio used by Physicians, Paediatricians and others, is holding feedback events. I’m sure that this is in no small part due to pressure from this site and discussions on Twitter. If you can, go along and make your voice heard.

People are listening.  I have meetings coming up with the Royal College of GPs who use a different ePortfolio system but share common needs. I am also having a follow-up meeting at the Royal College of Physicians. We must clarify the commissioning and costs of the ePortfolio in order to collaborate across Colleges and effect change. When money is scarce we need to make it go further. The Academy of Medical Royal Colleges Trainee Doctor Group are gathering data on the systems in use by all specialities which will be essential is informing this discussion.

It could be so much better! Please keep up your support.

Acronym Soup: RCP, JRCPTB, WPBA, SLE, AoP, AoMRC ATDG

The Royal College of Physicians

This week I met with the Royal College of Physicians in London to discuss the NHS ePortfolio. After the many discussions I have had with trainees and trainers on this blog, on Twitter and in person I felt well prepared. I was sure the RCP should be taking a keen interest in the ePortfolio and it’s place in the wider context of Postgraduate Education, and through some brief email conversations I felt we were likely to have common ground. But as I walked through the falling leaves of Regent’s Park, I wondered what they would make of me and my graffiti-decorated blog…

It would have been unrealistic to expect to leave the meetings with all the answers, but I truly believe we have taken the first step towards a better solution. There are lots of details to work out, and I found myself discussing things like commissioning and procurement – yet another new language to learn! What was so positive was that there was an acknowledgement that trainees (and trainers) are dissatisfied with the ePortfolio, and that the concerns being raised are not idle complaining, but are educationally valid.

This is an important issue because it affects thousands of doctors, and because it relates to other areas of Postgraduate Training. The RCP wants to support trainees in their professional development and acknowledge that the ePortfolio is part of this process. There is also a realisation that technology has moved on, that the ePortfolio was not future-proofed, and that it is important to take stock and think about how to move forward. Financial contraints will impact on these plans and we need to be both realistic and imaginative in our decision making. The fact that the new RCP revalidation tools for Consultants have no interface or link with the trainee ePortfolio is another example of a lack of joined up thinking which we must avoid in future.

I was happy to hear that the RCP have almost finalised the details of the new ePortfolio User Reference group, which will have several trainee representatives. Hopefully this will not only impact on decision making, but also improve communication, so that we don’t in future have changes appear with no warning. It was also encouraging to hear more about the research being done on WPBAs/ SLEs. The RCP are putting considerable time and resources into reviewing the use and utility of WPBAs and the results of this research is likely to have a significant impact on the assessment systems for all medical specialties and shape training for the next 10 years. This is a great opportunity to engage with the College and have a real impact on Postgraduate Training.

There are many questions that do not yet have answers, in particular the question of funding and commissioning ePortfolio systems in the future. All doctors have a core set of common needs and I believe it is essential that we define these together and press for collaboration across Colleges, and open-ness in every part of the process.  The Trainee Roadmap is a first attempt at this, and I encourage you to contribute. The RCP seem to truly be putting trainees’ needs at the heart of what they do, and are (slowly) responding to the concerns of the thousands of you who have visited this site. But the structures of these organisations are complex and my attempts to find a way through the committees and funding streams of the RCP, the JRCPTB and others is already bringing on a headache.

We need to make sure this stays at the top of the agenda for the College, and I look forward to follow-up meetings in the future. I hope the other Colleges are watching, and are considering their own strategies. Otherwise they may find their trainees asking questions they can’t answer….

The Academy of Medical Royal Colleges Trainee Doctor Group

Coincidentally, in the same week I also went to give a presentation at the AoMRC ATDG (seriously, the number of acronyms in the world of medical education is mind-boggling).

There were many nods of assent as I described my frustrations with the current ePortfolio, and the demands placed on trainees and trainers to complete activities with little educational value. The representatives at the ATDG come from a wide spectrum of specialities including O&G, General Surgery, Anaesthetics and Intensive Care, Emergency Medicine, Pathology, General Practice, Ophthalmology, Psychiatry, Radiology and Medicine. Various ePortfolio systems are used by these trainees and some, such as the Haematologists, have to use two systems which, of course, do not talk to each other.

There was also great enthusiasm for sharing information, and for collaboration across Colleges. There was agreement that there are common needs for tools that support learning and professional development, capture workplace learning, log assessments, and provide evidence for appraisal. These needs are shared by doctors of all specialities and span the start of FY1 to retirement (in fact, since four UK medical schools use the NHS ePortfolio, these needs span Undergraduate as well as Postgraduate training). Technical aspects were touched on, and some absolutes were identified: such as a single sign on for all systems; a set of core standards for any ePortfolio used by doctors; and the need for flexibility for Colleges/Specialities and individuals. There was enthusiasm and hope for a future in which there is a simple but flexible ePortfolio system, with mobile support, that truly supports learning, and that makes people smile not scream when they login!

This committee is unique in bringing together trainees across specialities. It’s also full of lovely and enthusiastic people. The representatives are going back to their respective College trainee groups to gather information on what systems are used, and what trainees think of them. I hope we can then finalise a Trainee Roadmap and Core Requirements document, that will help us move forward.

Watch this space!

Tell NES what you want: what you really, really want

It seems the powers that be are listening! This blog has always tried to encourage communication and collaboration with all interested groups, and the managers and developers at NES (the group who run the NHS ePortfolio) have been great, engaging with users on Twitter and here.

Now they want to meet you in person. On their latest post they say:

 [NES] is holding a series of user group meetings across the UK in late November 2012, open to all users of the ePortfolio but with a special interest in hearing from clinical staff.

The open meetings will serve a number of objectives including:

  • Disseminating the future plans for ePortfolio and building them in conjunction with feedback from all users
  • Providing an opportunity for users to speak their minds and share their ideas to improve the system
  • Giving users a chance to meet members of the ePortfolio team (technical, training and managerial) directly and informally
  • Offering a forum for users to present to peers and the ePortfolio team about their experience using the system

The meetings are in London, York and Edinburgh and are soon:

  • York: 19th Nov 10am-2pm
  • London: 20th Nov 10am-2pm
  • Edinburgh: 27th Nov 10am-2pm

Unfortunately the times set for the meetings will severely limit the number of people who can attend. I can’t go as I have prior work commitments. And I’m not even in a Clinical job this year! I really hope that anyone on shifts or with a day off makes an effort to go and give your feedback. I have emailed to suggest an evening meeting (with wine) would be better attended.

When people offer to listen, we need to make sure they hear us. Or we’ll be stuck with the system as it is forever. If you can, sign up to a user group meeting near you here:

http://guide.nhseportfolios.org/Resources/ePortfolioUserGroupApplication.aspx

PS. Apologies for the 90s Spice Girls reference in the title…