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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.



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 Commons)

Photo credit: Images_of_Money 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 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!


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?

NHS Hackday and the

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.


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….

The perfect ePortfolio

Thanks to @londonlime

Thanks to @londonlime

This weekend I am at NHS Hackday in Oxford. I have written about hackdays before. I am a huge enthusiast. It is amazing to see doctors, other healthcare workers, patients, organisations and software developers coming together in their free time to make stuff that could make the NHS better. A hackday IS agile software development, speeded up, with people motivated not by profit but by intellectual curiosity and a desire to make the world a little bit better.

There are some amazing people coming to NHS Hackday Oxford. Some of them are interested in rethinking a professional ePortfolio. The one we have currently is competent. It does a job. The creators at NES are great, but they are constrained by their history and location. In my opinion an IT project that supports thousands of healthcare professionals’ development should not be run by project managers in a Scottish NHS health board. Their customers are Royal Colleges, not ePortfolio users. However great NES are at their job are they really the best people to make the perfect ePortfolio?

As trainees we want more. In relation to the software we want seamless functionality, we want flexibility, we want personalisation, we want visualisation of data, we want speed, we want interoperability, we want openness and APIs, we want mobile offline data entry, we want intuitive navigation, we want reliability, we want to be encouraged and inspired, we want beauty.

Too much to ask? I hope not. 

I need to form these vague statements into some specifics between now and tomorrow. Wish me luck!

Feedback from NES events

Late last year, NES who run the NHS ePortfolio, held a series of user group meetings. The objectives included “providing an opportunity for users to speak their minds and share their ideas to improve the system.

The results of the feedback events were collated by NES, and they published a summary. So what can we learn from this?

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Firstly we must question whether the results are representative of the users of the ePortfolio. Unfortunately the feedback events were during normal working hours and very few trainees or clinicians were able to attend. It is clear from the feedback that there were a significant number of administrators present. Their views are important but are over-represented in this sample. The sample size of the feedback events is also very small. This is important considering the large number of users and the fact that the use of the system by different Colleges varies.

Despite this there is some useful information contained in the summary, which is grouped into categories:

  • what users like about the NHS ePortfolio (mainly that an ePortfolio is better than paper)
  • dislikes about the technical implementation and website design
  • dislikes related to the educational content or usage requirements of the ePortfolio
  • dislikes relating to the governance of the ePortfolio
  • what technical changes users would like made to the system
  • what new features users would like

The results are not surprising. Many of the comments align with those on this site. Users want an app, want the site to be more intuitive to use and navigate, and want it to have better and more flexible functionality. They want interoperability with other systems and they want clarity on the purpose of the ePortfolio “is it a learning tool or a recording tool?” They also want a lower burden of assessments.

NES must be congratulated for attempting to engage users and gain feedback, and for their openness in releasing the results, but I can’t believe there is anything in the comments that they did not know already. The problem is less lack of information, and more lack of action. But as NES highlights in their post “who makes decisions about the ePortfolio?” in the bigger picture the power really rests with the Colleges. 

Is it time to rethink how we use portfolios and workplace-based assessments in Postgraduate training? How can we adapt the software we have so that it works for us and we maximise the benefits of an ePortfolio for lifelong learning?  

What do you want from an ePortfolio?

Discussion of the NHS ePortfolio has been reignited on Twitter this evening, sparked by the publication of a paper in The Clinical Teacher “Evaluation of an established ePortfolio.”

The conclusions are:

“Continued support is needed for both trainees and supervisors in portfolio-building skills and in using the e-portfolio as an educational tool. Trainee tailored feedback is needed to ensure that portfolio-based assessment promotes lifelong, self-directed and reflective learners.”

My favourite quote is:

“Trainees remain unconvinced about the educational value of the e-portfolio”

An understatement perhaps?

The NHS ePortfolio

The comments this evening included some by people who have not been part of previous Twitter discussions, but they echo many sentiments I have heard before, and many comments on this site. They include frustration about the software itself, as well as complaints relating to the burden and perceived utility of workplace-based assessments.

So, it’s 2013, a New Year. Time to take a fresh look at the world and think about how we can turn all this frustration into positive change.

  • What do you think is the purpose of an ePortfolio?
  • What do you, as a trainee, want from an ePortfolio?
  • What value do you find in workplace-based assessments?

I will be writing more as soon as I get time – on funding and commissioning, on the need for trainees to join together across specialities, and on the future in the eyes of the various stakeholders. In the meantime please leave your comments here.

We need your voice. We need a better system – sometime before I become a Consultant would be nice……

2012 in review

The stats helper monkeys have prepared a 2012 annual report for me. Aren’t they nice?

Here’s an excerpt:

4,329 films were submitted to the 2012 Cannes Film Festival. This blog had 13,000 views in 2012. If each view were a film, this blog would power 3 Film Festivals

Click here to see the complete report.

This blog has had a lot of support this year. Thank you to everyone who contributed, commented, argued, debated, encouraged and supported it’s ideals along the way.

2012 was the year of debate about the purpose and functionality of the NHS ePortfolio. What will 2013 bring?