An introduction to the summary
Since I started this blog in frustration in July, it’s reach has extended beyond my expectations. There have been more than 10,000 hits to the site. If you are a new visitor it may seem unstructured and conversational without a clear narrative. This is the nature of collaborative projects, and particularly of blogs.
To help us move forward and engage new readers I have tried to summarise the main discussions and link to relevant posts and comments. These discussions continue: on the blog; on twitter; on Linked.in; via email; and offline. There is great interest in re-imagining what a trainee ePortfolio could look like, and how workplace-based assessments form a component but not the entirety of this vision. It is difficult to separate the two. As I have said from the start, we need all interested parties to clarify and crystallise their thoughts on what the NHS ePortfolio should do now, and in the future. This includes: users at all stages of training; clinicians, educators and trainers; Colleges; other educational bodies such as HEE; and the GMC in an advisory capacity. These discussions, although focused on the ePortfolio, reach wider into the nature and perception of Postgraduate Training.
Our time is precious. Technology must work for us, not against us. We need to work together to see this vision made a reality. I hope you join the revolution.
In “Manifesto” you can read about the initial impetus for this blog and how an interaction with the organisation who provide it, NES, led to me write my first post “I have a dream.” My focus initially was to think about the limitations in terms of functionality of the site, which I still think feels like it’s out of the 90s. We are part of a generation with high expectations from our software, and can see the possibilities. I proposed that better functionality could increase the educational utility of the ePortfolio and collated twitter suggestions to propose: a timeline; a better way to select roles; a loosening of the strict categories of reflection; and a more time-efficient way to link items to curricula. I also tried to understand why the site is so infuriatingly slow, with some interesting insights into the world of big data!
A major priority, in my opinion, is to get an offline cross-platform app. There are practical and educational reasons why this is essential which are discussed in “an app-ortunity” and I experimented with including a poll, but completion rates remain low.
Moving on from functionality, I tried to understand “the bigger picture” and suggested how greater collaboration between users, developers, and Colleges could be beneficial for all. I even made a lovely diagram. I suggested that it was time for a fresh look at what we expect of trainees, and what trainees can expect of the system.
I highlighted disparities between different ePortfolio systems in “where’s my logbook” and “all ePortfolios are equal, but some are more equal than others” and started to suggest how some relatively minor changes could significantly improve te user experience in “a vision of a better (ePortfolio) world.” On reflection these are limited, and my vision now is much more ambitious, but it’s a start.
Some of the discussions in the comments, and on Twitter, led me to examine some of the literature around this area, and I highlighted some relevant points from a paper on the limits of competency-based training in “competency: necessary but not sufficient.” A paper published by surgical trainees on their experience of their own ePortfolio, led me to draw parallels in “surgical spirit: what the surgeons think of their ePortfolio.” My conclusions were that there are grounds for serious concern about the perception of Postgraduate Training. The NHS faces many challenges and a demoralised workforce will struggle to face them. Physician and surgical trainees feel overburdened and undervalued. The system needs to change. Who will lead this change? And where will the ePortfolio fit in?
More exposure for the blog (with thanks to Ben Goldacre!) meant that others with an interest in Postgraduate Training got in touch, and wrote their own blogs, stimulated by discussions here and on Twitter. I wrote a response to a blog post by Dr Fiona Pathiraja in “the NHS ePortfolio fan club” in which I suggested that our aims were aligned, and that if we can all work together to effect change, I might just join the NHS ePortfolio fan club myself. This seems like a distant possibility at present!
I attended AMEE, a Medical Education Conference in lovely Lyon, and happened to spot a few sessions in which the NHS ePortfolio featured. One of the NES developers gave a presentation “Assessing NHS ePortfolio behaviour: variations in the online activity of doctors as they progress through training“, and wrote a blog about it. I was struck by the amount of data available on ePortfolio use, but felt the wrong questions were beingnasked, and that there were therefore missed opportunities. I explored this in “what to do with all that data?”
Some of the comments and posts have strayed into entirely new territory for me: the world of computer code. I tried to understand the arguments of the Open Source evangelists, and those with concerns in “to open source or not to open source?” and hope I remained fair. I have to say, I think there are strong arguments for a re-appraisal of the whole of the commissioning process of ePortfolios for doctors in the NHS, and an Open Source model has many appealing features. Read the debate yourself, in particular the exchange between Karen Beggs, ePortfolio manager at NES, and Carl, a doctor and Open source fan, and decide. Importantly an FOI was submitted for the source code which was refused by NES, citing the fact that it would harm their commercial interests and was not be in the public interest. I have no legal or FOI expertise, but find it hard to understand the commercial interest argument, when NES are not a commercial company, but part of a Scottish Health Board. And although the data within the ePortfolio may not be directly in the public interest, a rigorous, open, inspiring system for training doctors certainly is. Particularly interesting discussions revolve around who owns the data in the ePortfolio. I feel strongly that I own my data, but there have been hints that this view is not necessarily shared by others.
It seemed essential to gain some understanding of computer code, data manipulation and software design, in order to understand the challenges in dragging the NHS ePortfolio into the world of Generation Y. So I engaged with a group of NHS workers and computer software developers through NHS Hackday. In “NHS Hackday and the data liberation front” I describe my experiences of the weekend, and why I am now a committed supporter. It’s amazing what can be achieved in a weekend, with a lot of expertise and a lot of good will.
One of the more recent posts directs readers to an NHS ePortfolio wish list. Ben, a NES developer, would love to improve the ePortfolio. He does not have the managerial support or resources to do so. We need to add as many voices to this struggle as we can, and his is a valuable one. I’m hoping to persuade him to come to the next NHS Hackday In January….we’ll see.
Other pages direct readers to the “NHS Hackday wiki“, and an early attempt to collate the most useful tech improvements in “the tech improvement shopping list” which has recently been updated as some of those wishes have come true! Some twitter comments are collated in “twitter comments” although this could do with an update. If only I had more time…
I am having conversations in parallel to this blog with important people with power and hope to effect change, but this is not a simple process. I have summarised discussion I have had at meetings at the Royal College of Physicians and the Trainee Group of the Academy of Medical Royal Colleges in “Acronym Soup.” I started a collaborative document called the “Trainee roadmap” which you can find through “where do we go now?” Please contribute as this is vital to articulating how we wish to move forward.
I hope this summary has helped. Please explore the blog and comment, contribute, tweet, email, and stop me in the street. I want things to change but am powerless alone.
We need to invest in making the ePortfolio better because trainees matter, our training matters, and our time (and that of our assessors) is too valuable to waste ticking boxes. It could be so much better. Help me convince people with the purse-strings that this is true. Technology can work for us, not against us. We need to work together to see this vision made a reality. I hope you join the revolution.