Tag Archives: Medicine

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… 

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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!

The Bigger Picture

The NHS ePortfolio started as a local pilot project. It’s use was then expanded and expanded. There was no budget for this, and no vision for how trainees might want it to look and feel. It fulfills it’s purpose, is functional and allows trainees to record meetings and assessments. But is “functional” really good enough?

Here are some quotes from the ePortfolio site, and the JRCPTB (who fund the Physician version):

The NES (NHS Education for Scotland) ePortfolio has grown rapidly since its inception in August 2005 and now comprises over 20 versions for over 35,000 healthcare trainees within Scotland (Nursing, Midwifery, Dentistry and Pharmacy), across the United Kingdom (Medicine), and The Republic of Ireland (Medicine).

This ePortfolio is designed to support learning by providing a secure record of appraisal discussions, an ongoing personal development plan, workplace assessments plus reflection on clinical and other learning events. The ePortfolio links to the relevant GMC approved curricula appropriate to your stage of training.

The ePortfolio is designed to help gather and organise evidence in a way that is trainee centred and user friendly. The emphasis for this is on you as the trainee with support from your supervisor.

If the emphasis is on the trainee to gather and organise evidence, then the emphasis should be on the trainee to determine how that is done. There has been a lack of investment in the ePortfolio which has resulted in the current slow, unimaginative, frustrating version. This needs to change. As trainees we need to demand more.

Direct feedback to developers is needed to bring about improvements in day to day usability. Feedback to Royal Colleges etc is needed to communicate the need for investment in the overall structure and function of the system. We need an app and we need an overhaul of how the ePortfolio works in order to encourage trainee  and supervisor engagement. There is no obvious way in which this feedback can be given, hence this site….

Practice what you (aspire to) preach

What I don’t think the Colleges etc realise is that the ePortfolio is the only concrete thing we see as a result of handing over large amounts of money in JRCPTB fees.  Therefore in surveys it is said to be “poor value for money.”

Even more importantly the ePortfolio itself is a reflection of how training is currently viewed. It feels to many that we are aiming for competence – how uninspiring! What happened to striving for excellence? What happened to valuing the diversity and individuality of talent and interest amongst trainees? What happened to mentorship? Many trainees feel like just a number on a rota spreadsheet, getting through the day, jumping through hoops for assessments that often become tick-box exercises of no educational value. Of course competency in the required knowledge and skills is essential, but competency is a MINIMUM requirement. It often feels that this is all that is expected. Many trainees do extraordinary things but their supervisors and deaneries would never know this. One trainee’s portfolio looks just like any others, the only difference being whether they have done 6 mini-cex’s or 7.

If we want to inspire excellence, we need to show this in everything we do, and in every system we create. Trainees need a system that allows them to not only demonstrate that they have reached the minimum standard to progress, but that they are so much more than the sum of a few WPBAs. They need to be proud of their portfolio. Currently the system is failing them, with the danger of producing uninspired, undervalued, underachieving, burnt out doctors. Bad for trainees, bad for Trusts, bad for patients.

Time for a fresh look at what we expect of trainees, and what trainees can expect of the system.