Tag Archives: technology

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…..

Screen Shot 2013-05-20 at 12.29.28

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 

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!

Open Badges in MedEd?

Conversations started online lead to all sorts of places. Today they led me to Leeds School of Medicine to learn about Open Badges in Healthcare Education.

There’s a lot to say on this subject so please follow the links to learn more. I have tried to summarise some of the key opportunities and challenges and how they relate specifically to doctor’s ePortfolios and Postgraduate Training. This is not because Open Badges are limited to this context, but because this blog is focused on these issues. Overall my personal opinions are:

  • there is a need for a better method to collate and accredit learning, particularly informal learning. CVs are limiting
  • this is not a threat to established models of accreditation, or to institutions, but a complimentary system
  • Open badges have great potential as a mechanism of celebrating excellence and supporting medical trainees in differentiating themselves
  • as with all technology/software we need to be clear about what it can and can’t do, and not expect a panacea
  • as doctors we are currently limited by the fact that existing systems do not interface with other systems. No API = no possibility for progress. The whole point is that open badges cut across multiple systems and contexts, so they must not exist in yet another silo, separate from eg the ePortfolio. We need progress in this urgently
  • the drive for these new ideas and opportunities will come from the community, not institutions. Most institutions are likely to be sceptical initially but catch on later once the principle is established (examples would include Hospital Trusts, Royal Colleges, LETBs, Universities…). I would love to be proved wrong about this!

The Concept

Open badges are a mechanism for accrediting learning that happens everywhere. They are more than a graphic that you slap onto your online profile. The image has inbuilt into its’ code some essential data:

  • criteria for attaining the badge
  • the issuer
  • the earner
  • link to evidence

Doug put my picture into his presentation, so I’m returning the ‘favour’ You can find out more about him here: http://dougbelshaw.com/blog/about/

This is important as this means they can’t be simply copied or faked, and there is a way to probe what the badge means by checking the criteria and evidence. Much more information is on the Mozilla wiki, site, and collated blogs.

Future developments such as the ability to encode verification and endorsement mechanisms will be essential to win over the evidence-focused and reputation-aware landscape of healthcare education.

Doug’s presentation from today is on slideshare.

Opportunities for Postgraduate Training

Learning does not just happen in lecture theatres. We know this and demonstrate it every day. As medical students and doctors we piece together our education and training from a diverse range of informal and formal providers and contexts.

Last week I had many learning opportunities: I sat in on a specialist clinic, attended a Radiology meeting, completed an e-learning module, read several articles through UptoDate and pubmed searches, read a blog, contributed to debates on Twitter and followed links from tweets to journal papers, went to a seminar, and had a case discussion with a senior colleague. Trying to log all of this in existing tools is a challenge. My clinical NHS ePortfolio is certainly not flexible enough to facilitate this, and is unlikely to ever be, since it’s structure is dictated by committees of people who don’t use it. But the core system doesn’t have to fulfil every need if it interfaces with other systems. Open Badges could fit into this model very well.

Things that could be badged in medical education (a small and not at all exhaustive list):

  • attendance at a teaching session (1 badge), attendance at 80% of all ‘mandatory’ teaching sessions in your trust (separate badges build up like cheeses in trivial pursuit to unlock ‘St Elsewhere FY teaching attendance badge’)
  • contribution to #twitjc as a one off (1 badge), on a regular basis (higher badge), as host (super-badge)
  • completion of an online e-learning module (1 badge), completion of 15  modules relevant to your training programme (build up to unlock higher badge – BMJ already follow this principle with Silver/Platinum user. Wouldn’t it be great to draw other providers together along similar principles?)
  • giving a peer-led teaching session (1 badge), running a teaching programme as a result of an identified need (higher badge), having an impact ie safer handover/fewer bacteraemias/better compliance with antibiotic policy (super-badge)
  • completing generic mandatory training modules – many of which have been moved online (eg hand-washing, manual handling, equality and diversity), which could then be transported to a new Trust. A junior doctor could show their badges and not have to repeat generic training when they move jobs at 4 months, and instead spend time doing locally-specific training and then meeting the team (this was discussed at the workshop – great idea that I do not take credit for!)

Challenges

Many of these are discussed in more detail on the Mozilla pages (with additional technical, pedagogical, conceptual and philosophical considerations).

  • Equivalence: is my equality and diversity training module at St Elsewhere NHS Trust equivalent to your E&D module at St Somewhere Else? And will you accept is as such? Who decides?
  • Fake-ability: someone could set themselves up as a fake version of Highly Prestigious University and issue badges in their name. Future developments of verification (eg verified accounts) and endorsement would help with this
  • Over-exposure: If you can badge anything, does this devalue them as a currency? Not necessarily. There will be hierarchies of badge, just like there are hierarchies and power structures in other spheres. A peer-issued badge for ‘general awesomeness‘ would be value-less for a job application and no badge earner would choose to display this badge in that context. In contrast a University issued badge for ‘significant contribution to bedside Undergraduate Teaching’ or a Trust issued badge for ‘leadership in quality improvement’ would be worth significantly more.
  • Validity: What if someone earned a badge for hand-washing, but couldn’t then demonstrate the skill? Theory does not necessarily transfer to practice, but this is not a problem of open badges themselves, but of all teaching and learning
  • Admin support: the creation and issuing of badges needs thought and planning. It does not have to mean lots of additional work but of course would require initial startup resources. The discussion of beenfits vs costs needs to be fleshed out, and systems worked out to make badge issuing something people feel supported in doing, and will seek to do. The guys from myknowledgemap and reallymanagingassessment tools have thought about this already, and done a lot of the work. They have envisaged ways to support less code-literate mortals (like me) in the process. We can learn from their expertise, share the work, share costs, share, share, share….

What’s inspiring about the Mozilla Open Badges project is the level of transparency  and collaboration. The Mozilla Foundation is a global non-profit whose only motive is to “promote openness, innovation and participation in the internet”. This open-ness is incredibly powerful. They share all their code and processes, which allows others to create widgets and plug-ins and build layers of code/systems on top of their core system. This does not challenge or threaten Mozilla. It enhances their product and makes it more attractive and useful. This is a general lesson we can learn and apply to other contexts. The most obvious example would be NHS Hackday. Imagine what we could do with an NHS ePortfolio API (for a start we could already have built an app)! Imagine if Open Badges interfaced with the NHS ePortfolio! That would be one way to gather all the informal (and formal) lifelong-learning that is already taking place, and strongly encouraged by Royal Colleges, the GMC, and other healthcare bodies – from medical school entry to retirement.

I think an important point is that Open Badges are not a gimic. They are not a niche internet project. They are a response to a much bigger challenge to traditional learning. You may not think they are the right response, but they should be seen in this context. There has been a shift in how and where learning occurs which is challenging but positive. Better informed, engaged and motivated clinicians provide better patient care: what we’re all here for in the end. We need systems that facilitate and celebrate learning in new contexts. As learners we yearn for it it. As institutions we have a duty to support it. As patients we should welcome it. Open Badges could be such a system.

Thanks to Leeds School of Medicine for being so open and welcoming; to myknowledgemap for being so positive about collaborating; to Tim from NES for putting up with my ranting; and to Doug from Mozilla for his pragmatism,  enthusiasm and expert workshop facilitation. 

My 15 mins of fame

I am having some brilliant and highly productive meetings about the ePortfolio this week, which I will write about as soon as I can.

In the meantime, you can see my 15mins of fame in the NHS Hackday video:

NHS Hackday 2012: Geeks who love the NHS

“It’s an amazing atmosphere when you can come with a problem as a physician and say ‘I know nothing about any of this stuff, but I know what I want to be able to do.’ And then to have a room full of people who have the know-how and the enthusiasm to go ‘we can do that.'”

I love @wai2k‘s quote, which really sums up the weekend and the project: “with collaboration between the people who create the software and the people who use the software you can potentially create something quite magical.”

The ePortfolio needs exactly this. We are getting there.

To Open Source or not to Open Source

Recent discussions around possible solutions to the need for NHS ePortfolio development have led to the suggestion that harnessing Open Source Software (OSS) may be the answer.

So what is Open Source Software (OSS) I hear you cry?

Open Source is collaboratively developed, freely available software or application. You may now hear people using the term ‘Open Source’ across a wide variety of different sectors in order to describe a more open, networked and user generated way of developing ideas and projects. While the term applied originally only to the source code of software, it is now being applied to many other areas.

But it is not just for new projects. For established projects, the software or application itself does not have to be dismantled.  There can be huge benefits of opening up the code to outsiders who then use the software, fix bugs, submit patches, file  bug reports, and create new content. Often for free. In times of ever-contracting training budgets and with austerity in the national consciousness, free sounds very appealing.

NHS Hackday is the most relevant example of this concept, and does a good job of explaining why OSS fits with the concept of openness in healthcare and academia, and why it is financially beneficial.  Examples of projects so far include an app to aid safe handover (in line with recommendations from the acute care toolkit, and clinical governance principles), and OpenBNF (an open source app for access to the tax-funded British National Formulary of medications, currently only available at a cost of £30 via a private provider). I think the projected cost savings may be over-enthusiastic, but the model of using the knowledge of “coalface” clinicians, and harnessing technological expertise for the public good is clearly powerful. This same argument could be made for the NHS ePortfolio as in the short-term all time saved means more time for patient care or educationally valuable activities. And in the longterm a better ePortfolio could facilitate better education and training, ultimately producing better doctors.

There are Open Source evangelists:

Carl is an evangelist,  Ben Goldacre is an evangelist

And there are those with legitimate concerns about control, and whether Open Source would deliver what is needed. As Karen Beggs (ePortfolio project manager at NES) points out it is no panacea: we must look critically at our needs and apply the right solutions. Here are some responses to questions about security and maintaining control, and an insight into the potential hidden problems of not using OSS.

Encouragingly, OSS in healthcare is not new (examples), and OpenSource in ePortfolios is not new (see Mahara) so there is already work to build on.

A vision of collaboration, openness, and harnessing clinical knowledge to create rapid solutions to real-world problems, working from the ground up instead of the top down is incredibly powerful and one the NHS and education communities should celebrate.

Will OSS be the cure for the NHS ePortfolio’s chronic disease? If you’re a geek who loves the NHS maybe you can help us find out..

Why is it so slooooooooooow?

The site is very, very slow. It does not look like a complex site; there are no videos to run, there is only one page loaded at a time, it is not running complex algorithms. My IT/tech knowledge is in the “below expectations” category, but I gather there are a few issues that need to be resolved:

  • Some pages are big (even though they may not look it) – the lovely tech people are working on making them smaller so that they will run quicker
  • They way the site is constructed makes any individual action slow to complete  as it requires multiple clicks and refreshes – this is being addressed for the infamous linking process, but needs addressing for all functions
  • NHS computers are slow. The lack of IT investment is staggering, considering the amount of data we deal with in health care systems. But I don’t think I can fix the entire NHS’s IT systems so you will have to continue to struggle on your desktop at work. However, much of the ePortfolio content is generated at home, where most people have decent broadband speeds. If I can run twitter, BBC iPlayer, Waitrose online shopping and Ottolenghi’s recipes at the same time with no problems why is the ePortfolio site still so slow….?

  • ……apparently the ePortfolio is hosted on the NHS network. This is old, slow, and limits the speed of the site. It also has very limited capacity to cope with surges (which are inevitable ie pre-ARCP). A great option would be to move it to a Cloud. This is what everyone is doing these days. Big data needs big storage and there’s a lot more space in the Cloud. So what’s the problem? Let’s do it! To move the hosting to a Cloud needs investment, ie money. We need to persuade the Colleges that they need to fine some spare cash to sort this out. And soon.

You can help by leaving a comment. Go on….

Where’s my Logbook?

Surgical trainees already have an e- logbook that has been designed by clinicians, for clinicians.

A logbook is essential for a surgical trainee. But development of skills in certain procedures is also important for many medical specialities eg Bronchoscopies, Endoscopy, Angiography. Most trainees resort to creating an excel spreadsheet that is then uploaded to the “personal library” section. This is very dis-satisfying as in order to update it a whole new file has to be uploaded. It is also difficult for assessors to find and view, and so is often never looked at, with a cursory “how many Bronchs have you done?” being asked at ARCP. An ideal situation would be a page where you could rapidly add a procedure list or individual procedure with data fields for patient no, procedure, and comments (which would be flexible in allowing reflection on any difficulties or complications; or key learning points).

The surgeons even have an app which allows offline data entry and synching with the main site; is encrypted; and can be backed up. It has it’s problems, most notably the fact that it is only available for iPhone, but it is leagues ahead of anything on offer for physicians.

Come on, if the surgeons can do it….