E-portfolio learning log entries should show serious thinking (reflection) about an aspect of a GP trainee’s professional experience to demonstrate how they learnt from it.
Professional conversations are something that GP trainees might wish to document to highlight their learning . However, the recent Dr Bawa-Garba case has produced disquiet amongst trainees because evidence from a professional conversation, recorded on a reflective-style proforma, albeit not from her eportfolio, fed into the hospital investigation and trial.
This article does not explore the completion of proforma being used outside an e-portfolio. Rather its focus is on improving the quality of a personal LLE.
This article explores what an ST3 trainee learnt from a professional conversation. The medical student the ST3 trainee spoke to asked for advice about a tricky work situation. The trainee discusses how she learnt from being put on the spot.
After reading the reflection below, answer the questions that follow, which will help you understand how the reflection could be improved.
Example learning log entry
Subject title: Med student asks me for advice
What were the circumstances of the conversation (who, when, where)?
Rajeev, the medical student, asked me if I ‘had a moment' at the end of a joint surgery last week. Thinking he wanted to clarify something we'd seen in surgery, I said yes.
Rajeev told me that he helped Isobel, the other medical student, with the audit on acute sore throat, which she presented to the practice clinical meeting. Isobel did the audit but Rajeev created the entire PowerPoint presentation, including the graphs and graphics.
When Isobel was praised for her efforts, she acknowledged Rajeev's assistance but did not explain that the PowerPoint was entirely his creation. Rajeev felt Isobel had claimed credit for his work and didn't know if he should do something about it. He asked me what I would do in his situation.
Why were you having this conversation?
I assume Rajeev approached me because I'm an ST3 trainee, next up in the medical hierachy, and possibly because he felt I am approachable. I had this conversation because the GMC expects me to mentor junior doctors: ‘You should be willing to take on a mentoring role for more junior doctors and other healthcare professionals.’
What did you learn?
I learnt that I felt uncomfortable about being asked about non-clinical dilemmas. There was no right answer to give. I didn't want to get involved in a 'political' situation and I felt slightly out of my depth.On the other hand, there were times when I needed advice and I was grateful to colleagues who were generous with their time and mentorship. Now, it was my turn to be generous professionally.
Instead of giving Rajeev advice, I asked him what his goals were. What would he consider the best outcome? What would he consider the worst outcome? What options did he have? What were the pros and cons of each option? What did he feel was the right thing to do?
Rajeev answered these questions thoughtfully, so in the end I summarised, ‘So you feel that saying nothing does not sit well with you, on the other hand escalating this into a confrontation would be counterproductive, so perhaps an email asking her what she thought of the presentation may get your message across.’ Rajeev thanked me for my help.
What will you do differently in future?
I will be more confident about my ability to help colleagues with professional dilemmas. While I may not have all the answers, just listening, being a sounding board and being supportive may be of help to them.
What further learning needs did you identify?
I should more about leadership and management for doctors. I will read the GMC guidance on this. After the CSA, I should ask for a tutorial on mentorship skills.
Questions for GP trainees to consider
- What learning does this LLE demonstrate?
- What main concepts are discussed? How well are they discussed?
- Did the trainee discuss being able to apply this learning in future to solve problems in a different way?
- What conclusions did the trainee draw about the main concepts?
- Has the trainee discussed mentorship and leadership in a broader sense? For example, has she discussed any models of mentorship?
A trainer’s comment
This LLE, written by an ST3, demonstrates how she responded to a junior doctor's request for help with a professional dilemma. The trainee specifies the questions she asked and how she summarised the response.
This type of non-judgemental open questioning is one of the key concepts in mentorship. The mentee is also given the space to find their own solutions; the mentor does not hand over advice. The trainee concludes that being supportive to junior doctors is an important professional attribute and mentorship is now a role she feels more confident to undertake.
She identifies a learning need, that is, what skills does she need to learn for professional mentorship, and she intends to tackle this in a tutorial post CSA. When she writes up this tutorial, I hope to see a more in-depth discussion about medical leadership and an analysis of a few models of mentorship.
This LLE shows some evidence for the following domains:
- Maintaining performance, learning and teaching – shows a commitment to professional development through reflection on performance.
- Organisation, management and leadership – there is evidence of developing clinical leadership skills. Help is offered sensitively, with a recognition of own limitations.
Dr Prashini Naidoo is a GP trainer in Oxford. She has written three books on how to pass the CSA. The latest book CSA Practice Cases for the MRCGP was published in January 2016.
- Academy of Medical Royal Colleges. Improving feedback and reflection to improve learning - a practical guide for trainees and trainers. May 2017.