Improving learning log entries in GP training: a tutorial

The second part of our series on improving learning log entries looks at documenting learning from tutorials.

(Photo: Watt)
(Photo: Watt)

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.

This article focuses on what the ST2 trainee learnt from a tutorial. The tutorial was about contraceptive choices in postpartum women, which came about after she had  seen a patient who was three-week’s postpartum and requested ‘the Pill’. An example learning log is provided along with a trainer’s assessment.

The trainee discusses how she learnt about structuring her consultation about contraceptive choices into a ten-minute appointment.

After reading the reflection, please answer the questions that follow, which will help you understand how the reflection could be improved.  

Example learning log

Subject title: Postpartum contraception

What was the subject and aims of the tutorial?
The topic was what contraceptive choices to discuss with postpartum women, whether breastfeeding or not; in situations where children are being spaced or where their families are complete. The aim was to increase my skill and confidence with prescribing contraceptives to postpartum women and in advising them in a balanced manner on their long-term options. But there is a lot to go through, so by the end of the tutorial I wanted to nail down what was most important to cover in a ten minute appointment.   

What led to this particular subject being chose?
I found myself floundering in a recent consultation when a patient presented three weeks after the birth of her baby asking for a prescription of ‘the Pill’. The patient had a clear expectation of getting a prescription of a contraceptive Pill from me. I had to decide what the safe contraceptive choices were.

In the short time I had available, should I have bothered discussing options when she so clearly wanted ‘the Pill’? This consultation overran by seven minutes, so I need to improve my timekeeping by learning what to discuss and what to leave out.

What did you learn?
I learnt to prioritise the questions I ask to narrow down options and to assess which contraceptives would be less suitable for the patient in front of me. I learnt how to weave options into the patient agenda; how to adopt a negotiating technique rather than delivering a mini-lecture.

What will you do differently in future?
I will use a FPA leaflet (I downloaded the pdf on my desktop). If the patient is breastfeeding, I will draw a line through the oestrogen containing contraceptives and explain to the patient why I’m doing this.

I will then check if her family is complete or not, before discussing short- and long-term; hormonal or non-hormonal options. The FPA leaflet provides a nice framework that I can structure my discussion around without sounding too ‘lecturish’.

If pressed for time, I could prescribe a ‘Pill’, either POP or CHC depending on risk factors and patient expectation, give the FPA leaflet and invite the patient back to discuss other options in greater detail in a later appointment.  

What further learning needs did you identify?
Emergency contraception (EC), especially EllaOne, affects when the CHC or POP becomes effective. I need to learn this aspect of safe prescribing. My trainer suggested that it could be interesting to audit if this information is being recorded in patients’ notes and whether it needs to be added to our EC template.

Questions for GP trainees to consider

  1. What learning does this LLE demonstrate?
  2. What main concepts are discussed? How well are they discussed?
  3. Did the trainee discuss being able to apply this learning in future to solve problems in a different way?
  4. What conclusions did the trainee draw about the main concepts?
  5. Has the trainee discussed information sharing in a broader sense? For example, has she considered patient decision aids and the effect of these on patient communication and consultation models?

A trainer’s comment

This LLE was written by an ST2. Thankfully she did not write a long list of facts that she recalls from the tutorial. I would have been disappointed to have seen a ‘cut and paste’ from an article about family planning. Had she read an article, I would be interested in seeing the link (or url) and a brief comment on why she thought the article was useful, or not.

This LLE tells me the trainee learnt something about safe prescribing under time constraints. While the patient so clearly expected a Pill prescription, the doctor checked for contra-indications and considered safer options.

However, in doing such a thorough consultation, she overran, so the focus of the tutorial was on learning how structure the consultation and negotiate more quickly. This doctor could have explored the concept of ‘sharing decision making’ more deeply.

  • In guiding the patient through options, negotiation skills are needed. How did this tutorial help the trainee to improve her negotiation skills?
  • What happens if GPs do not learn how to transfer information in a clear, focussed and unambiguous manner?
  • What tools help GPs to give patients up-to-date information?

While there is still some work to do, this LLE shows some evidence for the following domains:

  • Maintaining performance, learning and teaching – addresses learning needs and demonstrates the application of these in future practice.
  • Organisation, management and leadership - Personal organisational and time-management skills are sufficient that patients and colleagues are not unreasonably inconvenienced or come to any harm.

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.

Additional reading

More advice for GP trainees

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