Abstract
Last night, I put six entries into my ePortfolio. They were going back over a period of 2 weeks and I was pretty tired. My elderly computer was going slower than a snail on zopiclone and I had a headache. As I sloshed down some paracetamol, I thought to myself ‘And, after this, you're going to sit down and write an article defending this barbaric practice?’
Yes, I am going to defend the ePortfolio. I am going to argue that the hours I've spent recording what I've learnt and how I'm going to address my learning needs are essential to both practice and training. I am going to argue that the ePortfolio is not only necessary in the context of the new era of accountability within medicine but also that it can be both rewarding and fulfilling.
The nature of medical professionalism in this country has been changing for decades. As society has become less deferential towards figures of authority, so the doctor–patient relationship has turned from that of parent and child (broadly speaking) to a partnership. Gone are the days when professionals could expect their clients to trust them based on the qualifications they gained in their 20s. In modern society, all those in positions of responsibility are expected to demonstrate their worth on a regular basis and doctors are no exception. We have a duty to show the public and each other that we are fit to practice.
This change in the doctor–patient relationship (on an individual and a societal level) was accelerated in the late 1990s by several high-profile cases (such as the Bristol Heart Scandal and that of Harold Shipman) that demonstrated the fallibility of doctors. Appraisal was a direct result of the many recommendations made after those public tragedies. Although appraisal alone would not have stopped someone with the criminal intent of Harold Shipman when linked with good clinical governance systems, it becomes a powerful means of demonstrating that practice is of good quality, that a doctor is being regularly reviewed and that any development needs are being identified and addressed.
Revalidation is the process that allows doctors to demonstrate that they are up to date and fit to practice. Yearly appraisals will mark the progress towards revalidation and should ensure that any performance concerns are picked up early and dealt with. The ePortfolio is the Associate in Training (AiT) equivalent of appraisal and revalidation. When we are slaving in front of our computers, we are actually demonstrating our competence and practising this skill (regular ePortfolio entry writing) for when our licences may depend on it.
An unexamined life is a life unlived
I suspect that some will find my paraphrasing of Socrates somewhat over the top in an article writing about the mundanities of ensuring sufficient case-based discussions (CBDs) and consultation observation tools (COTs) are covered in a 6 month period, but I think that the benefits of truly reflective practice cannot be overstated. To a greater or lesser extent, we all reflect on our daily practice but by actually writing about our experiences and trying to define how they will shape our practice, they attain far greater significance within our consciousness and are far more likely to affect us in a meaningful way. The format of the learning log can be frustrating and a private record could be just as useful but, in truth, how many of us would honestly keep to a personal log if there were no one checking up on us? Life would get in the way.
In addition to reflecting on our own learning events, the ePortfolio gives us a valuable opportunity to discover how others perceive our practice in a protected and constructive manner. Multisource feedback can give you small insights into the way others view you and patient satisfaction questionnaires might bring to the fore any communication difficulties. COTs and CBDs give your supervisors little snapshots into your working style.
I never travel without my diary. One must always have something sensational to read in the train.
Oscar Wilde The Importance of being Ernest Act 2.
These reflections, recorded and developed over the years of training, will eventually give a fairly full picture of how a person works and what their strengths and weaknesses are. As an individual, I actually find it very satisfying to look over my ePortfolio—some of my entries in my early years are almost embarrassingly simplistic in their approach to patients, but it is nice to see how far I have come. I have also found it quite useful on occasion; I recently reread my entry about a learning session on Independent Mental Capacity Advocates (IMCAs) and reminded myself of all sorts of useful facts.
So when you next sit down to your computer with a cup of tea, consigning an evening away to desperately trying to remember what your learning points were from a tutorial you had 3 weeks ago, remember that you are not just jumping a hoop. By fulfilling our appraisal/ePortfolio obligations, we are ensuring that we are worthy of the trust placed in us by the majority of our patients and demonstrating our competence to them, to ourselves, to our fellow doctors and to the public at large.