Posted in ARCP, eportfolio, ESR, MRCGP

Learning logs, capabilities and self-rating

Lets talk learning logs. The fourteen fish platform allows you to enter learning logs of varying types and keeps a tally of the number entered and how it compared to the expected number of entries. But how shall we use the learning log in the most effective way?

Lets think about what the learning log is aiming to achieve. What is it’s use. It’s clear aim is to allow you a place to store evidence of your development. It is there to allow you to evidence your capabilities and how you are covering the curriculum. When it comes to an Educational Supervisors report (ESR), you will use these entries to support your self-rating and your educational supervisor (ES) will use them to evidence their rating. Or, in the case of an interim ESR, to support your own self-rating. So in this respect the entries need to clearly demonstrate your level of competency.

The entries allow for reflection. Lets be honest – not everything you add to the learning log is going to create deep reflection. Attending mandatory BLS training is unlikely to leave you with a profound reflection. But the case reviews certainly should give you something to reflect on. But what this reflection is might vary.

I’m not going to discuss reflection any further in this post. You can see my earlier post on reflection here. What I’d like to do is think about the smart ways of using the portfolio to demonstrate evidence, and allow you to plan what you might need to add into the learning log.

So with each entry you are able to allocate both curriculum statements and capability statements. With respect to the curriculum statements you are aiming to show a well rounded coverage of these. Though the curriculum we cover will likely be influenced by the jobs we are in at that time. So to some extent you can plan which jobs will allow you work on which curriculum statements. Within general practice we will find that all areas can be covered. But medicine for the elderly and paediatrics will show some limitation, unless we are adding entries regarding weekly teaching sessions, revision for exams or other learning you undertake outside of the position you currently hold. By the end of ST3 though, we want to see a broad coverage of all the areas in fairly equal amounts.

Again, with each entry you are able to link it to up to 3 of the 13 capabilities. The trainee and their supervisor are then able to provide justification for demonstrating this capability. This is where I think the word descriptors should come into play. Below, after the example log entry, are some of the word descriptors for clinical management.

So when you’re recording this entry jump forwards to undertaking your self-rating and thinking about how to rate yourself. Make it easy on yourself. Look at the word descriptors as you record the entry. Copy and paste the descriptor that applies to what you are demonstrating and justify it. By doing this you are making it clear as to why you feel you achieve this self-rating and you are putting it on a plate for your ES to see and support your rating.

Lets take an example. I have a case where a patient came to me about their knee and was keen to get a referral for a knee replacement. I decided to examine them and as I was doing Lets take a made up example. A patient came to me to discuss their knee pain. They wanted a referral for a knee replacement. I asked if I could examine his knee. Whilst I was doing this I noticed he had a lesion on his shin. I asked a couple of questions about it and found out it had only been present for a couple of months but had grown quite a bit. The patient hadn’t been too worried about it and was more bothered about their knee pain. I was worried it could be an SCC. An SCC would warrant a 2ww referral. I therefore decided to acknowledge the knee issue but explained I was actually more worried right now about the lesion on their leg. I negotiated with the patient that I would organize a follow up call to talk further about their knee such that I could fully explain and discuss my worries about the lesion on the leg and what a 2ww referral entails. The patient was frustrated that I hadn’t sorted the knee out today but understood the importance of their referral.

So what capability is being demonstrated here? I looked over the word descriptors and think I have demonstrated and circled the ones I feel this case shows. So you can see that I have clearly covered NFD and competent word descriptors.

Perhaps if I had given the patient some more autonomy over when the follow up for the knee would be this would have also added a further competent area. I could also follow up with another entry from when I spoke the man again regarding his knee. Though he is showing signs of wear and tear he hasn’t gone down the physiotherapy route yet so he doesn’t meet local criteria for referral for knee replacement. It was a hard conversation to have and he asked me about how much I thought it would cost to have this done privately. After a further conversation we agreed that he would seek private physiotherapy to speed up the process and once this was completed I would refer him for consideration of a knee replacement. This then allows me to circle some of the word descriptors that come under excellent. I felt happy to consider myself ‘competent’ in my self-rating.

Regularly reviewing your capability areas and the evidence you have available in your portfolio will allow you to look for gaps and work out what you need to add to your log so that your entries are smart and relevant.

Also be aware that a case you log doesn’t have to always be something highly interesting/different/unusual. It just needs to provide evidence of what you are demonstrating in both capability and curriculum learning.

I addition I also urge you to think beyond this particular case/episode when reflecting. How does this case apply to your wider practice? Another example is:

You work in the endocrine department. You see a 23 year old who is suffering with DKA. You, alongside your seniors, initiate the correct management and her DKA resolves. You decide to enter a learning log and the reflection is that you now know how to manage DKA. So you link it to the clinical management and making a diagnosis capabilities. But in General Practice do we manage DKA? No. We need to recognize it but we will admit them to hospital. But what will we do as a GP? We will look after the long term management of this patient and her diabetes. We can provide education to prevent this from recurring, we can work with her to gain optimal control of her diabetes, monitor for complications and manage her emotional wellbeing. Was this something that was impacting upon her at the time of her DKA or subsequently. We could in fact draw upon the capability of practicing holistically because we are reflecting about how health beliefs can impact upon management of conditions, facilitating long term support, utilizing the community diabetes team or dieticians for support, for example. See where this is going? Think about the reflection more widely than “I was nervous because I didn’t know how to manage DKA but I do now and so in future I will not be nervous as I will know how to initiate treatment for DKA”

I hope this helps to think about how to use the learning log is a smart way that leaves you feeling like it has a purpose other than just extra work to complete!

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