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!

Posted in ARCP, eportfolio, ESR, MRCGP

Reflective learning

This entry has come about through a chat with one of our trainee’s. He felt that it was difficult to get to grips with reflection. He told me that he got to know about Gibbs (1988) reflective cycle, and that this had improved his ability to reflect. I also recalled this was the model my sister was encouraged to use during her midwifery degree.

So I went back to my theory from my Postgraduate Certificate of Medical Education, did a bit more reading, and thought I’d share the salient features. Having looked through numerous theories of learning and reflection I do agree that Gibbs’ method fits the GP e-portfolio learning log well.

It’s important to note that reflection is a very personal experience. It can give an insight to your personality, and can reveal how you are feeling at a point in time. It’s useful to be open when writing a reflection, and feeling comfortable that whoever reads your entries will treat this information as confidential, and be supportive and developmental in their feedback. Though, it is sometimes easy to fall into doing a lot of description, and sharing of feelings, but less about how this has impacted upon your learning, and any changes you might make. Hence, why having some models to frame your reflection upon can help.

One of the earliest theorists to consider reflective learning was Dewey. His thoughts were that reflection was potentially very useful when making sense of situations that we may have found difficult. To learn from it required a description of the event and questioning ourselves to analyse why it occurred in that way, and considering ways to change the outcome of the event. (Dewey, 1933)

One of the most common theorists to come up in discussion of reflection is Kolb. His learning cycle (1984):Kolb learning cycle

It’s a very simple model. But what I don’t like about it is that one of the stages is to ‘reflect’ and I find that it doesn’t help with structuring the reflection. Instead, I would use this model in association with another model, that discusses the reflection in greater depth.

So we come to Gibbs Reflective cycle (1988).

Gibbs reflective cycle

Gibbs’ model of learning is what we call iterative – learning through repetition. The aims of his model are to:

  • Challenge assumptions
  • Explore different ways of doing things
  • Promote self-improvement
  • Link practice with theory
  • Thinking about the positive as well as the negative

I’m going to give an example of a reflection using this structure

Description – I saw a man in his 30’s who presented with haematospermia. It had happened on 2 occasions. As soon as he told me what the problem was I realised I knew nothing about the topic.

Feelings – I felt myself getting stressed because I didn’t know what I was going to do. I really had no idea whether this was something to be concerned about or not. I think, looking back, I must have looked disinterested because my mind was wandering trying to think what I was going to do, whilst he was still telling me about the problem.

Evaluation – Actually, I don’t know if he noticed just how stressed I was, as I managed to keep calm on the outside which was good. I explained a need to check some guidelines so I could quickly look on GP notebook to work out what to do! He seemed satisfied with the consultation, though I was quite worried that I’d missed something else during the time I wasn’t fully listening.

Analysis – I think my worry that I knew absolutely nothing about the topic hindered my ability to listen to the patient, and thus my consultation skills were not up to scratch. If I had been able to keep calm, and think ‘I can look this up’ earlier on, it would have facilitated a better consultation.

Conclusion – I could have been completely open with the man and said I wasn’t sure and needed to have a look/ask a colleague. I could have done this during the consultation or afterwards and followed this up with a call. I also think that I need to separate my concern about a lack of knowledge from the consultation structure. It hampered the consultation, and added extra stress.

Action plan – I will read up on haematospermia more thoroughly, and this might lead on to other men’s health topics I have less knowledge about. I will also try and role play some consultations where I really don’t know the answer, and try to focus on what I can do. I can also try out different ways to signpost that I need to look up some information.


  • Dewey, J. (1933) How We Think. A restatement of the relation of reflective thinking to the educative process (Revised edn.), Boston: D. C. Heath.
  • Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.
  • Gibbs G (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.
Posted in Administration, ARCP, eportfolio, ESR, MRCGP, PDP, Uncategorized

A smart PDP

I attended a joint trainer and trainee meeting, and the focus of the afternoon was how to develop and keep an active PDP during your training and beyond.

I thought I’d share some learning from this because I know that this is not the best part of my appraisal process, and an area that I have spent very little time thinking about previously.

This session really helped change my thinking and knowledge of the process.

What is a PDP?

It’s a personal development plan. It’s a way of showing your supervisor that you are considering your learning needs and how you plan to meet these needs. This is by setting an action plan that details what you will do to address this learning need, how you will evidence that this has been completed, and a timeframe for this learning.

Why is it important I hear you ask……

……because we are learning all the time. A good PDP will focus your learning, and allow you to prioritise your time and learning needs. There is large amount to cover during GP training, and it’s going to seem daunting at times. So setting some aims and making plans might just make it a little easier.

Also, being MRCGP focussed, apparently some ARCPs have flagged up a poor PDP, or with nothing ‘active’ within it. This has held up some trainees’ progress to certification. In addition, the PDP you have at the end of GP training will form your PDP for your on-going appraisal process. Having an active PDP is mandatory for appraisals, and completed appraisals, are mandatory for revalidation.

How do I get started?

Firstly, how many entries should we have on our PDP? The golden number is three, however you may more or less! You need enough to show you’re addressing your learning needs, but not so many that you cannot keep up with the learning. Some might be more straightforward than others, and some more complex. Some may have a relatively short time frame, and some longer.

What shall I include?

This is where it gets difficult. It’s a ‘personal’ development plan. So you are the only person that can answer this. You need to look at your learning needs (lets talk about learning needs assessment/analysis another time). Perhaps they will relate to the current job you’re undertaking. They may relate to where in your training you are. For example, if you are preparing for AKT they may be related to knowledge development, or preparing for the CSA they’ll perhaps be more specific to consultation skills. They might be related to developing an interest you have, or managing your work life balance. If you can justify the reason for including it at this time, then go for it.

Creating the perfect PDP item

It needs to be ‘SMART’

S – specific

M – measurable

A – attainable

R – realistic and relevant

T – timescale

I’m going to use an example from my current appraisal, which I have now refined to reflect the above learning! I think if I use an example to talk through it, it will make more sense.

Specific – ‘To become accredited as a full trainer’. This is a specific aim, as opposed to something along the lines of ‘develop my training skills further’. The latter could include anything, and doesn’t necessarily have an end point, whereas the former has a defined end point.

Measurable – I can evidence that this has been completed via being approved as a full trainer. I can link to areas in my learning log that show the things I have done to support and facilitate my application.

Attainable – Can I get this done? Well I know there is a trainer panel in February time. I have been attending the right meetings, and undertaking the appropriate work in anticipation of this, so it is definitely possible!

Realistic and relevant – The work I need to complete to achieve this is already part of my workload, so I am not adding more work to my plate. I do need to factor in some time to complete the paperwork though. It is relevant, because we have an ST3 currently, and without being a full trainer I cannot be a named supervisor for an ST3, which I would really like in order to further my position within the practice where training is concerned.

Timescale – Well I shall aim for the end of March, as this gives me time to complete the application, attend the panel and hopefully receive confirmation that this has been achieved!

By laying out the objective like this I have focussed my learning, I know what I need to do, and I am telling whoever’s reading it what I’m going to do and how.

I have added a link to a good RCGP document on completing a PDP, with some good examples of real PDP entries, and what makes them work well or not so well. Follow this link and then click on the PDP pdf.

Why don’t you sit and write a PDP entry now and see if it’s a bit easier. Feel free to share some ideas or ask questions in the comment sections below!