Portfolio Learning – The Good, The Bad and The Ugly! Phil Rayner GP Trainer and Lead Programme Director – Nottingham GP StP

Objectives of this Session Share experiences of working with trainee portfolios Review the theory behind portfolios Use examples to identify why some learners struggle Identify how we as PDs/ TPDs can support portfolio learning? If time practice our own reflective writing skills

For example GP trainees have an e-portfolio Contributes to evidence for WPBA 3 rd component of MRCGP Comprises – PDP, Shared Learning log, Asessments, PSQ, MSF, Procedures Log, Supervisor reports, Educators notes. Demonstrates – curriculum coverage, competency attainment.

But why have a portfolio at all? Record of learning? Tool for assessment? Promotes reflection? Improves learning efficiency? Promotes ‘deeper’ learning? Learner led?

Reflection ‘A Tick Box Exercise or Learning for All?’ – Macaulay & Winyard BMJ 17/11/12 Part of GMC core guidance in GM Practice We are all required to ‘reflect regularly on our standards of medical practice’

So what’s the theory behind reflection? In essence- Thinking leads to Emotion leads to Action!

John Dewey (1933) ‘Active, Persistent and careful consideration of any belief’

David Boud (1985) ‘Exploring Experience to lead to new Understanding & Appreciation’

Stephen Kremmis (1985) ‘Active process, …from experiences, …relates to theory or previous learning and leads to an action plan’

Chris Johns (1995) ‘Personal process, … assessment understanding and learning from experiences, … leads to change for the individual and new learning.’

Donald Schon (1987) Described ‘Professionals working in the swampy lowlands’. Outlined ‘reflection in action’ & ‘reflection on action’

Jack Mezirow (1981) ‘Ultimately the outcome of reflection is Learning’ It broadens knowledge It develops skills It changes attitudes But only if done well?!

Examples of GP trainee learning log entries The Good, The Bad and The Ugly? What do you think about them? How would you help this trainee? How do we promote learning from a log entry?

The ISCE model Information Provided Self Awareness Critical Analysis Evidence of Learning From Atkins & Murphy

There's also Kolb (1984)

Or Gibbs (1988)

Practising reflection Reflective writing exercises? Superficial reflectors – how do we help them? Attitudinal barriers- how do we break them down? Activity!

Suggestions? Clear objectives of the reflective process Teach learners how to reflect (use a critical reflection checklist?) Make it easy to record Discuss reflections with someone (but are they trained to do this?) Make reflective practice and debriefing central to clinical activities ‘Informal’ case discussion can also count!

Consider 1 of these pictures – what do you see, how does it make you feel, how could you relate it to your practice?

For proper reflection you need Open-mindedness A commitment to self-enquiry Motivation A readiness to change practice Richardson & Maltby (1995)

‘Critical’ Reflection Linking past present and future experience Integrating the cognitive and emotional experience Considering the experience from multiple perspectives Re framing the experience Stating the lessons learnt Planning for future learning or behaviour

Summary Shared experiences of working with trainee portfolios Reviewed the theory behind portfolios Used examples to identify why some learners struggle Discussed how we as PDs/ TPDs can support portfolio learning. Practised our own reflective writing skills

Questions?