Professional and Personal Development Portfolios – Using Good Medical Practice

Professional and Personal Development Portfolios – Using Good Medical Practice Dr Isobel Braidman University of Manchester Medical School

Context in which portfolios introduced - 2004 • PBL driven course • Early Clinical Experience (EE) introduced for first time; September 2004 • >360 students • Using facilities from north of Preston – mid Cheshire

INTRODUCTION OF EARLY CLINICAL EXPERIENCE TO YEAR 1 Communication skills: simulated patients Primary care/community: Visits to GP’s, interviews with patients (relevant to PBL) PBL: Cases – Life cycle (Sem 1) Cardiovascular (Sem 2) Hospital medicine: Know hospital structure, interviews with patients, observe staff Clinical Skills Portfolio

Purpose of Portfolio • Is it only preparation for appraisal and revalidation? • Means of integrating learning experiences • Embed reflective learning • Emphasise combination of evidence for development and reflection

Important Questions • How to introduce portfolios (personal development ) to large numbers of students (“impersonal course”)? • By what means can reflective learning be introduced to School leavers? • How can students become accustomed to self evaluation compared with rigid “external” assessment? • How to introduce portfolios to students with little or no clinical experience?

Important to have right people Portfolio group: development over 5 years; overall view (GP’s, hospital, stakeholders, educators) Portfolio implementation group: delivery, clinicians, educators

Manchester approach -Use GMC Good Medical Practice Guidlines • Biographical Details • Good Medical Care • Maintaining Good medical practice • Working relationships with colleagues • Relations with patients • Teaching and training, appraising and assessing • Probity • Health

Good Medical Care • This section should contain accounts of your encounters with patients and visits to hospitals and GP surgeries. • Begin to develop a reflective style and consider what you have learnt from your experience and what questions you have developed. • You may also wish to include details of previous work experience that involved experiences within the NHS.

Working relationships with colleagues • You may wish to reflect on your first experiences of PBL, What was it like in your group? How does your tutor behave What type of person are you in a group? • Hints: • Did everyone in the group contribute? • What are you like as a chair or scribe? • How do you present information to the group? • Are you comfortable speaking? • Are you a good listener? • Does the group listen well? • Why does the group work well/less well? • What could be done differently?

Delivery • Lectures: 1 lecture on reflective learning; 1 lecture on portfolio • Tutored sessions: 2 tutored sessions for each PBL group/semester • Tutors selected by experience with Phase 1 medics, clinical experience of portfolios, experience with PBL

Advantages/Disadvantages • Encourages sharing of good practice among colleagues • Allows time for hand written pieces under guidance • Portfolio tutors can act as role models • Overcomes recruitment of individual mentors • Requires the “right” tutor • Investment of staff time

Tutored sessions semester 1 • Session 1: students receive portfolios, introduced to concept of their relevant experiences and their reflective writing • Session 2: Produce piece of reflective writing, based on interview with pregnant patient; use as a basis of discussion in the session

Tutored Sessions Semester 2 • Session 3; prepare reflective piece on “Working relationships with colleagues”, showing development as member of PBL group over the whole year • Session 4; Reflective piece based on hospital visits; blood pressure (first investigation performed on patients).

Introduction of reflective writing • Evaluation: what happened in the session? What went well and what did not? • Analysis: account of own performance/conduct, management of learning tasks • Drawing conclusions:evaluate own conduct/practice What problems are encountered and how overcome? • Formation of an action plan:wider picture as a learner How am I (as a student) maturing as a learner, communicator, colleague and in understanding medical practice?

Development into Year 2 • Integration into hospital experience (for one semester only) • Mini “appraisal” at end of second year of portfolio as a whole; passport to Phase 2

Outcomes over the year • Development as reflective learner • Begin to appreciate different aspects of professional development • Develop appreciation of the importance of evidence and reflection in portfolio

Decided against summative assessment of portfolio • Examiner variation • Students write for the assessment • Time and logistics

Assessment in year 1Focussed on: • Development as reflective learner • Begin to appreciate different aspects of professional development

Portfolio OSCE • Station 1: Student verbally analyses self selected example of interactions with patients, from portfolio, showing development, using all 4 levels of reflective learning • Station 2: Student verbally analyses brief scenario on “Working relationships with colleagues”, using all 4 levels of reflective learning • Both stations use communication skills

Evaluation • Focus on development as reflective learners • Also component of Evaluation of Early Clinical Experience

Has portfolio had an impact on students’ reflective processes? • Use of analysis based on the “Ideal self inventory” (Norton L et al 1995) • Students address “What makes a good medical student?”

DESIGN OF EVALUATION 1 The really good student The not very good student

DESIGN OF EVALUATION 2 • Stage 1: complete exercise in first portfolio session • Stage 2: towards end of second semester, grading exercise repeated , with same parameters identified in Stage 1. • Stage 3: using the above grid, write down the qualities or abilities now thought to describe a “really good medical student” and by one who is not very good. Grading as in Stage 1.

DESIGN OF EVALUATION 3 • Copies of forms collected for analysis at end of year 1 • Parameters : organisational, commitment, learning, meta-learning/reflective • Analysis of self grading score

Main points of the Manchester approach • Basic structure of portfolio is for the entire medical curriculum and beyond • Emphasises individuality of each portfolio • “Organically growing” • Importance of self evaluation • Simplicity

Big Questions • How to take this further forward to Phase 2 • Evaluation • Assessment in later years

Professional and Personal Development Portfolios – Using Good Medical Practice