You should aim to do around…

• 3 entries per week (as a minimum) if you are in a GP post
• 2 entries per week if in a hospital post.

• The simple answer is…. as many as is appropriate.    As a minimum, try and write about things that provide evidence of good performance in 3 entries.  
• But the more you can do, the more evidence in your ePortfolio, and hence the better!
• BUT DO NOT MAKE SOMETHING OUT OF NOTHING.    For example, don’t think that writing a one-liner about referring someone to the local support group for dementia will score you strong points for COMMUNITY ORIENTATION.
• Only write about those Professional Competences that had true meaning, depth and relevance in the particular case you are writing about.

It depends on the quality.  If you have a habit of waffling on and on – then NO, it is not a good thing.  You need to learn the art of conciseness, and there’s no better place than to start doing that now.  Besides, it will be good for your consultation write-ups too – no doubt you might be a bit wordy in your medical notes too!

However, some of you will write long log entries because the situation was complex and had many facets you wanted to talk about.    These type of long log entries tend to be more deep and meaningful and are probably log entries that might cover a number of competencies.  

Just remember – quality is more important than quantity.  And remember the poor person reading you ePortfolio.  So, whilst it is okay to write longer entries, this is no permission to waffle on and on.  Be concise and focus. 

The reader does not need to know all the exact details but the relevant ones that put the experience in  context.   So, if your focus of the entry is something ethical or about practising holisitcally, perhaps the clinical minutiae is not so important.  Can you summarise rather than spelling each bit out e.g. “Respiratory examination – a few wheezes but everything else was normal”.

However, if your focus is more clinically orientated – like Data Gathering or Clinical Management – then that’s when the specifics become more relevant.  For example, if I wanted to demonstrate evidence for CEPS, I might right “Respiratory examination – left sided creps and wheezes, good air entry otherwise, no overt signs of respiratory distress, no cyanosis, RR = 20, Sats 97%, HR 78, BP 125/86, Apyrexial 36.8”

The RCGP realises that doctors have not been routinely taught to reflect.  Hence, a lot of trainees struggle and often waffle on and on without truly reflecting.  They end up writing long pieces that simply describe what happen without analysing it in more detail.  As a result, the lengthy write up doesn’t actually demonstrate anything because it is lacking this analysis or reflection.  Then, your trainer or ES can’t award you competences.   And let’s not forget, the whole point of writing log entries is TO PROVIDE EVIDENCE for the competences on which you are ultimately judged.

 So, as a way to help you, the RCGP have provide a structure for your learning log entry by way of boxes and headers.    These boxes are meant to help you dissect a case and get you to think about it (analyse, reflect).   Everyone thinks they have to write in each of the boxes – but did you know that only those boxes with an red * must be filled, the others are optional. Another thing – you do NOT have to write in a way that responds to the questions that serve as headers for each box.  You can provide your own structure if you wish – I suggest you do that because what the college provides can be rather limiting when applied universally to the variety of situations we experience as doctors.

So, if you do want to use your own structure, then be sure to use your own headers.   Like this…

ETHICS
He was my first patient in the morning and my consultation time had just been reduced from 30 minutes to 20 minutes. I was still quite nervous about that reduction in time and now, I had to face this chap from Romania with this language barrier.   And then it got worse when I realised he was almost demanding antibiotics despite being told by the OOH service that this was not required and he needed to see a dentist.  I initially felt: “Why me this morning?” I felt like running out of the consulting room.   But few seconds after, I pulled myself together and asked myself: “Why not me?”  The motivation that kept me through and made survive the consultations were:

1. A sense of duty and respect for diversity – I had a responsibility to offer care and help to all my patient within the best of my ability irrespective of their tribe, race, religion or any other personal characteristics – i.e. without any bias.
2. Empathy – This patient is clearly frustrated. I could sense he probably felt “this doctor too would not want to listen to me” or “no one wants to hear me out” or “they all don’t understand my language”. And then I began to imagine if I found myself in another country where I don’t speak their language and they don’t speak English.  How would I want to be treated?   This made me become patient and relaxed with him, ignore the pressure of time and the inconvenience of dealing with language problems.
3. Patient safety – I did not want to rush through the consultation superficially without properly exploring the red flags. Language barriers can result in insufficient data gathering which may lead to harm. I patiently gathered my data and examine him to ensure that he is safe  and is not caused harm by my action or inaction (NON-MALEFICIENCE).

As a minimum, there should be some sort of interpretation, reflection and action – and can you see that in this example?  It is very clear.  And this trainee clearly demonstrates some core ethical principles.   By the way, this trainee was an ST1 of mine and someone graduated from Nigeria.   Amazing, wouldn’t you agree?  It shows you that reflection is a skill that can be taught and developed right from the start.

Oh and one last thing….   In the box future learning plans – many trainees write “I will do more reading”.   Let me tell you straight up – THIS IS IRRITATING to GP educators and ARCP panel because it’s a generic comment that can be said about almost anything.  You need to demonstrate that you HAVE read or done something (not that you are going to do it).   So, it would better phrased “I did the BMA’s e-learning module on Language Barriers in the Consultation and I learn’t that…”.  This will get you the competency of PERFORMANCE, LEARNING & TEACHING, whereas the former gets you nothing and is a waste of space!   So, if you are going to read or use another educational resource, explicitly state which resource you are going to read rather than ‘A book on Dermatology’.  The explicitness tells us that you’ve really thought about it.

It is important to make evident any emotional context to the learning log entry and reflect why this might be plus your past experiences of similar situations and the views of others (be this colleagues or the medical evidence base).   

Remember, earlier we said that LEARNING cannot happen without REFLECTION.  And part of REFLECTION involves SELF-AWARENESS and that means being aware of your thoughts and emotions.    It’s only through examining how something made us feel can TRANSFORMATIVE NEW LEARNING happen.  Isn’t that what you want?   

So, whilst we understand trainees are a bit scared of sharing their thoughts and feelings, also understand that Trainers, Educational Supervisors and ARCP panel consider those who share their inner thoughts and feeling to be mature adult deep-thinking learners.   And we love that.  We do not interpret someone as weak when they share their thoughts and feelings.   We do not think badly of you.   Instead, what we think is something positive – that it takes a motivated trainee who truly wants to better themselves to talk about their feelings.  So…. go on, have a go.  See what the reaction is.

Do not save up your entries – they will have lost some of their value to you by the time you do find time to expand on them.   Write them there and then – whilst everything is fresh in your mind and whilst the case excites you.   Write them any later – and you wont remember it so well, you’ll hate writing it up and your initial momentum will have gone. 

Also it’s unfair to land your GP Trainer or Educational Supervisor with 30+ entries all in one go shortly before your ES meeting.    Think about it.  How would you feel if you have many things to do in both your work and personal life, but then to be landed with a number of long’ish entries to read plus a deadline that it must all be done within 2 weeks “before my ES meeting”.  Would you be happy?

So do it all in a timely way, so that your GP Trainer or ES can also read them in a more gradual, relaxed and timely way too.   And besides, doing it this way means the GP Trainer or ES can give you advice and feedback on your entries and help you tweak them to make them better (and thus help you to reflect better in real life).

The process of using learning logs involves developing thinking and learning skills.   This can be super-enhanced by a peer partnership system.   So, how about forming a peer system with one-two-three-or four others.   In this peer system, the trainees would be encouraged to discuss and share their thoughts, as well as to develop their learning logs in a collaborative way. 

The advantage is that by the other mindsets within the group would expand your thinking even further.   Anyway, it’s just a thought.  Perhaps something worth developing at HDR – talk to your Training Programme Directors.

The bottom line is that the college says it should be the Educational Supervisor that reads your log entries.

HOWEVER…

There is an incredible amount of work the Educational Supervisor has to do when it comes to your reviews.   

• So, we think it is more practical if your GP Trainer reads them if you are in a GP post.  And here are our reasons why…
  They see your day-to-day work anyway and it’s good for them to get a better feel about you based on what you write about the day-to-day experience.   A good proportion of the ePortfolio entries will have been discussed with the trainer already. That places the trainer in an ideal position to more reliably validate log entries against the competencies.  Also, the trainer can read the entries in a progressive way throughout the 6 month attachment.  That means they can also provide feedback in an progressive and incremental manner rather than a whole mass of feedback being dumped on you by the Educational Supervisor.    We hope this will enable you, the trainee ,to develop better reflective skills in a progressive manner too.  Finally, continuously reviewing how their trainee is engaging with their ePortfolio provides the trainer with another informal form of assessment on how the trainee is progressing  (through their level and depth of reflection as well as active engagement).
• In a hospital post, encourage your hospital consultants to read some.   Many won’t because they are busy or don’t understand how to map your learning logs to the Professional Competencies (and actually, they may not understand some of the competences – after all, they are consultants in the hospital world, not the GP world).   That leaves the Educational Supervisor (ES) to read the rest.
• Once you have a set of 10 log entries – email or ask your Trainer/ES to read them.   Don’t leave it all til the end when they may have 60 to read in a very short space of time.  That’s unfair – please think about them.

• What I do with my trainee, which might help some of you, is to periodically (say once every 6-8w) hijack the tutorial to look at the ePortfolio entries, read them and see what we can learn from them.  
• I also ask my Practice Manager not to cancel the block of tutorial time when the trainee is away on annual or sick leave.   That gives me protected time again to look at and review their ePortfolio.
• And many Deaneries have now made it the rule that every GP trainer must be provided 1 hour PROTECTED GP training admin time a week.   This hour SHOULD NOT be squeezed in by your Practice Manager.  Instead, it should be in placement of surgery time.   And this time provides an ideal opportunity to read some entries and other GP training stuff. 

Trainees who are poor or extremely reluctant to write are often mistakenly characterised as either lazy or poor thinkers.   But this could not be further from the truth.   You may find that these reluctant writers, 

• aren’t willing to note ideas in a Learning Log because they are sharing personal perceptions, feelings and thoughts.
• aren’t willing to include emotional stuff for fear of being judged.
• aren’t willing to show their learning gaps for fear of being judged as incompetent.
• simply lack writing skills in English – especially if they are not native to the UK.
• have too much other stuff going on in their lives that failing to engage with Learning Logs is one of many indicators that suggests they are struggling.   eg going through a divorce, being in debt and working every hours God sends, being sued, alcohol, drugs, relationship problems, child custody problems and so on.  
• Medical problems like anxiety, depression, bipolar, chronic pain, and so on.

SO – DON’T JUDGE THE FAILURE TO ENGAGE.  THE FAILURE TO ENGAGE SHOULD MAKE YOU WANT TO OPEN UP A DIALOGUE ABOUT WHAT IS HAPPENING FOR THE TRAINEE (SO THAT YOU MIGHT BE ABLE TO HELP THEM BETTER).   RDMp them – if you’re unfamiliar with this term, look up RDMp on the BRADFORD VTS pages on ‘THE TRAINEE IN DIFFICULTY’.