We are currently two GP trainees, a few days into our ST3 year. We have been very lucky and have had some great placements during our training so far, which we have thoroughly enjoyed. However, earlier in our training, we made some silly mistakes, which could have resulted in very serious consequences. We are therefore writing this, to try to raise awareness for other trainees and to try to help in preventing anyone else from facing the potential serious consequences that we have.
During our clinical posts, we have always found the eportfolio difficult to maintain and keep up to date. We have tended to allow it to take a back seat, while our focus has been on our day-to-day jobs and patient care. We often saved up eportfolio entries and updated them in one go. We also had assessments completed in a similar manner, whereby we would ask an assessor to complete the form some time after the event and we often found it difficult to ask for assessments to be done, as we felt the assessor had more important tasks to do. We considered the forms as more of a tickbox exercise to get completed, rather than an actual assessment of our clinical skills and competencies. We felt that if our team, our consultant and our patients considered us to be good doctors and that we had performed well during that post, the forms were more of a formality.
However, we recently spent three of the worst weeks of our life learning otherwise.
During one of our posts, we asked a fellow GP trainee to complete two direct observed procedure (DOPs) assessments for each of us for 2 examinations, which we had performed earlier in the job, but that they did not directly observe. At this time, we were also asked us to complete assessments for him for procedures that we had not witnessed. We both considered that we were competent in the skills in question, having performed them many times previously. We completed the forms in the spur of the moment and did not take time to consider our actions either at the time or at any point following. Therefore, we were completely taken aback and shocked (to put it mildly), when we received an email following the ARCP panel, asking us to attend a meeting to discuss these assessments. The email outlined the issues of probity and fraud and highlighted cases of other doctors, who had been referred to the GMC. We could not believe how stupid we had been. A few minutes of stupidity and lapse in judgement could result in the career, which we love, being completely ruined. We knew that we had not meant to deceive anyone and that we had made a very silly mistake and not thought through our actions, but we now realised the significant issues that arose from this and the potential consequences that could result.
Due to the serious nature of the incidents, we did not receive an outcome after the initial meeting and were contacted by the Director of GP Education the following week. We felt incredibly relieved that both he and the Postgraduate Dean concluded that whilst we, and our fellow GP trainee colleague, had been exceptionally stupid, that it did not warrant referral to the GMC. We are very aware of how close we were to being referred and the effects that it could have on the rest of our career.
We know that we will never forget the events of the last three weeks, which have been the most stressful we have experienced in our life, and the way we have felt. A few minutes of thought and consideration of our actions and the potential consequences would have stopped us from doing what we did. We are already, and will continue to be, sure that we put into practice the lessons that we have learnt from these recent events and we have no doubt that they will continue to affect us throughout our life, both at work and away. The ARCP panels are very thorough and we would not want any other trainee to go through a similar situation.
We would therefore advise other trainees to learn from our mistakes and to prioritise their e-portfolios, as they are a vital part of our training. Please take extra care when asking for assessments to be completed: It only takes a few minutes to discuss with an appropriate assessor before you complete the assessment and then another few minutes to complete the forms afterwards but, from our experiences and having learnt the hard way, we can definitely assure others that this is time very well spent.
Commentary on “A Cautionary Tale” by Dr John Edwards, Associate Post Graduate Dean for Assessment
This case is an example of a failure by these two trainees to sufficiently recognize the following issues:
1) Work Place Based Assessments constitute one third of the MRCGP examination process with the same standards of probity and honesty expected as for the CSA or AKT.
2) The ARCP panel process is thorough and will scrutinise a selection of portfolios in great detail.
Duties of a doctor
All registered medical doctors have a duty placed on them by the General Medical Council (GMC) to be honest and trustworthy. Candidate performance in Workplace Based Assessments is reviewed by doctors who themselves have a duty to notify the GMC if they have concerns.
Misconduct before, during or after assessments or evidence of lack of competence may be referred to the GMC. Candidates whose GMC registration (or its equivalent overseas) is subject to suspension, referral or any condition must provide the RCGP with full details.
General Principles for All Trainee ePortfolio Users
The College expects all users to conform to acceptable and appropriate standards of behaviour when using the Trainee ePortfolio and undertaking Workplace Based Assessments.
This guidance is given in the expectation that users will exercise an approach consistent with standards expected by the General Medical Council, or the appropriate regulatory body, and/or your employing organisation.
Fraudulent misuse of the Trainee ePortfolio is an extremely serious offence. This would include any form of impersonation and also making entries that are deliberately misleading or malicious, particularly those that relate to assessments.
All allegations of misconduct and fraudulent misuse will be dealt with in accordance with the MRCGP Regulations
3) Any suspicion of dishonesty will be investigated by the Deanery and dealt with appropriately according to RCGP regulations and GMC guidance.
The Code of a Conduct for the MRCGP can be found on the front page of the ePortfolio after logging in, and the relevant excerpt is copied below.
We hope that this account will prove a useful lesson for all our trainees.
ePortfolioThe e portfolio is the on-line tool for recording learning and progression of your training throughout your three years as a GP speciality registrar (GP StR). All your assessments will be recorded onto it and your eligibility to progress through your training will be dependent on adequate information being present.
All new GPStRs will have received an e mail from the RCGP about becoming an Associate in Training (AiT) following appointment to the GP training scheme. You will need to register as an AiT before you can use the e portfolio. Click here for more information and a AiT Membership Guide
It is essential that all new entrants to GP training schemes (ST1s) register on the e portfolio and start using it as soon as possible from the first month of their first job.
Clinical supervisors, educational supervisors and trainers should be automatically linked to your GPStR by the deanery central office. If that has not happened please contact email@example.com at the deanery with your details and the name of your trainee.
The portfolio can seem daunting and complicated, but the following are useful resources for GPStRs and Trainers to support its use:
The RCGP guide to the e Portfolio for trainees: the basic handbook produced by the RCGP – an essential first read
The RCGP guide to the e Portfolio for Trainers: the complementary guide for trainers and educational supervisors
A walk through guide to the e portfolio: If reading through the handbook has not enlightened you sufficiently, then these excellent resources from Nottingham VTS will support both trainees and trainers get to grips with how to get started
ePortfolio Pearls: a handbook produced by the Yorkshire deanery, which is an excellent “real-life” explanation for trainees on how to get the most out of your portfolio and how to make it actually useful! http://www.yorksandhumberdeanery.nhs.uk/general_practice/documents/e-portfoliopearls-makingitworkforyou.pdf
Ticket codes tutorial: a podcast from the West Midlands deanery explaining how a trainee can issue a “ticket” to allow an assessor to enter an assessment (or results from a patient survey) onto the e portfolio
There will be new resources and links added to this page from time to time.
If you as a trainer, supervisor or trainee have any questions regarding the e portfolio, then first look at the FAQ section on the website. If that does not work then contact the help desk on 020 7344 3075.
The RCGP is constantly making upgrades to the e portfolio, for information on the latest developments: click here
If you have any questions regarding the administration or training regarding the e portfolio in Severn Deanery then please contact John Edwards.
Email: John Edwards