Sheet 6 Dec 2013

  1. What are shared log entries?
    A GPST is expected to record various professional activities as a personal log on the portfolio.  Examples include clinical encounter, professional conversation, tutorial, reading, audit/project. SEA etc.  If they choose to “share” these with their supervisor (by clicking on the Share button), then these activities can count as “naturally occurring evidence” towards attainment of the required professional competencies.  The trainee can also link the entry to a curriculum chapter to demonstrate curriculum coverage.

  2. How can a supervisor view shared log entries?
    The large icon on the home page will show the date of the most recent log entry. Click on log summary to access entries and open a specific entry by clicking on the subject title.

  3. What should a supervisor do after reading an entry?
    Click Mark as Read at the top of the page. Note that once you have done this, the GPST is unable to edit or add futher to this entry. If appropriate, give some specific developmental feedback to the trainee regarding the log entry by clicking "New Comment" at the bottom RH corner. The supervisor may then choose to validate the Evidence.

  4. Why does a supervisor validate evidence?
    Validation should be done if the supervisor considers that the entry provides evidence of learning or a relevant behaviour in the area of a particular competency. This implies that if a GPST simply recounts an event, or records attendance at a course or reading a book, this does not in itself give evidence of learning.  On the other hand, if the GPStR records reflections about an event or piece of learning that in your judgement demonstrates application of knowledge or describes a relevant behaviour, then it would be appropriate to link the evidence (validate) against a specific competency (see examples below).  It may also be appropriate to link against a competency if the supervisor observes the behaviour, or is able to have a reflective discussion about the event during a tutorial or review session.  By validating, the evidence will appear in the summary table when you write the ES report. Therefore it makes sense ONLY to validate that evidence that you consider will be helpful for the trainee or you in writing the ES report.

  5. What if the supervisor feels unable to validate the evidence?
    In this case, he/she can still link the entry to a curriculum area, to record curriculum coverage.  The ES can also remove wrongly linked entries by the GPSGT (commonly “The GP consultation” and “Management in Primary Care” are wrongly linked!).

  6. How does the supervisor practically record validation?
    To validate or link to curriculum areas, click Validate Evidence. To link to (or remove) a curriculum area, you then need to click on RCGP curriculum statement headings at the bottom of the page.

  7. Which supervisors should actually be doing the validation and when?
    It is appropriate for either Educational or Clinical Supervisors to validate log entries.

Examples of shared Log Entries

Example 1

Shared Log entry – Clinical Encounter

What happened?

I was called to a 70 year old lady who had a painful knee. She was known to have metastatic breast cancer, and was for palliative treatment. I ordered X Rays of her knee and hip, and discovered that she had a pathological fracture of the hip.

What, if anything, happened subsequently?

The orthopaedic team were keen to operate on her. I had a long discussion with her together with her family to discuss the options. They thought that operative treatment would be too stressful. I therefore contacted the physiotherapists, pain team and involved the palliative care nurse.

What did you learn?

The importance of listening to the patient and not pushing to do heroic procedures.

What will you do differently in future?

I will try to always emphasise at an early stage to patients that they have control over the treatments that they receive, and I will try to give them as much information as possible to allow them to make appropriate decisions.

What further learning needs did you identify?

I was not sure about the management of pain in this circumstance and am aware that I need to know more about palliative care pain management.

How and when will you address these?

During my next GP attachment I will spend some educational sessions with the palliative care team

Supervisor/trainer comment

I like the way you resisted the pressure for interventionist treatment and supported the patient to exercise her autonomy and express her wishes. You did well in involving various other team in her care

Comments: The registrar here demonstrated that she had acted ethically and involved the extended team as well as reflecting on what she had done and learning required.  This evidence could therefore be validated against the following competencies:
8. Working with Colleagues and in Teams
11. Maintaining an Ethical approach


Example 2

Shared Log entry – Reading

What were you reading?

Common Emergencies in General Practice

Why were you reading this?

So that I am prepared for my ST2 attachment in general practice in February

What did you learn?

About the various management pathways for different emergencies

What will you do differently in future?

Be better prepared

What further learning needs
did you identify?

I would like to see how I actually respond in real life!

How and when will you
address these?

During my GP attachment

Supervisor/trainer comment

It is good you have acquired this knowledge, it will be good to see if you have the opportunity to put it into practice

Comments: The registrar stated that he now knew how to manage emergency conditions, but he was not able to demonstrate how he would do it, or provide an example of actually doing it. Although the evidence cannot be validated against a competency, it can be linked against the following curriculum entry:
7. Care of Acutely Ill People


Example 3

Shared Log entry – Tutorial

What was the subject and aims of the tutorial?

The identification and assessment of depression in patients attending general practice

What lead to this particular subject being chosen?

My trainer had observed during COTs that I was not always picking up when people were depressed, or excluding depression as a potential problem

What did you learn?

Depression is very common in general practice, particularly in people with chronic conditions, backache, tension headaches and unexplained symptomsAlways be alert to the possibility of depression and ask screening questions when appropriate Make a full clinical assessment before offering the PHQ9 questionnaire

What will you do differently in future?

For patients in the above categories, and whenever I have the slightest suspicion, I will ask the two depression screening questions about being bothered re. low mood and loss of interest and enjoyment in things. I will write those questions on a card and put on my desk!

I will be more thorough in my assessment, particularly asking about negative thought patterns and asking about memory and concentration to assess reduced cognitive functioning.

I already knew about asking about thoughts of self harm, but I will practice asking it more spontaneously without being embarrassed

What further learning needs did you identify?

I need to know more about the side effects of antidepressants

How and when will you address these?

I will look up the side effects in the BNF, then ask my trainer about how common and how much of a problem they are in real life

Supervisor/trainer comment

It is good that you have come up with some specific ways to improve your detection of depression. It would be good to discuss a case as a CBD, or show a video of such a consultation

Comments: This registrar has demonstrated learning from her tutorial and also indicated how she is going to apply it in practice. Although she has not shown that she actually can do what she says that she is going to do, her practical and workable plan indicates that she “knows how” and so allows the trainer to validate the evidence against the following competencies:
3. Data gathering and Interpretation
5. Clinical Management


Example 4

Shared Log entry – Significant Event Analysis

What happened?

A patient collapsed in the surgery. The receptionist did not know about the emergency procedures, and the nurse did not know where the oxygen is kept. The practice had an SEA meeting with all practice staff present.

What issues were raised by this significant event?

Emergency procedures should be outlined as part of the induction process for new staff. The nurses should rehearse resuscitation procedures, including fetching the oxygen

What was done well?

The team contacted the doctor, who was calm and managed the situation well

What was not done well?

Time was lost in getting the oxygen and the patient was not moved into the recovery position straight away

What could be done differently in the future?

All staff members need to be aware of procedures and rehearse them

What further (personal) learning needs did you identify?

By observing this Significant event discussion, I have learnt the process, but would benefit from leading the next discussion

How and when will you address these?

I will ask the practice team if I can chair the next discussion

Supervisor/trainer comment

You have had a useful learning experience, both to see what can happen in real life general practice as well as how to learn from it. It will be good to offer to lead the next SEA discussion in your practice

Comments: The registrar has had a useful learning experience by observing this practice SEA and will hopefully be able to apply this by demonstrating the ability to reflect and learn from significant events in the future. Although the evidence has not actually demonstrated learning related to this competency, it can be linked to the following curriculum areas:
3.1 Clinical Governance
3.2 Patient Safety
7 Care of acutely ill people.