Hot topic: Include reflections in your ePortfolio

Drawing upon a recently reported case, Medical Protection’s Senior Medicolegal Adviser Dr Pallavi Bradshaw emphasises why it is important to include reflections in your ePortfolio.

As a foundation doctor, not only are you responsible for the care of patients but also for your professional development. You need to demonstrate core competencies and record such achievements through the ePortfolio. The ePortfolio, when used effectively, can help identify learning needs and set individual goals. It is a key part of evidence in demonstrating competence throughout your training.

Another important function is to allow open and honest reflections on clinical incidents or complaints. A patient safety incident, as defined by the NPSA, is any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care. It is very likely that at some stage of the foundation programme you will be involved in such an event. In certain situations, where moderate or serious harm has occurred, the new duty of candour will be engaged and certain defined steps will need to be followed as per the Trust’s policy. Even where harm has not occurred it is important to reflect on the circumstances of the incident in order to identify lessons learned or training needs.

A recently reported case raised concerns when a GP trainee’s personal reflections on an incident were released to a legal agency and apparently used against him in court. This is a very unusual situation and while I am not familiar with the particulars of the case, I am confident that the reflections in themselves would not have led to the success of a claim in negligence. While it is true that Significant

Event Analysis reports have to be disclosed if requested, such information should be passed via the Trust legal team. It is unclear why the trainee disclosed what should have been anonymised data directly to the legal agency or whether they had sought advice from their defence organisation first.

Crucially, following the media reports, Health Education England confirmed that personal reflections must be recorded in portfolios – a view shared by Medical Protection. Portfolios are invaluable for skills and career development and helps foster an open and reflective culture in the health system. Ultimately, if a claim is pursued there are many factors which will be taken into account and subjective reflections in themselves will not be determinative. Further, there is a greater risk to you by not recording an incident or complaint as this may lead to allegations of dishonesty which can be far more detrimental to your career. Failing to provide written reflections on such incidents in the portfolio may also lead to concerns about a lack of insight or failure to learn, again leading to possible scrutiny.