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21 November 2016
The Academy of Medical Royal Colleges (AoMRC) has released guidance for trainee doctors entering reflective notes into their e-Portfolios.
Doctors have an ethical duty, set out in the GMC's core guidance Good Medical Practice (2013) to take part in systems of quality assurance, including regular reflection on their standards of practice and the care they provide to patients (paragraph 13). More detailed guidance for doctors can be found in Continuing professional development: guidance for all doctors (2012). The GMC emphasises that doctors must reflect on all aspects of their professional work and should be informed by discussion with others and by specific evidence, including audit, complaints, significant events, workplace-based assessments and feedback from colleagues and patients (paragraph 17).
However a recent case, reported by HEE in March 2016, related to a trainee who agreed to the release of their written reflections but then found it used against them in court. Several Royal Colleges raised concerns about the circumstances surrounding legal requests to release information held on e-Portfolios. This was subsequently considered by the AoMRC.
A request for the disclosure of information contained in a trainee's e-Portfolio could arise in a number of ways. For example, the patient may be aware that a trainee has made a record relating to them, and they may subsequently make a subject access request for information under the provisions of the Data Protection Act 1998. Disclosures could also be sought in litigation, criminal prosecutions or inquests and potentially ordered by a judge or coroner. In addition, the GMC also has powers to compel the disclosure of information, as does the Ombudsman. But in many cases what is in the reflective note will mirror what is recorded elsewhere, such as a root cause analysis following a patient safety incident, and may not therefore reveal any new information.
The key point in the AoMRC guidance is that doctors should 'anonymise patients as far as possible in their self-reflective logs. This is an educational and not a medical tool and therefore there is no reason to include patient identifiable or personal data relating to a third party'.
When writing reflective notes in e-Portfolios, the AoMRC recommends to word the notes in terms of the following:
We have long advised that it is important that trainees follow the guidance and requirements of the GMC and Health Education England (or national equivalent body) as well as take account of guidance from their relevant Royal College. This includes any requirement to maintain a portfolio of evidence relating to training and evidence of reflection.
Careful and conscientious reflection on professional practice, particularly if things go wrong, can be helpful both in terms of learning lessons and in demonstrating insight.
Portfolio reflections should be anonymised. There is no need for patient identifiable information to be included in a portfolio entry. Trainees should review their reflections carefully, as it is easy to leave in details that could inadvertently identify the patient, particularly when small details are viewed in combination.
The following points may be helpful to keep in mind.
If you are unsure about what to include in a particular portfolio reflective note, speak to your consultant or educational supervisor for advice.
Finally, if you are asked to disclose information, it’s important to get advice from your medical defence organisation. You can contact the MDU medico-legal helpline on 0800 716 646.
This guidance was correct at publication 21/11/2016. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
Would the same advice apply to 'colleague identifiable data' in one's appraisal portfolio? Should appraisees be careful not to include specific criticism of colleagues in the portfolio if that colleague could be identified in any way? (eg via gender, initials, role within the team, job description, circumstances that gave rise to the criticism.) What does the MDU advise?
Dear Dr Anderson,Thank you for your comment. As an appraisal is your opportunity to demonstrate reflection on your own individual practice it is not usually appropriate to include comments about colleagues; however, should it be necessary to refer to colleagues, for example when various parties have been involved in a patient safety incident, the same principles regarding careful anonymisation would apply.
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