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Revalidation in Wales

Mock GP appraisal entry

Here is an example of the same educational activity treated in three different ways. The aim is to try and show how from the same activity different levels of learning outcome and reflection can be gauged from the entry.

Here is an example of the same educational activity treated in three different ways. The aim is to try and show how from the same activity different levels of learning outcome and reflection can be gauged from the entry.

The doctor attended a one-day talk on cardiology.

Example A

Title: Cardiology course 24/4/2020
Activity I attended a cardiology course
Reason It was available locally
Reflection The day was packed with all sorts of useful information. The course was given by local cardiologists and also speakers from far afield. Overall I feel that this has been a good update of my understanding of cardiology problems and how to manage them.
Outcome I have updated myself

This example shows no real reflection, it is simply recording that the doctor has attended the course. This is the sort of entry which, if repeated in all of the entries in your appraisal submission, is likely to get the appraiser to be concerned about your portfolio and consider contacting you to encourage you to provide more information/reflection on the outcomes of your learning. It is in effect simply listing what you did and even then very scantily. It gives the appraiser no indication of how it's changed your practice or even really how it has updated your knowledge. If all your entries were like this then it is likely that the appraiser would be contacting you to try and get further information included in your portfolio or may even deem your portfolio as being not ready for the appraisal to take place. It is a GMC requirement that you demonstrate reflection on your learning. It does not mean that you did not reflect on the experience it simply means you've not demonstrated it in the portfolio. From experience all doctors reflect on learning but some are better than others at demonstrating it within the portfolio than others.

Example B

Title Cardiology course 24/4/2020
Activity I attended a cardiology course
Reason I am the cardiology lead in the practice and I had set this as a target from last year's PDP
Reflection The talks provided over the day were useful and informative. They reminded me of some of the main changes in managing cardiology conditions that have come in over the last 12 months. I particularly like the talk on managing chest pain as this is often a clinical problem which can cause anxiety. The guidelines given by the local cardiologists were very helpful.
Outcome I will apply information I learnt in relation to managing chest pain and other clinical topics covered on the study day.

The above entry shows a degree of reflection in as much as we have some idea of which part of the talk meant more to the doctor than any other part. This would give the appraiser an entry point for discussion on the subject and an exploration around the guidelines on chest pain. This is a very borderline entry but does show the beginnings of the reflective process.

Example C

Title Cardiology course 24/4/2020
Activity I attended a cardiology course
Reason I am the cardiology lead in the practice and I had set this as a target from last year's PDP
Reflection

I found the study day useful. It covered the following topics:

  • Atrial fibrillation and anticoagulation
  • Diagnosis and management of chest pain
  • Diagnosis and management of heart failure
  • Aortic aneurysm screening programme

Atrial fibrillation and anticoagulation - This is an area which in the practice we have approached over the last few years. We have tried to use the HASBLED and CHADS2VASC2 scores to help encourage our patients to take anticoagulation. A few years ago we looked at this subject but have not conducted a formal audit in this area. The talk reminded me of the importance of anticoagulation as a way of preventing strokes. I think I'd like to take this back to my colleagues in the practice and review our current position and decide how to take matters forward.

Diagnosis and management of chest pain - The talk was based on the NICE guidelines for assessing chest pain. I found the prioritisation model suggested by the NICE guidance to be useful and I think I will start applying this in my day-to-day practice. The guidance was essentially a summary of what I tended to do anyway.

Diagnosis and management of heart failure - This module made me aware of the new drugs that can be used for heart failure, in particular the drug Enbrel. I think this is a drug which I need to learn more about and will think about how to do that.

Aortic aneurysm screening programme - I did not learn anything new from this talk.

Outcome

I need to discuss with my colleagues how we are doing with managing atrial fibrillation and think about how we can move matters forward in the practice.

I would like to develop a sheet of A4 to remind me of the key features assessing chest pain presentations and I might then disseminate this to my colleagues.

I will look at the BNF to look at new drugs in relation to heart failure and see whether we need to change the way we manage heart failure in the practice. In reality I don't think we'll have to do much because our local cardiology team manage these patients very well via the heart failure nurses.

This example clearly demonstrates how the doctor has reflected on various elements of the course and has indicated how it is likely to affect their practice. Furthermore the doctor has gone on to suggest ways in which the knowledge could be applied to their daily practice and how it might be important in terms of having an impact on patient care. This is the sort of entry which clearly demonstrates reflection at quite a high level and the appraiser would then be likely to discuss ways in which the doctor could take the ideas forward such as undertaking an audit around the management of atrial fibrillation.