Learning Log for MRCGP Workplace Based Assessment

The Learning Log is your personal learning record. It’s used to collect evidence about your progress and share it with your supervisors and ARCP panel, as part of the Workplace Based Assessment component of the MRCGP exam.

How the Learning Log works

Maintaining your log is just as important as completing your formal assessments.

Entries you choose to ‘share’ can be read and commented on by your clinical or educational supervisor. These log entries will contribute to the evidence available to your supervisors and ARCP panels when they come to take a view on your competence progression.

Confidentiality and professionalism

In addition to your supervisors and the ARCP panel your log entries may be read where necessary or legally required with others. It is therefore very important that in your entries you respect patient confidentiality and follow the Caldicott principles. You are also expected to use the ePortfolio as a professional journal, and to bear in mind advice from the GMC on the behaviour of doctors. Please also bear in mind that what you write is kept and may be seen as a reflection on your professional behaviour.

A request for the disclosure of information contained in a trainee's ePortfolio 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 Academy of Medical Royal Colleges (AoMRC) has released guidance for trainee doctors entering reflective notes into their ePortfolios.

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 ePortfolios, the AoMRC recommends to word the notes in terms of the following:

  • A brief description: what are you reflecting on? Outline the circumstance in general terms. Ensure that you anonymise data. You can describe a situation without including identifiable data. For example use 'Patient X' or 'Dr S' instead of names or patient numbers.
  • Feelings: what were your reactions or feelings to the event in general? Try not to be judgemental, both to yourself and others, particularly when your reactions and feelings are still raw.
  • Evaluation: what was the outcome? What was good and could have been done differently about the event?
  • Analysis: what have you learnt? What steps will you now take on the basis of what you have learnt? This is the most important section and will allow the other sections to be brief, generic and unidentifiable. This section will demonstrate both the learning outcome and reflection.
  • Take advice from a senior, experienced colleague when writing reflection about cases that may be contentious or result in an investigation.

Curriculum coverage

You can link entries in your Learning Log to curriculum headings, indicating which parts of the curriculum you think you were addressing. When linking a log entry to curriculum headings, take care to look at the learning objectives in the relevant curriculum statement. Check that the entry provides evidence relating to the specific statements you have selected.

A log entry will often be relevant to more than one curriculum heading, but try not to choose inappropriate headings. Your trainer or supervisor may remove curriculum links they feel are inappropriate.

Evidence in the 13 competence areas

Your clinical or educational supervisor can only validate log entries against the competences if they are of sufficient quality.

Log entries should be reflective, demonstrating personal insight into how you are performing and learning from your everyday experiences. A good, reflective log entry will show:

  • some evidence of critical thinking and analysis, describing your own thought processes
  • some self-awareness, demonstrating openness and honesty about performance along with some consideration of your own feelings
  • some evidence of learning, appropriately describing what needs to be learned, why and how

You won’t be expected to produce perfect log entries from day one. But your educational supervisor will expect to see improvement in the quality of your Learning Log entries and insight as you progress.

Example of a good reflective log entry

Current selections:

  • professional competences 4 - making a diagnosis
  • professional competences 5 - clinical management
  • curriculum statement headings 8 - care of children and young people
  • curriculum statement headings 15 - cardiovascular problems
Date 25/11/13
  What happened?

A two week old baby was brought to the surgery with a history of a few days of coryzal symptoms and poor feeding. The parents thought that the baby had a viral infection. I examined the baby and thought that she had some crepitations on the left lung. She was also tachypnoeic and tachycardic. I was concerned about this baby as she was not feeding well and the parents mentioned that she had been more sleepy than usual. I discussed the case with the paeds registrar on call, who said it sounded like bronchiolitis and suggested conservative management. However I stressed that I felt this baby needed to be assessed as she was not well and eventually the paeds registrar agreed to see the child. 

What if anything happened subsequently?

While in the children’s emergency department, the baby had a cardiorespiratory arrest, was resuscitated and transferred to a hospital in London. She had coarctation of the aorta and left basal consolidation of the left lung. She was subsequently operated on and is now progressing well in intensive care.

What did you learn?

To be aware that accurate assessment of a baby is vital as they can be seriously unwell and only display non-specific symptoms. I am very glad that I insisted on sending the baby to hospital despite the objections of the paediatric registrar. It felt very awkward at the time, but it has taught me to trust my judgement and I will find it easier to be more assertive next time.

What will you do differently in the future?

On reflection, the baby arrested while she was in the CED. The parents took her there by car. I could have arranged a blue light ambulance to take her to hospital. However, although I thought she was unwell, I did not expect such a serious underlying problem and she was certainly not looking like a baby that was about to arrest.

What further learning needs did you identify?

Need to refresh my memory re: congenital heart disease and its presentation in neonates.

How and when will you address these?

GP notebook and paediatric textbook, in the next couple of weeks.

Record created

15/12/13 21:24:32

Comments

[16/12/13 18:50:36] (Educational Supervisor) You did extremely well here, recognising the baby was not well and sticking by your own clinical judgement when a more specialist doctor was suggesting an alternative. This can be a difficult thing to do and in this case saved this baby’s life. Well done.

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