nm0360: are we all ready to to get started cou-, could i just ask namex just to come forward to the front just for a second if that's all right er could i just bring namex to the front nf0361: nm0360: namex is the secretary of our department and i just wanted to say a big thank you to namex because without today it wouldn't have happened she's organized everything from you to be here the food the lunch the coffee just to say thank you very much we're very grateful and thank you to everybody who's come today and er shared in the day particularly for representatives from both namex and er namex Universities we've been grateful for for the interaction and hopefully some collaborative initiatives will will come from today i want to introduce you to our last speaker namex i said that a lot of wonderful work had come out of the academic training scheme for G-P registrars namex used to be an academic G-P registrar here at namex but she's gone on to great greater things now and is a lecturer here in general practice within our undergraduate Department of General Practice but the project that she's been working on is personal development plans in the postgraduate side of of primary care and she's going to sh-, share that with us now thanks very much nf0362: thanks namex er normally when you give a lecture you usually check that people can hear okay but i think it's probably more important that people can actually see me over the lectern [laughter] er as namex said i used to be namex but namex employ far better looking registrars than namex and er i came here as an academic G-P registrar er it's probably about a year ago eighteen months ago now and was very interested in education especially for postgraduates and looked very much into personal development plans for G-Ps in the area and that's where my sort of area of research lay er i was very aware when i was asked to talk that A this was an u-, undergraduate research symposium er and that not everybody here would be a G-P and i didn't know how interesting my research would be to people so what i thought i'd do is this basically discuss the history of portfolios where they've come from er different methods of using portfolios in different er career areas especially medicine really and i apologize to those people that aren't from medical backgrounds obviously when discussing portfolios we do need to bring in an element of reflection er so i'm going to discuss that as well and then finally move on to the problems and the benefits of using portfolios in medicine and then i can touch on my research if anyone's desperate to go home at that point right so er i wanted everyone to think of something that reminds them of Italy er it may seem a bit of a strange question er i thought of a few myself obviously food came first er basically the reason why i put this slide in is the word portfolio actually originates from Italy er it started in the eighteenth century and it can be split into two components and i apologize for pronunciation as i don't speak Italian but the first is portare which is to carry and the second is folio which i'm sh-, er sure there is a proper Italian pronuncation for that meaning leaf or sheet and so really in its basic basic er meaning portfolio means a case for carrying loose sheets of paper and obviously in the artistic world that definition still carries and often you see people going for job interviews with their big portfolios er containing all their leash-, loose sheets of artwork they they've done basically since this time the definition and the word portfolio has been picked up by lots of different er occupations the commonest one's the government er they basically have developed the word portfolio to mean a case containing official documents for certain departments within the government and that's led to job descriptions such as Minister with Portfolio and Ministers without Portfolio for those people that do have the responsibilities for looking after these cases of documents in the N-H-S or in the educational field in general er the definition of portfolio has really taken on two main areas and that's what i'm going to discuss today starting with the first one of a scrapbook a very basic definition er it's a collection of written material or evidence of skills er a person possesses basically y-, years and years ago what used to happen is you used to finish school used to go and get a job down the road where you'd stay really until you retired you'd get married have two children et cetera et cetera things have changed very much so we're now expected to do extra qualifications we're expected to actively move round get different jobs different experiences even specialize in different specific areas within the occupation that we've actually chosen obviously we need to demonstrate to people the expertise and experience that we have so what we use are best doing is collecting certificates evidence of work that we've done er in order to prove where we've been er couple of people that looked into scrapbook type portfolios was Pendleton and Hasler basically they should said that you should be as imaginative as you can be with your portfolios put in anything you think of so that includes videotapes now audits research as we've been discussing today everything to prove where you've been and what you've been doing since you sat your first basic exams right so if we go back to the previous one portfolios can also be used as educational tools er and that's really what i'm going to concentrate on more now because it's what the government want us to do and what's being used most in the field of continuing medical education basically using portfolios as an educational tool you start with your basic scrapbook but you add in the additional dimension of reflection and reflective learning so what is reflection er here's a definition by Brown basically if we think of reflection it throws up images of mirrors and seeing ourselves how other people see us er in education this extends to visualizing or thinking about experiences that we've had courses we've been on making sense of them and perhaps seeing them in a different way or a constructive way er we've all got the ability to look at things we do and make changes to how we do those things in the future er even from when we're born if you think of a small child who puts their hand on a hot radiator they soon learn that it's best not to do that again er and that's really reflection in its very basic form it's been a topic of interest really to lots of educational writers er probably one of the most famous ones is John Dewey as you can see by the black and white photo he was born in eighteen-fifty-nine he actually became head of Philosophy and Psychology in s-, Chicago er and his main interest really lay in educational systems in different countries and he actually did considering the year that he was born did quite a lot of travelling to different countries looking at the educational systems that were growing in each country he also felt that education resulted in people fitting reacting in different ways and fitting into different niches within society and taking on different roles within society and he felt that was all educational based er he basically described two main types of learning the first was trial and error type learning er he felt that skills could be developed after practising a task over and over again resert-, resulting in a more of a learned behaviour er that could be used in just special circumstances only the commonest one is if someone came to you and said how do you ride a bike er we all know how to ride a bike we've all practised it when we were children with stabilizers and we now know how to ride a bike but try and describe that to someone it's very very difficult w-, because it's a learned behaviour he also felt there was a second type of learning and that was reflective learning he where information and feedback from previous experiences could then be used to draw conclusions which if ever you came across that experience again could be used er and basically he fi-, was the first one to introduce the concept of learning cycles and learning loops where conclusions from previous experiences could be fed back and used to manipulate the experience when you have it again he's very well known for something called his pedagogic creed and i just put that in really for the people who are interested in education the Master's students in education and as he said he felt education began unconsciously at birth and went throughout life and shaped that individual and it's that that fitted them into a certain area and function in society so after Dewey had had developed this learning loop David Kolb and i don't think that's the most flattering photo that i found of him [laughter] er he was another educationalist and he was Professor of Organizational Behaviour and he had a special interest not just in the way that people fitted into social society due to their education he felt that due to your education that made you more likely to pick specific careers and fit within certain organizations and often meant er that's where people ended up working in nineteen-seventy-one he joined together with Rubin and McIntyre who were also interested in education and developed Dewey's learning loop a bit further they produced this and it's well known as Kolb's loop he felt that a learner had to be competent in all of these different areas er and stated the cycle in order for to be an effective learner the whole cycle had to keep turning and if a person was inadequate in any of the areas they were just unable to learn at all so moving on to from this er the final person that i'm going to talk about today is Donald Schon he's also well known er for his techniques of reflection he like Kolb was very interested in individuals and the way they functioned within their working organizations and their working environment he really wasn't that interested in Kolb's cycle he wan-, went back to Dewey's original concept of the fact of er task learning and reflective type learning he felt that er Dewey had got it slightly wrong and instead of being two different ways of learning that it was actually one type of learning and that people actually performed a task and then while they were performing that task they were able to reflect er think about what they were doing and make alterations to their behaviour during the time that they were doing that he also felt that people were also able after they'd finished the task to look back and think about what they'd actually done from this he developed these three terms reflection in action is where you're doing a task and you actually think about what you're doing at the time and you can alter and modify your behaviour accordingly reflection on action he felt was the ability to look back at what had happened and again make changes for the future and both of those came together in order to provide individuals that had a knowledge in action so they're able to perform both these tasks in order to perform a function it's quite complicated and i think the easiest way for me to describe it and again i apologize to the m-, non-medical ones people here is someone taking out an appendix if a surgeon goes in and takes out an appendix there is the typical way of an appendicectomy if you read the textbook it's the sheet make the incision here find the appendix here remove it as such if the surgeon goes in and the appendix is in a slightly different position for example behind the secum then the whole process has to be modified the surgeon has to look somewhere else for the appendix take it out in a slightly different way extend the scar slightly and that's reflection in action the surgeon has seen while he's doing a function that modifications need to be made afterwards when the surgeon's stitched up and he's sitting down having his cup of coffee he can actually think about that patient was there any clues when he took the history from the patient on examining the patient that he wasn't going to find a typical appendix when he went in there if he does find evidence that there were some differences he can actually use that information in the future to be more prepared for the next operation that he comes across and that's more of a reflection on action right so basically reflection's a very complex process there's diferent influences that reflect what we er take home and basically what we choose to take from a situation depends on our personal aspirations our past experiences and where we feel our personal needs or inadequacies lie er and all of these result in modifications hopefully in our behaviour going back to the internal and external influences if you provide a group of delegates with the same lecture and provide them with a sheet where they're able to write home one take- home message the take-home message probably will be very different for everybody in the room er that's because each of us will find part of the talk slightly more interesting than another depending on our experiences er and that's really the element of the internal and external influences on reflection so what we need to do now is put all those all that information about reflection back into the use of portfolios so if we return to our scrapbook what we're doing now is we're using our reflective techniques to look at each learning experience that we've had so as we mentioned before the scrapbooks can be full of certificates and achievements so when you came today er you might have thought oh well i might have a certificate at the end of the day that i can put in my scrapbook and people will see that i've been to this interesting course at namex er however if we're going to use that to reflect hopefully some people after they look at that certificate will think oh i know a bit more about education now or i know perhaps that i'm inadequate in knowledge in this area of education and i'll go and find out more some people might have just come and actually found out where namex is and that it's actually got a medical school in the first place er that's another learning experience some people might have sat next to someone at lunch who's a P-C-T tutor after they started chatting to them and think gosh i've no idea what that is and then go away and actually look that up so a-, got absolutely nothing to do with the course but it's a learning opportunity er that has been picked up on reflecting just on that certificate or the course today so it's not just a scrapbook it's an actual reflection er right so it's not just courses that we can use as learning experiences er lots of different things out there there's feedback from colleagues or patients for the students here today trying to get all this back to an undergraduate level there's the use of simulated patients which give very useful feedback there's patients that they come across on the wards or in G-P practices there's so many opportunities f-, for learning and reflection that often it sort of goes in one ear and out the other 'cause we're busy doing something else at the same time so what we suggest people do is keep a log diary that's just a to do list for want of a better word er and basically all that you do is you write down the topic or areas er that you thought ooh hang on a minute i should really go and look that up er and you know it's there it's somewhere safe that you can come back to it and look at it at a time that's convenient when you've got the time to look further into it really what that is is the basis of a personal development plan a personal development plan is a log diary I-E a to do list but with the added dimension of actually a list of how you aim to achieve those needs and a final section on reflection again because it's a cycle shar-, saying how you have achieved those needs or whether you have achieved those needs basically the whole of this is due to reflection and self- direction so if we come back now to portfolios in the N-H-S and this is where my interest is is basically at the moment G-Ps that to keep up to date it's suggested that they go and attend lectures and collect points er once they've collected thirty points thanks very much pat on the back money from the government right you're keeping up to date er unfortunately it's been proven that this system of continuing medical education is failing G-Ps are going to near-, the n-, lectures that are nearest by they're going to the lectures that are free to attend they're going to lectures which interest them great but they're probably already exceptionally good at family planning and they're going to more family planning lectures while they know nothing about rheumatology so they're becoming very non-directed more and more evidence is coming out and s-, sure everyone knows that didactic lectures really are not perhaps the best way of learning for everybody also the G-Ps aren't providing any evidence of their learning er which the government aren't happy with er so they are keen for a new system er to come about basically Mathers who i think er is based in Sheffield did some research where he looked at portfolio learning and compared it to the old system of G-P learning and this point collecting exercise he did a crossover trial where for six months half the G-Ps did the old-fashioned type of learning and for the next six months the G-Ps did the newer type portfolio self-directed learning and basically the feedback and the outcomes were very good the G-Ps enjoyed greater flexibility er of using portfolios and picking things that were of interest to them they enjoyed the breadth of the topics which far excelled the local lectures that were being provided er but they did admit that more time and commitment was needed so therefore i thought i'd put up this final slide saying that even though i'm very much for it and have researched it there are some negative points to portfolio learning er the two in brackets really aren't applicable to undergraduates er they're more applicable to my area of interest which is G-Ps basically the old system and the new system of continuing education are running alongside which is where the confusion's arising er but basically most people are still uncertain about portfolios and reflection and the way that you can learn from them er well obviously it's relatively straightforward i think once people have run with it for a little while they'll feel more confident and get more out of it and so i'm more than happy to answer any questions on portfolios or if anybody wants to know any more about my research then i'm happy to discuss that as well nm0360: any questions at all nm0363: how do you control the level of reflecting when you do portfolio learning as you illustrated i could be just reflecting i met a a dental colleague and that will be on my portfolio nf0362: mm nm0363: having a chat or how deep do i reflect how do you nf0362: mm nm0363: it's the same as point isn't it nf0362: nm0363: yeah i just come and sit down here and i will write a few point nf0362: absolutely nm0363: but so if you you you think portfolio learning is the way forward how do you know that person just because they reflected nf0362: yeah nm0363: actually learned nf0362: i think the important thing is every single system there's an ability to cheat and not get involved as you need the points based system great you get a certificate you gain a point but that's not to say that you didn't turn up at the back of the lecture pick your certificate up walk straight back out the door er and very much i think with portfolios is the same you get out of it what you put into it er they've tried to minimalize that by proving evidence of learning that you've achieved what you set out to achieve now that could be just a certificate of attendance and the again in one door out the other it's meant to be more documentation of your reflection or changes in practice er attendance at clinics et cetera et cetera but i think there's you're completely right there's an abe-, you know er a possibility of cheating every system er nm0363: i just wonder what are you need to define what is that evidence of learning because earlier on you nf0362: mm nm0363: say i might come to this conference nf0362: mm nm0363: and i learn about P-C-T tutor nf0362: mm nm0363: might be accurate that is not s-, adequate nf0362: mm nm0363: in term of er acceptable that public money nf0362: mm nm0363: spent on learning about P-C-T tutor might well be need to be something change to quali-, nf0362: mm nm0363: patient care nf0362: i mean they are trying to push that the problem is it's in its very early stage er speaking as G-Ps it's in its very early stages and they're trying to get as many people to run with these P-D-Ps because of the uncertainty putting people off at the moment er so they're not being that specific or critical about what is done er even they're saying that perhaps they're still suggesting that you spend thirty hours a year on continuing medical education whether it be in the form of portfolios or point collecting er i mean some people have said oh well it's it's taken me ten hours to write my P-D-P er and again it's hard to justify that because you may have an A-four sheet in front of you that looks like it's taken thirty minutes to throw together but i think you have to try and get people on board and once it's been running for a few years perhaps they're going to be a bit more critical nm0364: er namex i found it really helpful this er whole idea i didn't know the er the word portfolio how it had originated thank you very much the way i er my students the ones from namex attach i use a method where they select a patient they talk to the patient then they present it to me nf0362: mm nm0364: then they provide their portfolio and they got a section that they have to do the research and then later i mark it s-, er so it has given them a chance one to present it to me then they write it and then they have to do some reading and research and then write it back again nf0362: mm nm0364: so the same portfolio can be used in a very reflective way nf0362: mm nm0364: to learn to see whether they when they present it and when they finally write it up er and give it back to you and then we see it again so you get a third way of going round the problem is er the students do an eight week thing and they give their portfolios in the sixth week nf0362: mm nm0364: it's not enough time you should somehow do you give the students this lecture on portfolio nf0362: no i don't nm0364: i think it would help them to get er this thing right at the beginning they must get their portfolios in at least one or two right at the beginning nf0362: mm nm0364: you otherwise eight weeks go very rapidly nf0362: mm nm0364: so if we want to get the best out of our students they must do this exercise one or two twice earlier on to answer the question about the reflection method otherwise what happens at the seventh week they rush in with three portfolios i have to mark them rapidly and sometimes they give it nf0362: nm0364: you know after they have left us nf0362: mm i think as well the students are seeing it very much as a tick box part of the course thank you very much that's another essay handed in i think they've lost the track of yes it is that but it's something they can carry with them for life and i think perhaps if early on they realize it's not just for the four years of this course they're going to be doing this they can keep that as evidence of learning that goes on and on and on unfortunately your portfolio starts to get bigger and bigger and bigger and bigger er but i think that's the problem is they're still perhaps seeing it as a a sort of milestone course nm0363: can i just another problem is if everything we do we need to reflect on it like general i read an article i read i will be spending a lot of time writing i find it's quite difficult nf0362: mm nm0363: every time i read see an article in the B-M-J i need to write another A- four pages i-, i just sometimes can be overemphasized nf0362: mm nm0363: and become paper collec-, collection nf0362: yeah er i think mm it's it's considered it doesn't have to be A-four it can even be a couple of lines you can even write i read this article it was completely and utterly useless and not relevant to me it's evidence that you've read that article it's elo-, evidence that you've been self-directed enough to recognize that that hasn't addressed your needs and people are not they're still going to count that as a learning opportunity the problem comes as the fact that now they're trying to use G-P portfolios for revalidation and appraisal and the whole thing about portfolios is y-, that you should be as reflective as possible it's a personal development plan so you can write in there er i don't know how to examine eyes i'm a G-P and i don't know how to examine eyes so i'm going to go to clinic and learn how to examine eyes and then you can write in an ideal world i went to clinic and i learned nothing about examining eyes but the problem is people the personal development plan side of it is if someone else is looking in then people are going to stop being as personal and as reflective that's the worry er in educational terms it was always held by the student not looked at by anyone else unless the student was happy and if they wanted to give part of their personal development plan f-, for a tutor to look at that was fine but unfortunately in medicine that's been taken out of our hands so even though i say to you you can write one line and say it was useless or one line and say it was very good i think er that people are going to be a bit more wary about what they write in their personal development plans as time goes on nm0366: can i kind of echo that as well nf0362: mm nm0366: this this one has a a slight resonance for me 'cause at the moment i'm i'm doing postgrad study in namex teaching higher education and there is a portfolio issue around that what you've just said has an amazing resonance because for me i this is great 'cause it dovetails today nf0362: mm nm0366: er but for me i i want to be able to write down things these are the things i need to be thinking about and and meant to be able to refer back to at a later date nf0362: mm nm0366: but i have an awareness that part of the process with P-G serves er at namex is that that material then is is able to be looked at or should be looked at by the head of department nf0362: mm nm0366: so i'm saying to myself what areas er how much can i declare about my teaching practice nf0362: mm nm0366: in this thing knowing that the person who is paying my wages could look at it and go he's a crap teacher nf0362: yeah [laughter] nm0366: i mean the whole point about reflective practice i think is is to be able to se-, to be able to write down i did this today this didn't work as well as it might have done here is what i th-, here is nf0362: to do nm0366: how i think it might be improved nf0362: mm nm0366: but the implication is that you did it poorly in terms of an arbiter reading it at some later point so i'm sorry that's not a question nf0362: no not at all nm0366: it's just a reflection nf0362: er it's interesting because nm0365: nf0362: [laughter] as i say i think it's going to be a real problem [laugh] nm0366: how do you do that how do you that nf0367: you w-, so walked right into that though nm0366: i'm going to write that down now don't use bad jokes [laughter] when nf0367: [laughter] nm0366: yeah absolutely my mental one [laughter] 'cause i didn't say any of that mm never mind nm0360: can can i just say a big thank you t-, t-, er er er something i 'cause this is a personal research area of mine but i've learned an awful lot from it so i'm going to ask e-, namex to print a handout of her er Powerpoint slides for me 'cause i found it very helpful and i was thinking particularly of your first slide where you put in relation to Italy l-, Italy leaning tower when i first looked at it i wondered if it was a spelling mistake and should actually say learning tower nf0362: it was er namex said that this morning [laughter] so thank you for a super presentation and very interesting thank you very much contrary to what namex has just been saying we're not actually i believe i'm correct in saying we're not giving out certificates of attendance [laughter] er because ss: aah nm0360: it's in a sense it's not that type of [laughter] it's not that type of course of collecting collecting points and so on there's one person that i haven't thanked and has been so quiet and unobtrusive even though there are lots of cameras here has fallen into the background is is namex that w-, er i haven't mentioned because in a sense it's made today's meeting er an educational research project in itself so i'm very grateful for namex being here and i'm sure if anybody wants to recall the events of today when namex eventually produces a D-V-D of today it will be possible to reflect [laughter] on today will you be writing that in your portfolio [laughter] nm0360: i will be certainly thank you very much for everybody to coming and thank you for everybody that has contributed and prepared for today and as i say particularly for namex at the last minute doing her er presentation and again to namex for for everything that she's done today thank you and i the only thing is i gather as a collaborative initiative we've already collaborated in that i'm think my colleagues in namex are going to run the next one of these similar days so we'll be looking very much fo-, nm0366: all we have to do is persuade the head nm0360: that's right [laughter] we'll be looking coming to namex thank you