Common FourteenFish portfolio challenges encountered by GP trainees

We cover the common GP trainee portfolio challenges and how you can avoid them. Learn from our experiences of working with GP trainees! GP trainees often struggle with reflecting. This isn’t because reflecting is difficult; it generally comes down to inefficient use of the GP trainee portfolio.

The FourteenFish GP trainee portfolio is among the most intuitive and easy-to-use portals I’ve encountered! If you’re slightly ancient like me, you would have had the pleasure of using the old RCGP GP trainee portfolio, which was nightmarish! 

Although the user interface has improved, there are a number of common pitfalls and challenges that remain! We will cover the common FourteenFish GP trainee portfolio challenges encountered by GP trainees and how to avoid them!

We formally started our GP trainee portfolio support package in May 2023, but we’ve been unofficially helping GP trainees with their portfolios since June 2021. Everything from within this blog directly results from our one-to-one trainee contact.

 

What should I reflect on?

 

GP trainees often struggle with reflecting. This isn’t because reflecting is difficult; it generally comes down to inefficient use of the GP trainee portfolio. 

In our experience, GP trainees often search for the “perfect case” to reflect on. The search for perfection isn’t necessary. If anything, it just increases apprehension!

 

“Reflecting is very similar to driving a car.”

Think about the last journey you made. How many of your driving decision can you recall?

Do you remember why you chose to change lanes? Or maybe why you decided to slow down? Generally speaking, it’s a subconscious experience, and it’s hard to pinpoint and write down every decision. Similarly, in our clinical practice, we are continually making decisions. 

 

Don’t look for the perfect case. Let the case come to you!

 

I can guarantee that you will think about patients during your non-working hours. As a GP, I often think about two-three patients per day, which is around 10% of my patient list. Often it’s a negative experience; unreasonable demands, a knowledge gap, worrying about my documentation, struggling with uncertainty and questioning my management choices. At other times positive experiences such as; patient feedback, compliments, correct diagnosis and good patient outcomes are also helpful.

To reflect efficiently, you should learn by observing and analysing such thoughts. These cases can form great reflections if you figure out why they’re on your mind. 

 

For example, let’s say you have a patient with unexplained headaches that bothers you. What’s your trigger?

  • Are you bothered by my lack of differentials for this patient’s symptoms?
  • Are you bothered that you’ve failed to discover the patient’s ideas, concerns and expectations?
  • Are you bothered that you’ve not managed the patient correctly?
  • Are you bothered that you’ve not communicated well with the patient?
  • Are you bothered that the case took thirty minutes, whereas you should consult in fifteen?

 

Similarly, you can switch them to a positive statement; are you happy with your range of differentials?

 

We cover reflection in detail in our free guide – A guide to help you with the GP trainee portfolio. Reflecting as a GP trainee.

We also cover several examples of reflection within our FourteenFish GP trainee portfolio support package!

 

How do I link to X capability?

 

If you’ve read our introductory portfolio blog – What is the FourteenFish GP trainee portfolio? or if you’re an experienced GP trainee, you will be well aware of thirteen curriculum capabilities.

In preparation for your bi-annual educational supervisor review (ESR), you must demonstrate evidence of progression under each capability.

Linking to a capability simply means justifying how your actions and approach have demonstrated the selected capability. You should aim to do this in every learning log you complete.

Early in your training, it is likely that your educational supervisor disagrees with your chosen capabilities. This can be quite frustrating, as it means finding alternative and additional cases to justify the capability.

 

Capability linking is like a driving test. Make it really obvious before you Mirror, Signal and Manoeuvre. 

 

There is a tried and tested way to achieve this in your FourteenFish GP trainee portfolio. We share this alongside seventy-eight examples of capability justifications across the thirteen curriculum capabilities in our GP trainee portfolio support package.

 

Preparing for your Educational Supervisors Review (ESR)

 

As part of each Educational Supervisors Review (ESR), you and your educational supervisor will rate your progress on each of the 13 capabilities. Each capability is rated as one of the following:

  • Needs further development (NFD) – below expectations
  • NFD – meets expectations
  • NFD – above expectations
  • Competent for licensing
  • Excellent 

 

This is a tedious task. 

During your ESR preparation, you will be asked to submit specific cases under each capability and then write a further justification for how these cases have demonstrated progress. All too often, trainees fail to prepare for the ESR at the time of writing their learning logs. If you’re ahead of the game, you can prepare for your ESR and pre-write the justifications while writing your learning logs.

In our FourteenFish GP trainee portfolio support package, we use our capability justifications to demonstrate this point further. Additionally, we cover how to self-rate in preparation for your ESR.

 

The burden of mandatory training

 

Mandatory training follows you from the moment you qualify as a doctor to retirement, and there’s no escaping it during your GP training. The FourteenFish compliance passport can help keep you on track, but it’s essential to keep an eye out for the mandatory evidence requirements for the end of the training year from the RCGP.

Having your three-yearly safeguarding certificate isn’t enough for your GP trainee portfolio. You need an annual knowledge update and reflective log entry, which can easily catch GP trainees out! 

 

Issues with your Annual Review of Competency Progression (ARCP)

 

The evidence you collect in your FourteenFish GP trainee portfolio is reviewed at least every 12 months in the Annual Review of Competence Progression (ARCP).

Early in your GP training, the ARCP panel will judge your progress against the competencies and whether they are ready to move on to the next stage of training.

In your final ARCP panel, they provide a final statement that forms the basis for recommending satisfactory training completion.

 

You’ll be incredibly lucky to sail through every ARCP without a hiccup! Our best advice for your ARCP is to keep a close eye on your deanery emails, as they will often send reminders for your form R and covid declarations.

One mistake I made was completing my form R too early, and this led to an early morning phone call post nights from the ARCP panel, asking me to resubmit the form within twenty-four hours.

 

We hope that you’ve found this blog helpful! Please share it with your fellow GP training colleagues, and if you’re looking for additional GP portfolio support, check out our FourteenFish GP trainee portfolio support package by clicking here!

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