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INSTRUCTIONS: Use this template to write your log entry. Trust me… it will help focus your learning log and as a result you will write it in half the time with greater reflection and deeper learning. Then simply cut & paste into the ePortfolio. Your supervisors will be impressed with your entries. Write a BRIEF introduction. 2 mins, 2 lines max.QUICKLY go through the 13 PCs below to determine which you want to write about. “Is this capability relevant and something I want to write about?”. Yes keep. No delete. 5 secs max on each.Write in DETAIL about the PCs selected. Write over the grey italicised guiding text. One and only rule: Don’t make something out of nothing; don’t try and make something fit.Remember the ISCE criteria for a good reflective write upI (Information) – provide enough description & detail about the event - but keep it brief.S (Self-Awareness) – if appropriate, include any emotions or feelings you were experiencing at the time.C (Critical Analysis) – analyse what happened: good things, bad things, could be better things.E (Evaluation) – what have you learnt? What will you do differently in the future?If ISCE is too hard, try this alternative… for each capability write at 2 levels…The ground floor level: write about exactly what you did (=Information)Example (consultation skills): “I explained to the patient that I was going to start him on thiazide diuretic and why we were adding this new medication on top of the other two that he is already on. I also explained about he may end up passing more urine – so take it during the day”The bird’s eye level: write about the intelligence behind what you did or should have done (= Critical Analysis / Evaluation)i.e. a statement derived from what you did specifically from this case that can be generalised to other patients. Or put another way, what “key messages” would you give to (say) a bunch of medical students who you were told to teach about this case?Example (on the above) “I explained things to the patient about his medication because I wanted him to be involved and to tell me if he had any problems. I explained the rationale behind starting a thiazide because the research says compliance is better with a shared understanding”‘Cut and Paste’ timeCut and paste the brief description into the 1st box of the eP (has a red asterisk)Cut and paste the all of the Capabilities section into the 2nd box with a red asterisk.Other boxes without an asterisk can be left blank (you do not have to fill in every box!). BRIEF INTRODUCTIONWrite over this italicised text. Introduction should be maximum 2 sentences. Do not spend long on this.PICK SEVERAL CAPABILITIES FROM THE LIST BELOWWrite about each. Write over the italicised guiding text. Remember to provide enough specific detail.CONSULTATION SKILLSDetail specific consultation skills you used like verbal, non-verbal cues, exploring ICE, PSO, explanations, signposting, using space and time etc. Give examples. PRACTISING HOLISTICALLYHow is the presenting complaint affecting them in their home, work and social life? Explore Psycho-Social-Occupational (PSO). Nearly all complaints have a PSO component. DATA GATHERING & INTERPRETATION Write about what bits of the history were important that you gathered. What red flags? What examination did you make? Detail findings of examinations/investigations/scoring systems. MAKING DIAGNOSIS & DECISIONSFirstly, this is not just about diagnoses. It is about decision-making (making a diagnosis is in fact a decision!). So, write about all your clinical AND non-clinical decision making. Write not ONLY about the decision you made but why and how you made that decision. Was it made in collaboration with the patient or relatives? Did you use any decision aids like NICE guidance, local pathways, other pathways, scoring tools. FEVERPAIN, NEWS, Wells etc. Use any help from other doctors – in the practice, specialists?CLINICAL MANAGEMENT?Detail exactly what clinical management you put in place. Put in the specifics.MANAGING MEDICAL COMPLEXITY & PROMOTING HEALTH?Note: this is not just about Medical Complexity – there’s Promoting Health too. Medical Complexity – did you have to manage lots of chronic things on top of the acute problem? Please don’t think that dealing with three simple things is Managing Complexity – IT IS NOT and if you write about them as if it was, it shows you don’t understand what Medical Complexity means and then that makes you look bad. Other things in Medical Complexity – talking about uncertainty, explaining risk. Promoting Health – opportunistic health promotion – smoking, alcohol, diet, exercise. For example, a patient who comes in with Carpal Tunnel Syndrome but you notice their HBA1C is in the Prediabetic range. Other examples - trying to reduce polypharmacy, unnecessary ANISATION, INFORMATION MANAGEMENT & LEADERSHIP Leadership skills – did you take charge of this particular patient and co-ordinate all the different people involved in their care? What did you exactly do? Information Management – in what way did you use the computer to augment the GP consultation? Organisation – did you do anything to improve clinical care at a systems level e.g. changing/implementing a new protocol? (if yes, write about the management of change).WORKING WITH COLLEAGUES/TEAMS?Did you work with any colleagues? Who did you involve? Why did you involve them? How did they help? If referring to hospital, what did you communicate via telephone and what did you communicate in your referral letter. eg SBAR (Situation, Background, Assessment, Recommendation). COMMUNITY ORIENTATION?Did you do anything as a result of the care of this individual patient to make the care of other patients with a similar condition better? For example, you might have heard the latest that drug x is contraindicated in patients with condition y. So, you sort out this particular patient but then you suggest to the in-house pharmacist to do an audit of all patients with condition y who are on drug x. Note: this does NOT mean you have to do a project. MAINTAINING PERFORMANCE, LEARNING & TEACHING?What did you look up and learn? Any e-modules you took up as a result? What things will you try and remember in the future for your clinical practice. Write about the big things that matter. Doesn’t have to be clinical. Could be a communication thing, an ethical thing or something else. What has transformed your way of thinking?ETHICAL APPROACHIf you are going to write about this, then you must show you understand your ethical principles. Don’t just write “I did this to help the patient” or “for the benefit of patient care”. Instead write in terms of one or more of the following: 1. Patient Autonomy, 2 Beneficience, 3 Non-Maleficience, 4. Justice (or Fairness), 5. The Principle of Utility (=greatest good for the greatest number), 6. Right’s based practice, 7. Aristotle’s principles around Morality (= doing the right thing), 8. Consent 9. Confidentiality, 10 Respect for Diversity. Every consultation and patient encounter has ethics in it if you look hard enough.FITNESS TO PRACTISE?Be honest and write about YOUR OWN fitness to practice. ARCP panels love reading about trainee’s honest inner feelings about things. The doctor who is true to themselves, open and honest is the doctor who will do well in General Practice. And therefore that means being open and honest about your faults. So, talk about things that affected your performance – home things, tiredness, juggling work-life balance, running behind on surgeries, and so on. BUT this section is also about identifying Fitness to Practise issues in your colleagues and your duty to raise them and support your colleagues. So, do you think a colleague made a mistake? Did you gently raise it with them? Or are you worried about a colleague? What did you do about it? Fitness to Practise is all about being true and honest with ourselves and others because it helps build our resilience. Otherwise patients, staff, our colleagues and ourselves all suffer. It brings about positive change if we embrace it. CLINICAL EXAMINATION & PROCEDURAL SKILLS Detail exactly what you did and what the findings were. Don’t write “Chest normal”. Instead something like “SOB at rest: RR= 32/min, using accessory muscles, SaO2= 97%, Ausc BS vesicular creps L base Percussion: L basal effusion”. ................
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