Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland

Abstract

Introduction: Reflective practice has become the cornerstone of continuing professional development for doctors, with the expectation that it helps to develop and sustain the workforce for patient benefit. Annual appraisal is mandatory for all practising doctors in the UK as part of medical revalidation. Doctors submit a portfolio of supporting information forming the basis of their appraisal discussion where reflection on the information is mandated and evaluated by a colleague, acting as an appraiser. Methods: Using an in-depth case study approach, eighteen online portfolios in Scotland were examined with a template developed to record the types of supporting information submitted and how far these showed reflection and/or changes to practice. Data from semi-structured interviews with the doctors (n=17) and their appraisers (n=9) were used to contextualise and broaden our understanding of the portfolios. Results: Portfolios generally showed little written reflection and most doctors were unenthusiastic about documenting reflective practice. Appraisals provided a forum for 2 2 verbal reflection, which was often detailed in the appraisal summary. Portfolio examples showed that reflecting on continued professional development, audits, significant events and colleague multi-source feedback were all felt to be useful. Reflecting on patient feedback was seen as less valuable because feedback tended to be uncritical. Conclusion: The written reflection element of educational portfolios needs to be carefully considered, since it is clear that many doctors do not find it a helpful exercise. Instead, using the portfolio to record topics covered by a reflective discussion with a facilitator would not only prove more amenable to many doctors, but would also allay fears of documentary evidence being used in litigation.

Evidence-guided approach to portfolio-guided teaching and assessing communications, ethics and professionalism for medical students and physicians: a systematic scoping review

“… 78 81–83 CEP portfolios in the postgraduate setting have also been used for revalidation purposes. 81 …”

Doctors' attitudes to maintenance of professional competence: A scoping review

“…Although some were positive, 26,48,49,60,62,65,68,70,76,78,90–100 several sources of evidence reported significant anger, frustration and negativity 21,47,66,67,82,83,88,101–105 . Attitudes of dissatisfaction were present across multiple specialties, scopes of practice and jurisdictions, with doctors describing MPC as a bureaucratic tick‐box exercise, serving little practical purpose 20,25,26,40,47–49,51,54,60,66,72,105–108 . Doctors with a role in implementing MPC were more likely to have a favourable view about the process than the doctors on whom the process was imposed 53,71,74,76,78,94,97,109 .…”

“…Doctors valued some aspects of the process more than others, in particular those that were formative and developmental. They reported positive experiences with and a preference for activities such as self‐assessment, 58,64,68,76,121,128,135–138 significant event analysis 25,54,108,115,126,139,140 and personal development plans 70,73,95,97,109 . Methods for keeping medical knowledge up to date, 86,141 multisource feedback, 108,130,142,143 formative feedback, 62,84 portfolios 75 and self‐directed learning activities 60,116,124,144 were all valued formative experiences.…”

“…A few studies, however, did find that doctors perceived value from participation in quality improvement activities 80,92,114,122,123,148,149 . Written reflections and patient feedback, although developmental, were two further elements of MPC that doctors did not appreciate 25,91,105,106,108,130,145,146,150,151 . Doctors questioned the reliability of patient feedback tools used in MPC to accurately reflect a doctor's performance and identified barriers to the process of collecting patient feedback 44,51,108,115,130,145,146,150,151 …”

“…Doctors who were near the end of their career who had limited access to clinical practice, locum doctors, doctors who frequently moved between health care organisations, working part‐time or were working in a different jurisdiction, because of their individual circumstances, required additional support in meeting the requirements of MPC 39,41,48,49,60,62,96,110,115,146,159,161–163 . Some thought MPC was complex, desired simplification of the process and lacked a proper understanding of MPC requirements, logistics of evidence collection and the standard of evidence required 47,62,68,94,103,108,115,119,120,127,142,146,147,151,159 …”