Registrar feedback on ‘Formative assessments in medical education’

I write in support of the article ‘Formative assessments in medical education’ by Dr Lakasing.1

I love my job as a GP registrar and look forward to qualification in a few months. Despite the contract wranglings, bad press, and the ever-increasing workload, I feel optimistic and enthused about the future.

I support most aspects of the ePortfolio process from the AKT and CSA exams to the Case-based Discussion and Consultation Observation Tool assessments. I think the patient satisfaction questionnaires and multisource feedback assessments are crucial aspects of good training, as these collate the views of the many people we are working respectively for and with.

I completely agree with Dr Lakasing about the negative impact of the requirement for writing huge volumes of reflective entries. I believe that potentially excellent GPs with the ability and energy to be involved in innovation and improvement within primary care are shackled by the need to endlessly document reflections in accordance with the curriculum. I also think that the quantity of trainee reflection must be hugely wearing for GP trainers and must put off good people from doing the job. Given the pending rise in need for GP trainers, as a profession we will need all the good people we can get.

Another problem with the ‘log entries’ is the variability of volume required across deaneries. In the London deanery, registrars do two entries per month. In Oxford, Kent, Surrey, and Sussex deaneries the recommended minimum is two per week. This creates inequity of training and I would suggest that the London deanery has nearer the right balance.

The recent Francis report identified the adverse consequences of box ticking on clinical care. I would suggest that excessive box ticking has the same negative impact on training. Coerced excessive written introspection erodes professionalism and motivation. It has the potential to encourage gaming and creative writing among trainees trying to keep up in a numbers game with their peers.

Compared to my friends in other specialities such as medicine, paediatrics, and psychiatry, I feel we GP registrars have a superior training programme and I am grateful for this. The majority of the ePortfolio is good at documenting a basic level of competence. With a sensible reduction in ‘log entry’ volume and a rethink on the content and purpose of the clinical supervisor’s report, the ePortfolio could be a fantastic aid to training. That said, what I really value in training is dedicated tutorial time with experienced GPs to talk through challenging cases and difficult scenarios. This apprenticeship-style learning and the passing on of the ‘art’ of medicine is invaluable and completely irreplaceable by the ePortfolio.

• © British Journal of General Practice 2013