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Trainee's portfolio 'used as evidence against them' in legal case

A trainee’s ‘written reflections’ on an incident in their training development portfolio was used against them in a legal case, which GP leaders have said illustrates the medico-legal ‘minefield’ that GPs are having to operate in.

Health Education England bosses in London and the South East have warned that a recent legal challenge saw a trainee release their reflections - a vital part of a trainee’s portfolio - which ‘was subsequently used against the trainee in court’.

But in a letter to postgraduate deans and training supervisors, HEE said trainees should continue to make particular note of cases where ‘things do not go well’.

It highlights that for trainees the reflection process is exactly the same as for GP appraisal, and that these should avoid patient-identifiable information and focus on the positive lessons learned.

GP leaders warned that GPs need to take all precautions to not incriminate themselves

The letter from HEE, which was shared by doctor and medical educator Dan Furmedge on Twitter, said: ‘Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court. This has resulted in questions about whether trainees should still provide reflection about incidents in their portfolios.

‘Health Education England in London and the South East is clear that all doctors have to provide written reflections for their ARCP and appraisal, and so doctors in training must continue to write reflections, especially when there are things that do not go well.’

GP trainers have said they are concerned this could have a knock-on impact on their relationship with trainees.

Dr Peter Holden, a former GPC negotiator and a GP in Derbyshire, said: ‘I do think some of our colleagues are a little naïve and should be taking legal advice before they do things. And the problem is there’s a whole generation of doctors whose training is incomplete, they’ve not been given enough medio-legal training to at least recognise a medico-legal minefield when they see it. 

‘When you get into legal territory, all is fair in love and war and your registration comes before the patient.’

Dr Kamal Sidhu, a GP and trainer in East Durham, told Pulse the move was ‘unprecedented though not surprising’ because appraisal evidence is already used by regulators when investigating GPs.

He added: ‘It is bound to create discomfort for trainees and will potentially limit uninhibited and free reflection, which is vital for learning at this stage. On the other hand, evidence of learning from significant events can also demonstrate that the lessons have been learned.

‘It then befalls on a robust trainee-trainer relationship to have free discussions on significant events without being worried about legal implications.

‘We all make mistakes and an opportunity to be able to reflect and learn will only make us better doctors. I think the regulatory bodies too, have a duty to look at such reflections in the context.’

GPC executive member Dr Dean Marshall said: ‘This is very concerning and I would encourage all doctors to consider exactly what they commit to paper and who might subsequently have access to what is written.

’It’s sad that this is likely to result in less reflection by doctors but if we can’t expect confidentiality then we need to act accordingly.’

A Health Education England spokeperson said: ‘The purpose of the letter is to provide guidance and clarity on what trainees need to be aware of when preparing their reflective notes.’

Readers' comments (56)

  • OMG
    When is this going to end?

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  • The art is to self flagilate oneself just a little bit to avoid suspicion. Reflect on that time you were running 10minutes late and the patient was a bit annoyed. You laid down on the floor, kissed the patient's feet until they grudingly accepted your apology.

    Big Brother is not a game show.

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  • And what if the dr writes that the patients was abusive and lied through their teeth? Would that be included? Probably not

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  • I honestly cannot wait to retire.

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  • this really encourages honest reflection doesn't it?! will be encouraging my trainees to just play the game, keep your head below the radar if you wish to even bother with general practice!

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  • I was going to do a log entry reflecting on this event and the implications it will have on the honesty of trainees' log entries in the future, but I felt that doing such a log entry could be held against me.

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  • You are quite right to point out that what is written can and will be held against you.
    Having described a concern about a colleague with the intention of asking for help and advice, I was told that my appraisal would not be signed off until I had reported my concerns to the medical director and that, if I did not, I would be reported to the GMC for investigation myself.
    The result was catastrophic for all concerned and I am lucky that I did not act on my suicidal thoughts. I received no support whatsoever and have now retired early. I did nothing whatsoever wrong. I would advise all trainees to be incredibly careful about what they write.
    In fact, just don't!

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  • Cannot wait to leave.

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  • This really encourages honest reflectivity, doesn't it?

    All it means is that we now have to game our portfolios as well, just to be safe.

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  • 10:07 you have it exactly right.

    HEE say we "must continue to write reflections, especially when there are things that do not go well." True reflection in the name of learning has to be honest self-interrogation with admissions of mistakes, which are a natural part of our job, but that is GOING to be self-incriminating, and if no-one will help us keep that confidential or protect us from that developmental process being used to hang us, then why the f*^k should we do it?

    Keep the portfolio as a friendly pastiche that HEE will like and that can't be used against us, keep true reflection to ourselves.

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  • AND "THEY" keep telling us that we should have a safety culture like aviation. Yes in aviation the reflection would be there and it would be publicised in anonymous form AND THERE IS NO RETRIBUTION against the aircrew for letting others learn by their frank openness
    DoI Medical Aircrew Lincs. & Notts. Air Ambulance

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  • Triple-jeopardy-fuster-cluck.Another thing to stop doing.

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  • I wonder if patients are aware how much information we write about them in places other than their medical notes? It's very different to Grand Rounds where patients stories are just a preamble for more discussion on the technical aspects of medicine. E-portfolios are surely an epic data scandal waiting to happen should The Mail et al find out what is going on. We don't take consent to log case notes and I expect some patients would be horrified if they realised their most personal information was being used outside the consultation. Digital data has a habit of persisting and is easily copied. I very much doubt all these e-portfolios have banking level security; we have already seen examples of government records going astray with embarrassing and potentially serious consequences. It seems likely that there will be a major breach of the Data Protection Act at some point in the future so perhaps now is time to reconsider the whole portfolio thing and keep patients records in the notes?

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  • Surely, it all depends, doctors, whether you consider THE TRUTH is more important or YOU !

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  • What a mess we have slept walked in to!! The academic GP's encourage openness, reflection and recording to aid learning and now it is being used by lawyers. What are the RCGP lawyers advising now??? The witch hunt after Shipman has destroyed the profession as everyone is guilty till proved otherwise and if it was not recorded it didn't happen. Damned if you do damned if you don't. As a trainer it is impossible to sign up a trainee unless it can be demonstrated they are improving and learning from their mistakes or educational needs. If those deficiencies can now be used in court who is going to record them?? The RCGP and GMC must advise us. My Registrar has just gone pale and asked should he review all his records?

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  • I do not need to write something down in order to reflect on my actions.
    This changes very little. I will continue to reflect appropriately and professionally on significant events. My eportfolio, however, will continue to be pleasantly waffy about minor events

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  • 1) Hands up who is at all surprised by this? Self reflection is good and honest and positive - but should be done safely and in my view that means internally. Don't share your deepest fears with the guy who can sign your death warrant (appraisers and the like)

    2) @June Greaves - go troll somewhere else. Your opinion is worthless.

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  • My last (ever) appraiser told me that I hadn't reflected enough and started making things up on my behalf. His suggestions were completely insane but his heart was in the right place.
    I've heard he's not appraising any more.

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  • It would encourage you only to reflect on unimportant things in an appraisal ( How confidential are they anyway?)

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  • This is why I always write anonymous posts!

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