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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)

  • This is a truly sad situation. I entered GP in 1987, and during 1990, Kenneth Clarke accused GPs of feeling the thickness of their wallets,after dissenting about proposed changes. and things deteriorated after that, and exponentially in the last few years.
    It seems that GP is heading for complete disaster. Please younger GPs do something and fight back before it is too late. I retired 18 months ago as I could not stand the nonsense we were being forced to do, but I still miss doing the proper Doctoring stuff.

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  • Really shocking and quite frightening..

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  • Reflection is bulshit. Bullshitsrs are good to reflection. To do well in UK you need to learn to bullshit well.

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  • Do not submit any thing before getting it OKed by your defence Union.

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  • Genuine admission of mistakes, reflection and a written account of learning from mistakes was introduced to trainee doctors only after Harold Shipman's horrendous revelation of his crime. The claim that documentation of mistakes on the eportfolio is to help trainees to improve and avoid future similar mistakes is really 'wolf in sheep's clothing'. The real purpose behind this is the possession of a legal document of trainees' self admission of their weakness and personal character which facilitates future successful litigation against the trainee if a case is ever brought to a law court. The GMC had learned from their mistakes when they had no legal document portraying Harold Shipman's character during the trial. I begin to wonder.

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  • 7:17 otherwise how can the GMC answer the question why the trainees' mistakes should be documented on an eportfolio which is open to scrutiny by anyone rather than documented on the trainees' own note books for presentation to their trainers.

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  • Isn't revealing any flaws one of the main features behind some religious cults, like the one John Travolta and Tom Cruise are members of, to keep people subdued and fully signed up continually?
    Don't people have to tell all their life secrets and mistakes or something at the beginning?
    This would accidently on purpose make perfect blackmail material in the future if they ever wavered in loyalty and wanted to leave.

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  • Makes me want to vomit. It is as if the bastards are out to get you from every possible angle. You are dammed if you do and damned if you don't. cant't wait to get out of crap.

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  • few suggestions for significant events to admit to, apologise for, and reflect upon:

    1) patient receives letter from practice with flap not properly gummed down
    2)patient upset by music in waiting room
    3) patient upset by door slamming loudly in surgery
    4) patients upset by smelly person in waiting room
    5) missed diagnosis mistook lipoma for sebaceous cyst
    6) reverse of 5)
    I have lots more, stick with this style and puff them out with plenty reflection: how it made you feel, what you've learned about yourself, gratuitous apologising, learning activities, present powerpoint of findings at practice meeting etc

    This is the game

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  • PS 1:37

    If GMC/CQC watching, these SEA's NOT from my own appraisal of course, but presented by colleagues

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