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Should I be careful what I put in my trainee portfolio?

A trainee GP’s portfolio is an important part of their professional development. It is used as a tool for training, learning and reflection. Crucially, it allows trainees to openly and honestly record reflections on incidents that occur. It was therefore worrying to see reports that a trainee, who released their reflections to a legal agency on request, saw it used as evidence against them in a legal case.  While the case in question is disconcerting, we must bear in mind that the written reflection is likely to have formed only part of the evidence in the claim. By itself, it probably would not be enough to cause a claim to be successful. 

Who can see my portfolio?

The portfolio belongs to the trainee; however key parts of it are available to others through a permission system. The trainee’s appraiser, deanery, trainer and potentially a responsible officer could all see the portfolio.

Is it better to avoid recording incidents in the portfolio?

As with any reporting system, if an incident recorded in the portfolio caused considerable concern, for example demonstrating a serious risk to patient safety or to the public confidence in the profession, it may lead to an investigation by NHS England and/or the Deanery. But if such a case came to light, but it had not been recorded in a training portfolio or GP appraisal, this may raise questions about the practitioner’s probity, which in my experience is usually far more concerning to regulatory bodies than the index event. Trainees should also be aware of their duty of candour.

GP trainees should use the portfolio to reflect on any learning opportunities that present during training, and this includes reports of when adverse incidents occur. Medical Protection promotes openness and transparency, and this is also expected of all medical practitioners by the GMC.

How can I avoid my portfolio being used against me?

While having the contents of a portfolio used against a trainee in a legal case is exceptional rather than the rule, measures can still be taken to reduce the risk of it occurring.

Clarity about precisely how the information captured in portfolios sits with the GMC’s general guidance is certainly needed. The GMC’s Confidentiality guidance states: ‘The use of information about patients is essential to the education and training of medical and other healthcare students and trainees. For most of these uses, anonymised information will be sufficient and should be used whenever practicable.’

Therefore, when making any entries in the portfolio, the trainee should take steps to ensure that all records are anonymised. While the contents of a portfolio could be used as evidence in a legal case in theory, this would only be admissible if the entry identified a patient.

If a trainee is asked to provide the contents of their portfolio as part of an investigation or case, before releasing any information they should seek clarification from their medical defence organisation as to the amount of detail they are obliged to pass on.

What about trained GPs?

Reflection is not only vital for the development and learning of trainee GPs, but also for GPs undergoing appraisal, and the case referenced above should not deter either from recording cases where reflection and learning has occurred in an anonymised fashion. While there have been instances where appraisal evidence has been used by regulators investigating GPs, this is actually to the benefit of doctors and allows them to demonstrate insight.

Dr Zaid Al-Najjar is a medicolegal adviser at Medical Protection and a GP in London