Personal Professional Development The Portfolio Dr AnneMarie Feeley

Personal & Professional Development The Portfolio Dr. Anne-Marie Feeley

Are you ready? A. Yes B. No

When will you first see patients? A. In a few weeks B. In a few months C. Next year

When will you have your final medical school exam? A. B. C. D. In 3 years In 3. 5 years In 4. 5 years

Which of these titles best describes you today? A. Medical students B. Trainee doctors C. Tomorrow’s Doctors

Your curriculum: Tomorrow’s Doctors

• Personal & Professional Development (PPD) • Portfolio

Portfolio Reflection Wellbeing PPD Teamwork Feedback Learning & Teaching

Personal & Professional Dev. sessions Induction Learning Wellbeing Reflection 1 Learning 2 Reflection 3. Teamwork 4. Org. skills 5 PPD group sessions are on last Thursday of induction week and blocks 2 -5

Portfolio Reflection Wellbeing PPD Teamwork Feedback Learning

Reflection • It’s not a ‘thing’, it’s a process • It’s a way of thinking about what you are doing, so you learn quicker and better • It is not optional (for doctors) • It is not necessarily easy (at first)

Reflection is like…. • It’s not something you can learn about in a lecture • Observation of others can be helpful • Ultimately, you have to practice • You can have a natural talent for it • (or not) • Even as a non-expert, it’s quite easy judge between ‘satisfactory’ and ‘unsatisfactory’ examples

Factors that suggest a ‘satisfactory’ score • • Topic chosen is relevant No other person identifiable Genuine effort made to reflect Language used is professional • • • Even better if…: Reflection is personal Other perspectives are taken into account Action plan is specific Learning is related to future career

First, an example

Situation • • • Deliberate self-harm is common 1% suicide risk amongst those who self-harm Well-known risk indicators for high suicide risk Proposal: All self-harmers fill out a ‘tick box’ form prior to assessment in A&E on suicide risk

Should A&E introduce a new risk assessment form for suicide? A. Seems like a good idea B. Not a good idea

If you were suicidal, would it help you to be put into a room alone to tick boxes about your suicide risk? A. Yes, sounds therapeutic B. No, would not be therapeutic for me

Reflecting as a trainee doctor • What should junior doctors think about? • What are the factors that make a good reflection from a trainee doctor? • What do you need to think about, if you are to become a better doctor?

Reflection is …. • It’s not something you can learn about in a lecture • Ultimately, you have to practice • You can have a natural talent for it • (or not) • Even as a non-expert, it’s quite easy judge between ‘satisfactory’ and ‘unsatisfactory’ examples • Observation of others can be helpful

A reflection on acute brain failure T S E N I F Y M T IN OL’ O R ‘N HOU CHO S L A DIC y E e l M ee F AM. r D

How I ended up with this in my final medical exams • Surgery: Honours • Medicine: Honours • Obstetrics & Gynaecology: Pass

Reflection template • • • Situation/ Context What did I feel? What did I think? How were others affected? What did I learn? What can I take away from this?

Situation • Obstetrics & Gynaecology course: excellent course • Honours oral: 100% certain • Prof O’Herlihy: ‘no student has ever scored lower than 80/200 in this exam’ • First ever oral exam for me • How did I feel? • Fine

And then I saw this…. _________________ __Anne-Marie Feeley________ __Eileen Fitzmorris_________________ 26______ 27_______

_________________Anne-Marie Feeley____26______ ___Eileen Fitzmorris______27_________________ • What did I feel? • Nothing (shock) • What did I think? • I have done worse than anyone ever in the history of this course • Eileen has done really badly as well (but not as bad as me) • What did I do? • I went into the interview room

In the interview room • • I sat down They asked me questions I said nothing I left

The Yerkes Dodson Curve Versus AROUSAL

• Diagnosis: • Brain failure

Do you think that this could have happened to you? A. Yes B. No

WHY? ? Why ME? ? ?

So, why me? • Never reached my limit before, so understandable that I didn’t see it coming. • Feeling observed and judged is my most hated thing. • ACTION PLAN: Recognise that this kind of situation is horrible for me: practice more.

End of reflection. So, what do you think? A. Satisfactory? B. Unsatisfactory?

Factors that suggest a ‘satisfactory’ score • Some adherence to basic technique • Must put yourself into it – (not just ‘go through the motions’) – Relevant topic

• Strengths? • Areas for development?

On mature reflection…why me… • • Reflection template Situation/ Context What did I feel? What did I think? How were others affected? What did I learn? What can I take away from this?

Any part of the reflection template I didn’t really address? A. B. C. D. E. Situation Feelings Thoughts Effect on others Learning

On mature reflection…why me…. Effect on others? None! I hadn’t involved anyone! • I had never had an oral before: why didn’t I practice? Why didn’t I ask for advice from others? • Without even realising it, I expect myself to be able to do things without help • I expect to be somehow ‘naturally excellent’ • If I ask for help, I must be failing in some way

What can I take from this? • • • I can ask for help I should ask for help ACTION PLAN: Identify when I’m doing something new Get help early rather than late OLD THOUGHT: I should be excellent at everything NEW THOUGHT: I am not (and never will be) excellent at everything

Reflection on my reflection • Topic: is it relevant to me and my development as a doctor? • Action plan: is it realistic? Does it give me clear actions to follow? Will it be useful?

• 40 minutes later, I realised my mistake… • 3 days later, I went to the professor to explain myself

What would you say to me if you were the professor? A. ‘You can have your honour grade’ B. ‘We’ll organise a further oral exam for you’ C. ‘I’m afraid there is nothing we can do’

Useful things I have learned about reflection • You can reflect on things BEFORE they happen, that makes it even better during and after. • Sharing your thoughts with someone else makes it better. • You get better at it over time. • It’s mainly useful if the thing you’re reflecting on is ACTUALLY IMPORTANT to you. • Don’t be constrained by the reflection forms

Models of Reflection • Gibbs’ model • Rolfe’s model • There are others -What -So What -Now What Rolfe 2001

Your first reflection • Choose a topic that is important to your medical training • Take a blank page • Choose a reflection form (or take a few!)

Reflection and your progression through medical school • Students need to earn the right to sit the end of year exams. • Several elements: – Engagement with your own development: 3 Reflections • You’ll have loads of reflections • You need to submit evidence of three • Discussed with someone else, and ‘signed off’

How to submit an unsatisfactory reflection • The vast majority should be SATISFACTORY • Unsatisfactory: – Didn’t do it – Unprofessional language: • • Situation: Getting VERY ANNOYED in group work ‘Jessica is a %$&*’ x no ‘I feel that X is really annoying’ x no ‘I was interrupted 3 times today during group work by the same person: I felt very annoyed’ yes

Peer review checklist: Signing off a reflection for a colleague • Theme of Reflection: • Checklist for student and peer reviewer: • The theme of the reflection is broadly relevant to medical training/personal & professional development • No other person is identifiable in the reflection • Language is professional and appropriate for submission • A genuine attempt has been made to think about the identified issue • We declare that this reflection has been discussed and deemed to be suitable for submission as one of three required reflections during year one.

Portfolio Reflection Wellbeing PPD Teamwork Feedback Learning

Wellbeing

Wellbeing • Absence of illness? • Presence of life satisfaction, morale, resilience, happy times, etc?

We know a lot about the factors that affect wellbeing Personal: *Relationships *Learning and development *Healthy living (diet, physical activity, sleep, mindfulness/relaxation, etc. ) *Creative activities (art, music, writing, etc. ) *General Health *Spiritual wellbeing *Emotional intelligence (the ability to identify your own emotions and those of others, and respond to them appropriately Community/Structure of daily life: *Social networks and social support *Financial security/debt *Green spaces and the physical environment *Work/life balance *Participation in your community, volunteering, helping others *Feeling safe physically and emotionally.

Wellbeing Friends Family Meaning, engagement Nature

Mindfulness

Wellbeing (& mindfulness) • More this Thursday…. • …And during the year

Portfolio Reflection Wellbeing PPD Teamwork Feedback Learning

Teamwork • It is vital, vital

What do our newly qualified doctors say at the end of their first year? • Very intimidated initially but I grew in confidence • No way to know if I was right or managed them ok; need feedback • It is tough! • You rarely have a full clinical team around you but make good use of them whilst there – rounds, supervision / teaching of tricky procedures / tasks, coffee • Good handover; give & demand!! • Always make it clear to everyone that you are an Fy 1 so they know you will need a bit more help e. g. than CT 1 s • Have a good chat to your educational supervisor early in the post & at regular intervals (at LEAST 3 times in the post for appraisals). Tell them about areas where you lack confidence

Teamworking • More in Block 2 • …And every group session you do (starting today)

Portfolio Reflection Wellbeing PPD Teamwork Feedback Learning

How well do you hope to do in your end of year one exams? A. B. C. D. E. Come first Come near the top Comfortable pass Scrape a pass Hope I don’t fail

95% of students want to pass comfortably 51% want to be at/near the top 2013 cohort, week 1 42% 45% 40% 35% 30% 25% 20% 15% 9% 10% 4% 0% 5% 0% Come First Come Near the Top Comfortable Scrape a pass Hope I don't Pass Fail

The questions students ask… How much depth do we need to go into? What is on the exam paper? Do we seriously need to know this?

…And the answers What is on the exam paper? How much depth do we need to go into? Know the exam Learning the stuff that is EXAM-RELEVANT CLINICALLY IMPORTANT Do we seriously need to know this? Change this to: WHY might we need to know this? HOW might it be useful to us?

Learning to Learn • More this week, and block 1…and formatives…and practice osces…

Portfolio Reflection Wellbeing PPD Teamwork Feedback Learning

Feedback • Giving and receiving constructive feedback is a very important skill • Students love feedback • Ask for it • Beg for it • Don’t be shy!

My wish for you all • That you have a fantastic time • That you take care of each other and yourselves • That you keep good people around you who will help you think when your thinking has stopped

Summary • This is me: Anne-Marie • A-m. feeley@warwick. ac. uk

How many reflections do you need to submit in year 1? A. B. C. D. E. 1 2 3 4 5

What does PPD stand for? A. Personal and Professional Development B. Practical and Professional Development C. Protracted and Prolonged Development

What did I say is ‘vital’? A. B. C. D. E. Wellbeing Reflections Teamwork Learning to learn Feedback

You should expect your tutors to be better at reflecting than you are A. Yes, absolutely B. No, not necessarily

Are you excited to be here? A. Yes! B. Hmm, not sure C. No!