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Starting Your Surgical Career: Maximising your portfolio as a Foundation Trainee
National Surgical Teaching Society
Overview
This video provides a comprehensive guide for foundation trainees aiming to maximize their portfolio for a surgical career. It covers essential components of the Horus portfolio system, including core procedures, supervised learning events (mini-CEX, DOPS, CBDs), reflections, and the Team Assessment of Behaviour (TAB). The speaker emphasizes the importance of starting early, seeking opportunities in surgery, and actively engaging with the portfolio requirements. It also touches upon financial protection for junior doctors and the significance of audits and quality improvement projects in demonstrating enthusiasm and commitment to surgery.
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Chapters
- Wesleyan offers financial education and income protection for medical students and junior doctors.
- NHS sick pay is limited, making income protection crucial for covering expenses during illness.
- The Wesleyan student income protection plan is free for students and covers physical and mental health issues.
- This protection extends to sports injuries and is globally valid.
Understanding financial protection options like income insurance is vital for junior doctors, as NHS sick pay is insufficient to cover living costs during extended periods of illness.
The Wesleyan plan provides a tax-free income if you cannot study or work due to illness or injury, helping to cover outgoings.
- ARCP (Annual Review of Competency Progression) is a twice-yearly assessment for F1 and F2 doctors.
- F1 ARCP grants full registration, while F2 ARCP signifies completion of foundation years.
- The Horus portfolio system is central to demonstrating competency for ARCP.
- Key portfolio sections include core procedures, supervised learning events (SLEs), and other evidence.
ARCP is a mandatory milestone for progression in medical training, and a well-maintained Horus portfolio is essential for successfully passing these reviews.
Successfully completing your F1 ARCP grants you full registration as a doctor.
- While not always mandatory, performing core procedures demonstrates practical skills and enthusiasm.
- Common procedures include bloods, cannulas, ABGs, blood cultures, and catheterizations.
- Theaters offer opportunities for procedures like local anesthetic blocks and catheter insertions, especially on unconscious patients.
- Nurses and trained colleagues can sign off on skills like IV infusions and prescriptions.
Actively seeking opportunities to perform and get signed off for core procedures builds essential practical skills and shows initiative, which is beneficial for your portfolio.
Combining a local anesthetic with an ABG or giving an IV flush through a newly inserted cannula can allow for multiple skills to be signed off simultaneously.
- Aim for 15-20 SLEs per year, including mini-CEX, DOPS, and CBDs, to demonstrate a range of clinical management skills.
- SLEs can be signed off by anyone more senior than an F2, including registrars, consultants, nurses, and allied health professionals.
- A combination of SLEs is encouraged (e.g., 2 mini-CEX and 1 DOPS per placement), but check local deanery rules.
- Mini-CEX involves observed patient interactions, DOPS focuses on practical procedures, and CBDs discuss clinical decision-making.
SLEs are a primary method for demonstrating your clinical competence and learning, providing structured opportunities to receive feedback and document your development.
A registrar observing you perform an A-E assessment on an unwell patient and discussing your management plan can be signed off as a mini-CEX.
- DOPS are ideal for showcasing enthusiasm for surgery through practical procedures like joint aspirations or assisting in theatre.
- CBDs focus on clinical reasoning, investigation rationale, and treatment risks/benefits, often stemming from discussions with seniors.
- Proactively ask registrars and consultants for DOPS and CBD opportunities, especially in surgical settings.
- Ensure you understand the rationale behind investigations and treatments to effectively discuss them in CBDs.
Targeting DOPS and CBDs in surgical specialties allows you to highlight your interest and gain experience relevant to your career aspirations.
During an on-call shift in orthopedics, you could ask to perform joint aspirations, which can be logged as a DOPS.
- Reflect on every SLE and significant event to document learning and personal development.
- Taster days, training program days, difficult shifts, complaints, and patient deaths are all valid reflection topics.
- The TAB requires feedback from a range of colleagues (doctors, nurses, admin staff) to assess professional behaviour.
- Start gathering TAB feedback early, sending out more forms than you need to ensure you meet the target number within the deadline.
Reflections demonstrate self-awareness and a commitment to learning from experiences, while the TAB provides crucial feedback on your professional conduct and teamwork.
Reflecting on a difficult conversation with a patient's family about end-of-life care can highlight your communication skills and empathy.
- Curriculum mapping involves linking evidence (SLEs, reflections) to specific learning criteria required for progression.
- Maintain a personal learning log to track 30 hours of core (foundation school) and 30 hours of non-core teaching.
- Non-core teaching excludes mandatory inductions, ILS/ALS courses, and ward-based teaching from consultants.
- Setting up and running departmental teaching sessions is an excellent way to enhance your portfolio and demonstrate leadership.
Demonstrating curriculum coverage and active participation in teaching shows a commitment to continuous learning and contributing to the education of others.
Organizing a weekly peer-to-peer teaching session for junior doctors in your department and getting it signed off by a consultant can count towards your non-core learning hours and potentially the 'Developing the Clinical Teacher' competency.
- Engage in audit and quality improvement (QI) projects, especially in surgical departments, to gain senior support and visibility.
- Proactively contact future clinical supervisors about audit opportunities even before starting a placement.
- Showcase enthusiasm by identifying areas for improvement and developing QI project ideas.
- The example case highlights how a single complex patient encounter can generate multiple SLEs and reflection opportunities.
Audits and QI projects demonstrate a proactive approach to improving patient care and are highly valued by surgical training programs, often leading to publications and conference presentations.
A complex post-operative patient with abdominal pain could generate multiple SLEs (mini-CEX, DOPS for procedures performed) and a detailed reflection, while also potentially leading to involvement in a relevant audit.
Key takeaways
- Start building your portfolio early in your foundation years to avoid last-minute stress and demonstrate consistent effort.
- Actively seek opportunities to perform procedures and engage in clinical discussions, especially in surgical settings, to gather evidence for your portfolio.
- Proactively request supervised learning events (SLEs) from seniors, nurses, and allied health professionals, as they are crucial for demonstrating competence.
- Reflect thoughtfully on all significant learning experiences, including successes and challenges, to showcase self-awareness and a commitment to professional growth.
- Initiating and organizing teaching sessions or audit/QI projects can significantly enhance your portfolio and demonstrate leadership potential.
- Understand the specific requirements of your deanery and Horus portfolio, as rules and emphasis can vary.
- Financial protection through income insurance is a critical consideration for junior doctors due to limited NHS sick pay.
Key terms
Horus PortfolioARCP (Annual Review of Competency Progression)Core ProceduresSupervised Learning Events (SLEs)Mini-CEX (Clinical Evaluation Exercise)DOPS (Direct Observation of Procedural Skills)CBD (Case-Based Discussion)ReflectionTAB (Team Assessment of Behaviour)Curriculum MappingPersonal Learning LogAuditQuality Improvement (QI)Income Protection
Test your understanding
- What are the three main types of supervised learning events (SLEs) and what does each assess?
- Why is it important to start your portfolio building early in your foundation years?
- How can a foundation trainee demonstrate enthusiasm for surgery through their portfolio, even if not on a surgical rotation?
- What is the purpose of reflections in the Horus portfolio, and what types of experiences are suitable for reflection?
- How does the Team Assessment of Behaviour (TAB) contribute to a foundation doctor's portfolio, and what is a key strategy for ensuring its successful completion?