Medical School

MEDICAL SCHOOL PORTFOLIO – just one big box ticking exercise?

⚠️Warning⚠️: When you get into medical school you will find that every year you are asked to get a minimum number of events signed off to complete the academic year and progress. Together these sign offs combine to make up your portfolio.

These include:

• Clinical skills.
• Supervised learning events.
• Case-based discussions.
• Clinical examinations.
• Meetings with various supervisors.
• Reflections.

You will come to associate portfolios with frustrated medical students and junior doctors. Many medical students visibly deflate at the mention of their portfolio sign offs. Often badly organised, these are poorly put together and rarely follow any logical order or hierarchy of skills.

King’s has just managed to transition to an electronic portfolio (e-portfolio). This is great, it means I now don’t have to carry around a chunky physical book whenever I am on placement.

However, this hasn’t been explained very well to any students… I’m foreseeing some issues at the end of this block with sign-offs that haven’t been completed and returned by already busy doctors.

So, having to complete portfolio tends to suck.

But…

They serve an important purpose. There are many things that we need every single graduating medical student to be able to do. Too many, in fact, to be able to formerly assess with exams or OSCEs (the clinical exams we sit).

Portfolios, then, are a necessary evil. One that you have to put up with from the time you become a medical student to the point you retire from being a doctor.

When you are training as a medical student, you will find that you have to publidh papers, presesnt at conferences, take part in ongoing clinical trials, attend extracurricular learning events and demonstrate a commitment to your speciality.

Personally, I can see some logic behind this. Of course we want doctors to be smart, dedicated, involved in research and up to date with current best practice. However, there has been a lot of debate recently (particularly on #MedTwitter) about the requirements of surgical training programmes. Requiring young doctors to get involved in research can perpetuate many of medicine’s issues.

What are these issues?

Nepotism

The UK’s most commonly inherited profession is being a doctor. Just let that sink in.

There are huge structural barriers in place stopping students from non-medic families entering medical school, and having overcome these barriers the same people face further barriers to career progression. You mostly rely on the goodwill and help of your seniors to get published as a medical student. Having family connections to doctors in the field you wish to pursue can make it easier for you to find a supervisor and get published.

Publications that add little to the field

Another issue with forcing young doctors to publish journal articles is that you increase the rate of publication of papers that add very little to their scientific fields. Sometimes, papers are published for the sole purpose of getting a publication. Instead, there could be a scale that assesses applicants based on the impact of their research. Of course, this may work to further the divide between applicants as those with links to more senior doctors will have more opportunities to be involved with high impact research.

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I think @BritOrthopaedic @bota_uk is, honestly, leading the way.

I think being able to critically appraise & evaluate research is a vital skill

I think this obsession with publishing (only in PubMed, too) is unhealthy and unhelpful.

Competency is *not* demonstrated like this

— Simon Fleming ? (@OrthopodReg) September 12, 2020

Predatory Journals and Conferences

Believe it or not, there are conference organisers and journals whose sole purpose is to make a quick buck off of academic. They do this by charging academics a large fee for publishing their work. In return, the journal fails to provide any of the expected services of a scientific publication: no or poor peer review process, little impact on the scientific field, no plagiarism checks, not care for the accuracy of published work. I didn’t even know these existed until I started looking for somewhere to present the research I conducted for my dissertation last semester!

We all know there are hoops to jump through in medicine.

Many of these are necessary – we want our doctors to be able to do the things they need to do! Portfolios are a necessary evil. One that you have to put up with from the time you become a medical student to the point you retire from being a doctor.

Want to know more about the hoops you have to jump through as a senior medical student? You can read more about the Educational Performance Measure (EPM) here. EPM is essentially the ‘grade’ you are given when you graduate medical school in the UK. You are then ranked against all other graduates nationally.

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