F1 portfolio confusion...SLEs CBDs... Please Help

Hi everyone,
I was just going through the f1 portfolio. Although I've done SLE and CBD's before, they were on a hardcopy portfolio and not an Electronic one? Do you have to chase your supervisors for them to fill it in or is it relatively manageable? Also, was looking at the GMC 14 key procedures, some of them are really niche; ie, not sure if I would get a chance to do ABGs or blood transfusions are part of my rotations...

My rotations are
Gen Surg/Urology
Endocrinology
Psych


Any help or guidance would be much appreciated.

Hi

Everything from now on generally will be an electronic portfolio rather than hard copies. Not everything needs to be signed by your supervisor, the majority actually is just signed by other (non-supervisor colleagues) e.g. SHOs, registrars, nurses, other consultants. You have to chase a reasonable amount to get stuff signed off yeh.

You’ll easily manage to get all your core procedures signed off - blood transfusions happen on surgery very often and you’ll be doing ABGs in any sick patient. If that’s the order of your rotations, it’s fine because you need your portfolio basically finished before your last rotation because the ARCP deadline is only a month or so into the last job. Just get all the core procedures finished quickly (1 sick patient can get loads signed off - bloods, venflon, ABG, airway management, fluids, blood cultures, ECG for example) and keep on top of the minimum requirements for CBD and mini-Cex and will be fine.

It is often hard to get CEXs and CBDs and you'll end up chasing people for months for them to fill in tickets which they never do. That's the problem with tickets which are emailed rather than hard copy you can fill out there and then. It's hard when you first start because you're finding your feet and forming relationships with your colleagues and seniors but if possible you have to try and keep your portfolio in mind from the beginning. Make sure you are completely clear about what the criteria are including local criteria (because the eportfolio itself sometimes has inaccurate advice with the local criteria being more stringent in some way than the stuff they advertise to you on the portfolio). For instance make sure what grade of doctor is required to fill in the CEX and CBDs, make sure you know if they expect a certain percentage of them to be completed by consultants in each job, make sure you know if they want at least one to be done by your clinical supervisor. Those were all additional local guidelines where I did F1 that were not mentioned on the main portfolio site, and caught pretty much everybody out at the end of the year, I remember scrabbling for consultants to fill in CEXs for me because I'd been asking mostly registrars and had a stressed 4 final weeks pre-ARCP in F1.

I'd be worried if you didn't do an ABG or blood transfusion in a surgical/medical job. ABG is a key investigation in the deteriorating patient and you tranfuse people all the time on surgery. Endocrinology is always secret code for 'general medical patients most of whom have terrible leg ulcers' (this is my personal translation :P). You're basically doing a general surgical job and then a general medical job so you should have plenty of opportunity to do all the procedures. None of the core procedures are actually impossible to get in F1 - things like blood transfusion you have to go out of your way to do because it's nurses who set up transfusions and basically you need a kindly nurse to supervise you doing it. However there will certainly be plenty of transfusions in both those jobs.

Thank you very much for the detailed reply. I'm assuming a "ticket" is an online link they have to fill in or something, is it not part of my clinical supervisor's role do them for me? As the foundation year page says 6 miniCex and 6 CBDs, (2 each per rotation), can you please tell me what are DOPS, can't seem to find much information on it. Also, as an F1 can I go to to other wards/ A&E to get skills signed off, during my time off? or is it not allowed

When I did F1 you could exchange max 1 CEX for a DOPS may still work similarly.

Yep, still works the same as of 2017/2018 - you need 3 CEXs and 2 CBDs per rotation, but in each rotation you can do one DOPS in place of one CEX. You're meant to do one of each (CEX and CBD) with your consultant supervisor.

OP: I did my DOPS in things like putting in a PICC line, taking bloods from a PICC line, putting in NG tubes, ascitic taps, administering intrathecal meds, taking out ICP bolts, making a burr hole (!) - it's quite easy to find opportunities to do these things.

As for ABGs and blood transfusions, I would be super surprised if you didn't manage to get those done at least during your endocrine and urology rotations. I'm on D+E at the moment, and I seem to prescribe blood on a weekly basis, and have probably done 50+ ABGs since I started FY1, just in the course of my normal jobs. You'll be fine.

Yep, still works the same as of 2017/2018 - you need 3 CEXs and 2 CBDs per rotation, but in each rotation you can do one DOPS in place of one CEX. You're meant to do one of each (CEX and CBD) with your consultant supervisor.

thank you very much, are you sure about the MiniCEx & cbd being with your clinical supervisor. It's just that I'm assuming it will be a nightmare trying to chase your Clinical supervisor for a CBD or Minicex, especially if they're always in surgery or only working part-time. I read the online document about MiniCex, its says Registrars or even band 5 nurses are allowed to do it. Is that correct? Sorry to bombard you with questions, it's just the whole anxiety of starting F1 and thousand things going through my mind....
thanks

I think this might be deanery dependent - we were not allowed to do DOPS in place of a mini-CEX, and DOPS didn't even count towards our SLEs. And our absolute minimum was 1 CBD/mini-CEX per rotation (though you still had to get a certain number of them throughout the year). There was also no requirement for us to do any SLEs with a consultant.

So I think things might me a bit different depending on where you will be working, OP, and you will more than likely receive guidance on this during shadowing week.

thank you very much, are you sure about the MiniCEx & cbd being with your clinical supervisor. It's just that I'm assuming it will be a nightmare trying to chase your Clinical supervisor for a CBD or Minicex, especially if they're always in surgery or only working part-time. I read the online document about MiniCex, its says Registrars or even band 5 nurses are allowed to do it. Is that correct? Sorry to bombard you with questions, it's just the whole anxiety of starting F1 and thousand things going through my mind....
thanks

I think this might be deanery dependent - we were not allowed to do DOPS in place of a mini-CEX, and DOPS didn't even count towards our SLEs. And our absolute minimum was 1 CBD/mini-CEX per rotation (though you still had to get a certain number of them throughout the year). There was also no requirement for us to do any SLEs with a consultant.

So I think things might me a bit different depending on where you will be working, OP, and you will more than likely receive guidance on this during shadowing week.

Pretty sure this is normal (from personal experience, and from friends who are scattered across the UK). Other people can supervise for your other CEXes/CBDs/DOPS, but we had to have one CEX and one CBD with our consultant supervisor per rotation. It's not actually as hard as it sounds!


Oh.. how long ago was this? We've used the Horus eportfolio in FY2 (not sure if this is the same everywhere yet - it was a different portfolio for FY1), but the requirements seem to be based on the 2016 national HEE curriculum..

I finished FY2 in August so in the last couple of years. I think I either read or heard somewhere that foundation schools can choose their own requirements for SLEs, but maybe that has changed now. But I do remember panicking about having to do a huge number of SLEs when I started FY1, and then breathing a sigh of relief when I realised we didn't actually have to do so many.

We use Turas e-portfolio here. Just had a look, and in FY2 I had 3 mini-CEXs, 5 CBDs and a couple of DOPs and developing the clinical teacher. Plus 20+ reflections...

Oh, that's weird.. ours follows that HEE document pretty much to the letter, so kind of assumed it was compulsory! Even then, it's really not that many SLEs (nowhere near as bad as for core training anyway..) - just need to be a bit opportunistic I think.

I'm in Scotland and using Turas, we just need 1 SLE per block, and one of each type (DOPS/CBD/mini-CEX)

Does Horus have an option to 'sit with your assessor' and do the whole thing immediately, instead of sending off a ticket? I've found it's the absolute best way to actually get stuff done. Especially if you've a quiet moment on nights, just grab one of your seniors and fire off a few SLEs in one go.

1 SLE per block would be living the dream! I'm guessing you must be able to get tickets done by quite junior seniors. Or your Consultants routinely work nights :P

CMT is a nightmare because only consultant completed CBDs/CEXs/ACATs count, yet your senior by and large remains the registrar who supervises you 99% of the time but cannot complete any tickets for you

I'm in Scotland and using Turas, we just need 1 SLE per block, and one of each type (DOPS/CBD/mini-CEX)

Does Horus have an option to 'sit with your assessor' and do the whole thing immediately, instead of sending off a ticket? I've found it's the absolute best way to actually get stuff done. Especially if you've a quiet moment on nights, just grab one of your seniors and fire off a few SLEs in one go.